NHS National Treatment Agency for Substance
Misuse
1. THE NTA—WHO
WE ARE
AND WHAT
WE DO
The NTA is a special health authority within
the NHS, established by Government in 2001 to improve the availability,
capacity and effectiveness of treatment for drug misuse in England.
Since 2007 the NTA has been similarly responsible for young people's
substance misuse (drugs and alcohol) services.
2. ABOUT DRUG
TREATMENT
The aim of treatment is to overcome dependency,
and reduce the harm caused by drugs to users, their families and
communities. The NTA supports a balanced treatment system that
accommodates a range of needs and circumstances. The needs of
young people differ from those of adults, while clinical and psychological
therapies alike can be effective at different stages of recovery.
The overall number of individuals in contact
with treatment services has more than doubled over 10 years (to
a record 202,666 last year). Four out of five either complete
a treatment programme satisfactorily or stay in treatment long
enough (12 weeks) for them and the community to gain lasting benefit.
The numbers of individuals successfully completing a drug treatment
programme has risen steadily to more than 34,000 last year. In
2007 the national average waiting time for drug treatment was
recorded as one week, down from nine weeks previously.
3. DEFINITION
OF COCAINE
AND CRACK
COCAINE
— Cocaine refers to cocaine powder, which
is water soluble and is typically "snorted" but is also
injected.
— Crack cocaine or "crack" is
the base form of cocaine which is not readily soluble in water
and is usually smoked.
4. TRENDS IN
TREATMENT FOR
COCAINE USE
The overview and analysis below look at treatment
trends across three periods: 2005-06; 2006-07; and 2007-08. Please
note that we distinguish between numbers for all individuals in
treatment (new entrants to the system and existing clients); and
individuals entering treatment that year (new entrants to the
treatment system). The latter is a more robust reflection of trends
in treatment. Primary use is where treatment being provided is
mainly for that drug. Adjunctive use is where the treatment provided
includes a secondary drug. The figures referred to below are shown
in tables following the analysis.
4.1 Overview:
— The last few years have seen a steady
increase in the total number of individuals entering and receiving
treatment for their cocaine and crack use. However, this must
be viewed in the context of an expanding drug treatment system
which has succeeded in getting more people into treatment for
all drug misuse, in significantly reducing waiting times for those
trying to access treatment and in keeping people in treatment
once there.
— The total number of individuals both
receiving and entering treatment for cocaine use as a proportion
of all drug treatment has risen, but not that significantly (from
5% to 6%). However, for 19-24yr olds, individuals being treated
for cocaine use as a proportion of all drug treatment for their
age group almost doubled between 2005-06 and 2007-08 (from 7%
to 13%). Again, for all 19-24yr olds, those getting help for cocaine
misuse as a proportion of all new entrants to the drug treatment
system rose from 9% in 2005-06 to 15% in 2007-08. Across all ages,
new entrants for cocaine use rose from 6% to 9%.
— The drug treatment system is expanding
and diversifying to accommodate individuals with arange of needs
and circumstances. Broadening the number and availability of approaches
for treating cocaine use has led to more people being helped to
overcome problems. The NTA is developing innovative new approaches
to the delivery of drug treatment so that more people can recover
from dependency, particularly new psychological interventions.
For further information and to download practitioner resources,
please visit the NTA's psychosocial interventions resource library:
http://www.nta.nhs.uk/areas/clinical_guidance/psychosocial_interventions_resource_library_(PIRL)/default.aspx
4.2 Further analysis:
— The number of individuals receiving treatment
for primary cocaine misuse has risen more than for those being
treated for primary crack misuse, particularly amongst those aged
19-34 yrs.
— The number of individuals receiving treatment
for adjunctive crack misuse has risen more than for those being
treated for adjunctive cocaine misuse, particularly amongst those
aged 25 yrs and over.
— Throughout all periods, treatment for
primary cocaine use was most prevalent amongst those aged 25-34
yrs (but 19—24 year olds in percentage terms).
— In 2007-8, 2,909 individuals aged 19-24
yrs entered treatment for primary cocaine use. This was up from
1,749 in 2005-06.
— In 2005-06, there were more new entrants
to the drug treatment system for primary crack use than for primary
cocaine use (6,657 for crack vs 6,049 for cocaine). In 2007-08,
this was reversed (9,001 for cocaine vs 7,234 for crack).
5. NUMBERS IN
TREATMENT FOR
COCAINE USE
Table 1
ALL INDIVIDUALS IN TREATMENT (NEW AND EXISTING)
FOR COCAINE AND CRACK MISUSE 2005-08
|
| 2005-06
| Proportion
(of treatment
population)
| 2006-07 | Proportion
(of treatment
population)
| 2007-08 | Proportion
(of treatment
population)
|
| Cocaine | |
| | | |
|
|
| Main | 8,252
| 5% | 10,770
| 6% | 12,592
| 6% |
| Adjunctive | 9,072
| n/a | 11,525
| n/a | 12,129
| n/a |
| Crack | |
| | | |
|
| Main | 9,526
| 6% | 10,826
| 6% | 10,996
| 6% |
| Adjunctive | 30,309
| n/a | 35,591
| n/a | 41,905
| n/a |
|
Table 2
INDIVIDUALS ENTERING TREATMENT (NEW ENTRANTS TO THE TREATMENT
SYSTEM) FOR COCAINE AND CRACK MISUSE 2005-08
|
| 2005-06
| Proportion
(of new
entrants
to drug
treatment)
| 2006-07 | Proportion
(of new
entrants
to drug
treatment)
| 2007-08 | Proportion
(of new
entrants
to drug
treatment)
|
| Cocaine | |
| | | |
|
|
| Main | 6,049
| 6% | 7,476
| 7% | 9,001
| 9% |
| Adjunctive | 5,935
| n/a | 7,067
| n/a | 7,357
| n/a |
| Crack | |
| | | |
|
| Main | 6,657
| 7% | 6,904
| 7% | 7,234
| 7% |
| Adjunctive | 19,693
| n/a | 21,375
| n/a | 25,227
| n/a |
|
| Please note that The adjunctive drug numbers are not reported as a percentage of the overall treatment population as the compliance levels of reporting second and third presenting drugs have improved consistently over the last three years and some of the increase shown in numbers could be in part be due increased improvement in services reporting these data items.
|
6. IMPROVING TREATMENT
FOR COCAINE
USERS
6.1 Clinical guidelines and the range of treatment for
cocaine
Current treatment for cocaine dependency
NICE guidelines[124]
and the 2007 Clinical Guidelines[125]
(Drug Misuse and Dependence: UK Guidelines on Clinical Management)
make it clear that psychosocial interventions are the mainstay
of treatment for the misuse of cocaine and other stimulants. The
NTA advocates a number of innovative psychosocial approaches and
is supporting the drug treatment workforce to deliver these effectively,
including: brief interventions (focusing on motivation and providing
feedback to change behaviour); contingency management (using incentives
to encourage client to remain drug free); mutual support (such
as Cocaine Anonymous and Narcotics Anonymous); behavioural family
/ couples therapy; and family based interventions.
Other interventions can include: in-patient treatment and/or
residential rehabilitation—which may be appropriate for
people with more severe cocaine problems; appropriate medical
or psychological interventions for people with cocaine-related
psychiatric problems.
All of these interventions need to be available for primary
cocaine misusers and those who are misusing cocaine in conjunction
with other drugs.
All drug users in treatment should have a personal care plan
that assesses their needs and maps out the steps they will take
through treatment. This covers not only drug use but also health,
social functioning and criminal involvement.
For further guidance on treating cocaine misuse—see
sections 4.1, 4.2, 4.4, and 5.10 of the 2007 Clinical Guidelines
Please note that there is no effective substitution prescribing
for cocaine (or crack) dependency.
6.2 Guidance on crack and cocaine treatment
The NTA has previously produced a range of guidance on treatment
for crack and cocaine misuse, which is available on the NTA website:
www.nta.nhs.uk.
6.3 Future developments in pharmacological interventions
for cocaine dependency
A number of pharmacological treatments for cocaine dependency
are in development including substitutes, withdrawal treatments
and vaccines. The NTA is monitoring these with interest but is
unable to comment on them at present because most are still in
the development stage and are not yet considered effective treatment.
June 2009
124
NICE (2007). NICE clinical guideline 51 Drug Misuse: psychosocial
interventions. London: National Institute for Health and Clinical
Excellence
NICE (2007). NICE clinical guideline 52 Drug Misuse: detoxification.
London: National Institute for Health and Clinical Excellence Back
125
Department of Health (England) and the devolved administrations
(2007). Drug Misuse and Dependence: UK guidelines on clinical
management. London. Department of Health (England), the Scottish
Government, Welsh Assembly Government and Northern Ireland Executive Back
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