From addiction to recovery — why we need person-centred care
We reviewed feedback from people using local drug and alcohol addiction services and saw that people were struggling to get the help that they needed.
Key issues in people’s feedback:
- People struggling with addiction often have complex and multifaceted needs.
- People trying to get help with their addiction are often not treated as a whole, making sustained recovery difficult to achieve.
- Current addiction treatment pathways are often disjointed and involve multiple services, making access difficult.
- People’s experiences with addiction services are largely dependent on understanding and empathy from service staff and the choices offered to them.
- Some people shared stories of effective and successful services.
Growing need for recovery services
Local authorities fund and arrange support and treatment for people struggling with a range of addictions, including alcohol, drugs, and smoking. Councils partner with the NHS and/or specialist addiction charities to offer people looking for help with drug and alcohol addiction different treatments and strategies. These commonly include talking therapy, detoxification, self-help, and referrals to community support groups.
The demand for recovery is continuously growing.
- Over 300,000 adults used drug and alcohol treatment services between April 2023 and March 2024 — a seven per cent increase from the previous year, and the biggest rise in users since 2009. Over half of these adults accessed these services for the first time, up 15% from the previous year.
- However, the number of adults in the UK who are alcohol-dependent or frequent drug users is estimated to be much higher.
- According to ONS data, over 350,000 adults in England are classified as 'possibly dependent' on alcohol and around 600,000 adults in England and Wales are frequent drug users.
Although it is encouraging to see increasing numbers of people seeking help with their addictions, less than half of people complete their treatment and are free from dependence.
Government plan
In 2021, the Government published "From Harm to Hope", a 10-year plan to combat illegal drugs.
Embedded within this plan is an aim to have a "world-class drug and alcohol treatment and recovery system across England" that treats addiction using a person-centred approach.
In 2022/2023, the Department of Health and Social Care provided local authorities an additional £96 million for drug and alcohol treatment and recovery systems, with further allocation of £155 million in 2023/2024.
But has this changed the people's experiences of addiction treatment?
We reviewed feedback shared with us in 2024 about people's experiences using drug and alcohol treatment services, which suggests we are still closer to harm than hope.
What people told us
Lack of personalised care
One recurring theme from the feedback was that people seeking help with their addiction do not feel seen as individuals. Instead, they are seen as part of a homogenous group and treated as such.
“I feel like we're treated like shit just because we're addicts…I don't feel that healthcare professionals give us enough time in appointments, they don't get to know us as individuals and consider the best form of treatment. Sometimes it feels like we're all treated the same and put on the same medication and we all need different medication, we're all different! I really do feel ignored a lot of the time.” Story shared by Healthwatch Rotherham
Each person we heard from has a unique story and an individual path that led to addiction. However, we know that addiction often goes hand-in-hand with other issues that leave people feeling vulnerable and excluded, and this was evident in the people's experiences.
Understanding people’s stories is the key to unlocking appropriate and effective addiction treatment.
"Felt it was focused on the drinking rather than on the reasons why I was drinking. Issues stemming from childhood. The root cause should have been looked at rather than just the drinking alone." Story shared by Healthwatch Cheshire West
Access issues
We heard about difficulties accessing both addiction services and broader health services. Often, these challenges fell more on those who were traditionally disadvantaged. Research by Healthwatch Cumberland found that less addiction support was available for women and that people living in rural areas had trouble accessing recovery services close to home.
"There aren't enough women to mix with, and with limitations on the stages, you can feel stunted. Women in recovery are so much more vulnerable, but there are no full-time female key workers, and in general, there is not enough women-specific support nearby." Story shared by Healthwatch Cumberland
Many people struggling with addiction have underlying mental health issues,which are often the driving forces behind the addiction. We heard from people who were unable to get mental health support because they were in active addiction.
"[I] was told I couldn't have mental health support if I was facing addiction. Addiction is a mental health problem. I don't choose addiction, but it keeps me from killing me, but for some reason, I'm not entitled to the same care to treat the underlying issue." Story shared by Healthwatch Kent
Unfortunately, the stigma attached to addiction remains a barrier for people trying to get help. Fear of judgement and internalised shame stopped people from starting or continuing their recovery. For some, breaking these barriers was fundamental to successful treatment.
"[Name deleted] and [name deleted] have been amazing helping me with my drug problem; before this group, I was ashamed to speak about my weed and alcohol misuse, but now you two have taught me that dealing with your problems shows strength and willing to want to change. Thank you to both of you for not judging me and helping me to recover from a dark place." Story shared by Healthwatch Isle of Wight
Even when people could access healthcare services, their experiences were often negative. People spoke about poor management of withdrawals by frontline NHS staff. These included instances of pharmacies refusing to dispense medication to those in active addiction, and people discharging themselves from hospital due to improperly managed withdrawals.
"I've been hospitalised three times in the last few years… As soon as they hear about the drugs, you get fobbed off; they don't want to know. You get judged for being on methadone, and they refuse pain relief because you are on methadone, but I'm taking methadone just to feel normal. I had to get a taxi out of hospital so I could get my own pain relief." Story shared by Healthwatch Dorset
Additionally, people in active addiction may find it challenging to make and keep appointments due to the chaotic nature of their lives, particularly those who deal with unstable housing circumstances or are unhoused.
Experiences with addiction services
People's experiences with addiction services were mixed; some people felt unheard and judged, while others formed good relationships with services and were able to overcome their addiction.
Some people's experiences pointed to a lack of trust between service users and providers, compounded by a lack of streamlined treatment pathways. The lack of continuity care means people in active addiction find it difficult to build trusting relationships. It also means that they must repeatedly share deeply personal stories whenever they speak to new healthcare providers.
"[Service user] feels his recovery worker at [service deleted] is treating him unfairly and is not allowing him to reduce his methadone prescription as they do not trust him and has reportedly told his probation worker [that] they believe he is 'close to a relapse'. He and his mother are quite distressed, and he wants to either change his recovery worker…or move to a different service." Story shared by Healthwatch Richmond upon Thames
We also heard how stigma and judgement from frontline staff can manifest and lead to distressing experiences.
“I went to an addiction centre in [place deleted]… to come off the opiates I take for my utterly debilitating musculoskeletal and nerve pain. I was treated like a convicted criminal. I was made to blow into a breathalyser - no explanation - no request… I was having a heavy vaginal bleed, and they really pushed me to provide a urine sample. I do understand that some users of this addiction service are sent there by the courts as a part of their conviction and sentencing, but I had different needs. I was phoned by them about two weeks later and told they could not help me; I did not fit their pattern of care provision. It seems they have a one-size treatment and had nothing to offer me coming off analgesia that was prescribed and that I chose to reach out for help with." Story shared by Healthwatch Brent
When people shared positive stories about their addiction treatment, there were common themes — good relationships with service staff; access to peer support; positive framing; and a friendly, non-judgmental atmosphere.
Key learnings from successful addiction treatment
Personalised approach
Just as each person has their own story, the journey to recovery is different for everyone. Recent research by Healthwatch Cheshire West revealed the importance of timing and people's mindset on the success of addiction recovery. Moreover, it found that the effectiveness of specific addiction treatments not only varies from person to person but can vary at different times for the same person.
“I’ve tried six times before to give up… This time was different because I asked for help rather than people offering it to me. I’ve been to [service deleted] before when the GP sent me, but because I was not ready it didn't work. This time, I was ready to give up and have not looked back." Story shared by Healthwatch Cheshire West
Holistic, joined-up support
Treating addiction requires treating the whole person, which often involves a number of different services.
"A woman told us she knew the underlying cause was mental health but couldn't get any help with that unless she stopped drinking. She was told this on numerous occasions, but she knew without the joint approach, she wouldn't be able to stop." Story shared by Healthwatch Cheshire West
There were also a number of aspects of addiction service delivery that were indicative of a better experience and greater treatment success.
Attitude of support workers matters
When people spoke about positive experiences and successful treatment, they almost always talked about their relationships and the attitudes of their support workers. Service users who felt they were seen as people and not as addicts had better experiences and were more successful in treating their addiction. Paramount to this was an open, welcoming atmosphere with an empathetic approach.
“I was allocated to a recovery worker, [Name deleted], straight away he made me feel at ease and relaxed. He was empathetic and supportive...Since achieving my goal, my physical and emotional health have improved, as well as my relationships with my family.” Story shared by Healthwatch Isle of Wight
Peer support
Peer support was also highlighted as a key factor in successful recovery journeys. People described feeling that those with lived experience of addiction can better understand and, therefore, connect with people struggling with their addiction.
"Peer-to-peer support is the ultimate weapon. Therapy from those with lived experiences who have changed their lives. I couldn't connect with the 'professionals'. They hadn't been in my shoes. I didn't trust them or believe I could change when speaking to them." Story shared by Healthwatch Cheshire West
Smoking cessation
Interestingly, there was one addiction service area that invariably received positive feedback — smoking cessation.
Smoking cessation services are universally available, with a range of convenient venues available, such as GP surgery, pharmacy, high-street shop, mobile bus clinic. Local authorities arrange a variety of stop-smoking services, such as one-to-one appointments, group sessions, and drop-in services. There is also the option of online or phone appointments for people who cannot attend in-person appointments. Smoking cessation services also freely provide a variety of stop-smoking treatments, for instance nicotine replacement and medications.
In short, smoking cessation services are a good example of a person-centred approach to treating addiction. People can access the service without restriction and choose the elements that best suit their needs. The experiences of the people we heard from show that this approach is better for people not only in terms of people's experiences but also in terms of success rates.
Our recommendations
National level
- The government should continue to provide additional funding for the provision of drug and alcohol treatment services as part of the ongoing 10-year "From Harm to Hope" plan. This would help protect drug and alcohol addiction services from the financial pressures on local authorities.
- The government should provide longer cycles of guaranteed funding streams for the provision of drug and alcohol treatment services. This would help local authorities dedicate more resources to plan staff recruitment.
- The government should ring-fence funding specifically for addiction service worker training. This would allow drug and alcohol addiction services to upskill workers on links between addiction and other factors, eg. childhood trauma, neurodivergence, sexuality and identity, and mental health, as well as the principles of person-centred care.
Local level
- Local authorities should consider partners' person-centred practices (e.g., choice of venues, choice of appointment types, range of treatment strategies) when commissioning potential drug and alcohol addiction services. This would help ensure that drug and alcohol addiction services are equipped to provide effective, person-centred treatment.
- Local authorities should set up multi-agency Combating Drugs Partnerships to lead joint local needs assessments, agree on a local drugs strategy delivery plan, and regularly review delivery of the local drugs strategy. This would help streamline drug and alcohol treatment pathways and promote system-wide ownership.
- Mental health services should ensure people presenting with dual diagnosis are not excluded from care, signposting to more appropriate services where necessary. This would help people who are struggling with addiction get the help that they need.
- Drug and alcohol addiction services should offer people passports that include information relevant to their addiction (e.g., mental health conditions, neurodivergence, current treatment strategy) to relay when accessing other services. Passports could help minimise the need for people struggling with addiction to repeatedly retell their stories when moving through the system.
