How addiction took hold of the UK – and cost the NHS millions

In 1948, the treatment of addiction was not a pressing issue for the fledgling NHS. Even in the 1970s, it was confined mainly to the treatment of a relatively small number of heroin addicts. But in the years that followed, a combination of social change and increased availability of drugs and alcohol meant that treatment became a key strand of the NHS’s work.

The latest report by the National Drug Treatment Monitoring System reveals that in 2016-17 some 279,793 people were in contact with drug and alcohol services in England. Just over half were opiate users.

It is an expensive business: in 2014 the former National Treatment Agency (NTA) estimated the cost to the NHS of treating drug misuse at around £500m a year. The total cost of alcohol misuse to the NHS in England has been estimated to be as much as £3.5bn a year.

However, according to Public Health England, the NTA’s successor agency, there’s a social return of £3 for a every £1 spent on alcohol treatment, and a return of £4 for every £1 spent on drug treatment.

About 5,000 people in England were thought to be using heroin in 1975. But numbers soared in the 1980s, in part in line with rising unemployment following the deindustrialisation of the north and midlands, explains Roger Howard, former chief executive of the UK Drug Policy Commission. This coincided with a flourishing supply of heroin from Afghanistan via Iran, after the Iranian revolution.

“What you get then is vast areas of the country where a huge male population is kicking its heels,” Howard says. “You’ve got a demand and it’s easily maintained by supply.”

Recreational drug use also increased, and the same decade saw the arrival of HIV/Aids and its link to injecting drug users. This prompted investment through the NHS in harm-reduction services such as needle exchange schemes, as well as inpatient treatment alongside intervention schemes run by a vibrant voluntary sector.

Much more funding came from the Labour government after 1997, as ministers realised that investment in treatment reaped rewards through reduced crime levels. Howard describes the early 2000s as the “glory years”, with Britain regarded globally as a leader in preventive services.

Since 2010, however, the picture has changed again. Under the coalition and Conservative governments, there has been a shift towards abstinence-based treatment rather than prescribed substitutes, such as methadone. Competitive tendering has led to many more services being delivered by the voluntary sector than by the NHS.

And, of course, austerity has hit hard. Collective Voice, an umbrella group of UK addiction charities, says spending on drug and alcohol services has been cut by around a quarter since 2013.

Meanwhile the alcohol-related burden on England’s hospitals is increasing: a report by the Nuffield Trust health thinktank has suggested that A&E attendance rates due to likely alcohol poisoning doubled between 2009 and 2014, while inpatient admissions linked to alcohol increased by almost two-thirds between 2006 and 2014.

As many as one in three GP visits could be related to alcohol, the 2015 report estimated. “Action to reduce harmful alcohol use requires a collaborative effort, involving GPs, community pharmacists, the police, education and licensing authorities,” it concluded.

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