A comprehensive survey of England’s drug and alcohol treatment workforce has revealed critical insights into what motivates professionals in this essential sector and the significant challenges they face. The research, commissioned by the Office for Health Improvement and Disparities, gathered 2,179 responses from individuals working across treatment services, commissioning teams, and lived experience recovery organisations between November 2024 and January 2025.

The Primary Drive: Making a Difference

The survey reveals that 91% of the drug and alcohol treatment workforce entered the sector driven by wanting to make a difference to others. This altruistic motivation remains constant throughout careers, with 92% stating that making a difference to others is important in their role now.

When asked what they like about their jobs, over a quarter of the workforce mention the ability to help others (28%) and to make a difference to people’s lives (27%). For some regulated roles such as psychiatrists, the interesting nature of the role is an even stronger motivation to work in the sector.

Other top motivations for joining include thinking the work would be interesting (83%), the work suiting respondents’ skills and abilities (75%), and being interested in learning something new or taking on a new challenge (73%).

Career Pathways Within the Sector

The research reveals important patterns about career progression. Half the delivery and commissioning workforce have previously worked as a drug and alcohol worker (50%). This is the case for 56% of commissioners, 71% of service managers and team leaders, and 19% of regulated roles.

Most substance abuse treatment professionals (57%) entered their first paid job in the sector by seeing the job advertised. Other pathways included someone suggesting that they apply for the role or recommending them (27%) or volunteering at the same or another organisation before taking a paid role (19%).

People with lived experience relating to their own personal drug or alcohol use are much more likely to have volunteered as a way into the sector (39%) compared to those without lived experience (7%).

Workplace Support and Supervision Challenges

One positive finding concerns peer support within the drug and alcohol treatment workforce. Colleagues provided the second most frequently mentioned positive factor about respondents’ jobs, and 86% of respondents agreed that their colleagues give them the help and support they need.

However, clinical supervision presents significant concerns:

• Only 45% of frontline workers receive monthly clinical supervision
• 40% of frontline workers do not take part in clinical supervision at all
• Levels of clinical supervision are higher among regulated roles, yet only 57% receive this monthly and around a quarter of regulated roles (26%) do not receive any clinical supervision
• Of those who do not receive any clinical supervision, around a quarter said this was a challenge for them (23%)

Major Workforce Challenges

Pay Concerns

The most commonly identified challenge is low pay, mentioned by nearly half the workforce (48%). It is also the most common reason to consider leaving and the most commonly mentioned aspect that would make people feel more supported.

One third of the overall workforce (34%) say that low pay has made them consider leaving the drug and alcohol treatment workforce, and this rises to over half of 25-34 year olds (51%). When asked about how they could be better supported at work, better pay was the most common response with 19% of respondents mentioning this.

Workload and Caseload Issues

More than two in five frontline workers (43%) believed they were supporting too many people on their caseload. High caseloads appear to be a particular issue in the South West, with 55% of respondents there reporting too many people on their caseload.

The survey used the Health and Safety Executive’s stress indicator tool, revealing that 55% of respondents say they have to work very intensively, and 33% have to work very fast. The average score across all eight statements on demands of the role was 3.22, indicating that on average respondents ‘sometimes’ felt affected by these kinds of stressors.

Training and Development Gaps

Learning and development opportunities are very important to respondents and were second only to pay when respondents were asked to suggest how they could be better supported. While three-quarters (72%) agree that they have access to guidance about how to do their job well, two in five (42%) report that heavy workloads and time constraints often prevent them from taking these up.

Among drug and alcohol workers and peer support workers, training levels vary significantly across different interventions. The most common training given has been in measures such as overdose prevention, blood borne virus testing, administering naloxone, wound care and safer injecting (85%). Over four in five (81%) have also been trained to deliver motivational interviewing.

Workforce Demographics and Inequalities

The survey reveals important demographic characteristics of the substance abuse treatment professionals:

• 26% report that they have a disability
• 33% report that they have lived experience of their own problems relating to drug or alcohol recovery

These two groups reported more challenges and sources of stress than others in the workforce. They were more likely to say that their role was badly paid compared to similar roles, that they faced emotional exhaustion and compassion fatigue, and that they were not consulted about changes at work.

Disabled people and people from ethnic minority backgrounds were also more likely to report bullying and harassment at work.

Intention to Leave and Retention Issues

The survey reveals concerning retention patterns within the drug and alcohol treatment workforce:

• Three in ten (28%) are strongly considering, or already have plans to, leave the sector within the next two years
• A further quarter of the workforce (26%) might consider leaving over the next two years
• Younger age groups (18-34) and those employed by NHS organisations exhibit the highest intention to leave
• Over a third of respondents aged 25-34 (37%) and three in ten aged 18-24 (30%) said they would definitely or strongly consider leaving
• Those employed by LEROs were least likely to report intention to leave (15%)

The primary factors driving respondents to seek opportunities elsewhere are:

• Low pay (34%)
• Emotional exhaustion (22%)
• Job insecurity/organisational change (15%)
• Lack of career opportunities (14%)

Destinations of Those Leaving

Among those most likely to leave the sector within the next two years:

• Over a quarter (28%) want their next job to be in the NHS, health or social care but not in substance treatment
• A quarter (24%) want to leave health and social care entirely
• Only 14% would want to move to another organisation still working in drugs and alcohol

This pattern suggests the sector is losing talent not just to competitor organisations, but to entirely different fields.

Professional Support and Development Needs

The research indicates strong demand for professional development within the substance abuse treatment professionals. Nearly three-quarters of respondents (73%) said that learning something new or having a new challenge was important to them when they joined the sector, and a similar proportion (75%) still consider it important in their current roles.

However, barriers to accessing training and development opportunities present ongoing challenges:

• Lack of learning and development opportunities or time to take these up were mentioned as a challenge by 25% of the workforce
• Younger respondents (29% of those aged 25-34) and regulated professionals (31%) were most likely to mention this as a challenge
• Staff working for LEROs report more time to take up learning opportunities (only 26% feel they are too busy), whilst those in London (50%) and the South West (50%) are more likely to agree their workload means they are too busy to take up learning opportunities

Building Workforce Sustainability

The survey findings highlight several critical areas requiring attention to maintain a sustainable drug and alcohol treatment workforce:

Addressing Financial Concerns: With pay being the most common challenge and reason for considering departure, developing competitive compensation packages is essential, particularly for younger professionals who show the highest intention to leave.

Implementing Proper Clinical Supervision: Ensuring all appropriate staff receive regular clinical supervision, with particular focus on meeting recommended standards for professional development and quality assurance.

Managing Realistic Caseloads: Addressing excessive workloads through improved workforce planning, recognising that overloaded staff cannot deliver effective interventions and are more likely to leave the sector.

Providing Development Opportunities: Creating structured training programmes while ensuring workload planning accommodates professional development time, particularly given the strong appetite for continuous learning.

The research demonstrates that England’s substance abuse treatment professionals are fundamentally motivated by helping others and find their work intellectually stimulating. However, systemic challenges around pay, supervision, workload, and career development threaten the sector’s ability to retain these committed individuals. The 28% of staff considering leaving within two years represents a significant risk to service continuity and quality.

Addressing these challenges requires coordinated action from employers, commissioners, and policymakers to ensure sustainable working conditions that support both workforce wellbeing and effective service delivery for those seeking help with substance use issues.

Source: dbrecoveryresources