England’s drug and alcohol care system is leaving thousands without joined-up support. A major RAND Europe report, published in 2026, finds that structural barriers, deep-rooted stigma and weak policy direction are still blocking progress where it matters most.

The report is part of a wider evaluation called D-SITAR. Researchers examined how well drug and alcohol treatment links up with NHS mental and physical health services across England. They found a postcode lottery. Some areas are making real progress. Others have barely started.

The Scale of the Problem in Drug and Alcohol Care

The numbers tell a troubling story. Around 74 per cent of people in treatment and recovery services in England have a co-occurring mental health need, according to the National Drug Treatment Monitoring System. Yet one in five of those people receive no mental health treatment at all. Some experts believe this figure is an underestimate. Certain studies suggest the true rate of co-occurring conditions reaches 80 to 90 per cent.

Physical health is just as concerning. One study found that half of all deaths among opioid users over 50 were at least partly linked to physical health conditions. For opioid users specifically, the standardised mortality risk for suicide sits four times higher than for the general population.

These are not marginal figures. They describe a system where the most vulnerable people consistently fall through the gaps.

What the Government Has Tried to Do

Dame Carol Black’s 2019 to 2021 independent review of drugs made the problem impossible to ignore. In response, the previous UK government committed an additional £780 million over three years from 2022 to 2025. Local authorities received this through the Supplementary Substance Misuse Treatment and Recovery Grant (SSMTRG). The goal was to strengthen treatment and recovery services integration with wider health services.

On paper, things have moved forward. By 2024 to 2025, around 84 per cent of local authorities planned to use SSMTRG funding for some form of service integration. That compares with 71 per cent the year before. The most common priorities were expanding health screening and building NHS partnerships.

But progress has been uneven. Local context, existing relationships and available resources all shaped how far each area got.

Five Models, No Single Blueprint

Researchers identified five broad models through which drug and alcohol care integrates with wider health services across England.

The first is a single point of access, where one service assesses a person’s mental health, physical health and social needs at once. The second is embedded workers, where drug and alcohol staff sit within hospitals, GP surgeries or mental health services to raise awareness and bring people into treatment. Third is joint planned care, where staff from different organisations discuss cases together and agree coordinated action. Fourth, some services leverage external support by arranging specialist clinics rather than building expertise in house. Fifth, others build expertise in house by hiring clinicians with mental health or physical health specialism directly.

No single model stands out as the right answer. Many local areas run several at once. Researchers stress that what works in one place may not transfer neatly to another.

Where Integrated Treatment and Recovery Services Are Still Falling Short

The report is honest about where treatment and recovery services integration remains shallow or fragile.

Stigma causes the most damage. Mental health services regularly turn away people who use drugs or alcohol. Staff often expect people to address their substance use first before qualifying for mental health support. This contradicts clinical guidance. It is not evidence-based practice. NHS staff in broader settings also sometimes hold stigmatising views that shape how they treat this group. Many service users carry self-stigma too, which stops them seeking help at all.

Capacity creates a secondary crisis. Dame Carol Black recommended a maximum caseload of 40 clients per worker. Many workers carry more than 100. A service stretched that thin cannot build the partnerships and pathways that meaningful integration demands.

Funding uncertainty has driven real harm. Many staff hired through SSMTRG money said they planned to leave their jobs because the programme’s continuation was unconfirmed during data collection. Without stable, multi-year commitments, services struggle to make long-term plans.

NHS engagement has also been inconsistent. Treatment and recovery services drove most integration activity themselves. NHS mental and physical health services largely sat on the sidelines. Several integrated care boards (ICBs) told researchers they had no one with explicit responsibility for drug and alcohol issues. Without policy direction and financial incentives aimed at the NHS specifically, that picture will not change.

What Needs to Happen Next

The report sets out clear recommendations. Central government should publish a Physical Health Joint Action Plan for people who use drugs and alcohol. This would complement the Co-occurring Mental Health and Substance Use Delivery Framework released in December 2025. The report also calls for ring-fenced funding for integration, rather than burying it inside broader unprotected grants. Funding cycles should be longer and confirmed earlier.

Integrated Care Partnerships (ICPs) can play a stronger coordinating role. They span both local authorities and NHS bodies, which makes them well placed to bridge the gap. The report recommends that ICPs create a dedicated role to drive treatment and recovery services integration across health systems.

Training is a practical lever that services can pull now. All drug and alcohol staff should receive basic mental health screening training. This includes tools such as the PHQ-9 and GAD-7 for depression and anxiety, alongside specialist tools for assessing suicide risk. NHS staff across all settings should also receive systematic training on substance use. Mental health services should lead this shift. The guiding principle the report endorses is simple: no wrong door.

A System Still Finding Its Feet in Drug and Alcohol Care

Efforts to improve drug and alcohol care across England are real. But they remain fragile. Some areas have built genuinely innovative services. Others are still deciding what integration means for them.

The human cost of this variation is high. A person navigating addiction, mental illness and deteriorating physical health at the same time needs a system that talks to itself. When it does not, the consequences can be severe.

The report does not claim that integrated care guarantees better outcomes. The evidence base is still developing. Early-stage implementation makes firm conclusions difficult. But the report is clear on one point: leaving everything to local goodwill and patchwork funding is not sustainable.

England has the structures, ICBs, ICPs and local authorities, and now has some frameworks, to make drug and alcohol care integration work. Whether the political will and sustained resources follow through remains the real test.

Source: dbrecoveryresources