Addiction in the UK: Why the New National Picture Demands Earlier, Kinder and Better-Connected Treatment

A response to The Forward Trust and Crest Advisory’s 2026 report, Addiction in the UK

Addiction is often discussed as though it belongs at the edges of society: a problem confined to a small and easily identified group of people. The new Addiction in the UK report from The Forward Trust and Crest Advisory challenges that assumption. Bringing together evidence on alcohol, illegal drugs, treatment, mortality, homelessness, crime, employment and family life, it portrays addiction as a major public-health and social issue whose effects extend far beyond the individual using a substance (Forward Trust and Crest Advisory, 2026).

The report estimates that approximately 750,000 people in the UK are addicted to alcohol and around 400,000 are addicted to illegal drugs. It also cites opinion polling in which more than one in ten adults said they were currently, or had previously been, affected by addiction. Extrapolated across the adult population, that would represent roughly 5.5 million people. These figures are not directly interchangeable: some are modelled estimates based on dependence or high-risk drug use, whereas the polling figure relies on people’s own understanding and disclosure of addiction. Nevertheless, taken together they show why addiction cannot credibly be regarded as rare.

The report’s most sobering finding is that around 17,000 people die from alcohol- or drug-related causes across the UK each year. Behind this total are different statistical definitions and recording systems, so comparisons require care. Yet the direction of travel is unmistakable. In England and Wales, 5,565 drug-poisoning deaths were registered in 2024, the highest number since the series began in 1993 (ONS, 2025a). In England, 8,274 alcohol-specific deaths were recorded in 2023, 63.8% more than in 2006 (OHID, 2025a). Scotland recorded 1,017 drug-misuse deaths and 1,185 alcohol-specific deaths in 2024; although both totals fell from 2023, they remain extraordinarily high by historical and international standards (National Records of Scotland, 2025a; 2025b).

These are not abstract statistics. Each death represents a person, a family and often years of missed opportunities for prevention, engagement and treatment. The central message of the Forward Trust report is therefore urgent but hopeful: addiction causes immense and preventable harm, yet recovery is possible when people can obtain timely, compassionate and evidence-informed help.

Addiction is a health condition, not a failure of character

Language shapes how society understands addiction and how people affected by it understand themselves. The report rejects the idea that addiction is simply a moral weakness or a series of poor decisions. The World Health Organization describes disorders due to substance use in terms that include impaired control, increasing priority given to substance use and continuation despite harm (WHO, 2022). Contemporary neuroscience similarly identifies changes in reward, stress, motivation, learning and executive-control systems, although no single biological mechanism explains every person’s experience (Koob and Volkow, 2016; Volkow, Koob and McLellan, 2016).

This does not mean that people have no agency. It means that agency is exercised within a complex interaction of biology, psychological learning, relationships, trauma, opportunity, poverty and environment. McLellan et al. (2000) famously argued that substance dependence resembles other chronic health conditions in its recurrence, response to treatment and need for continuing care. More recent research supports a dynamic model in which vulnerability and recovery are both shaped by the person’s social world as well as the substance itself (Heilig et al., 2021).

Adverse childhood experiences are associated with increased risks of harmful alcohol and drug use later in life. In a large systematic review and meta-analysis, people reporting four or more adverse childhood experiences had substantially elevated risks across numerous health outcomes, including problematic alcohol use and drug use (Hughes et al., 2017). Trauma is not present in every case and should never be presumed, but services need the capability to recognise it and avoid re-traumatisation. Addiction also frequently co-occurs with depression, anxiety, post-traumatic stress, psychosis, personality difficulties and physical illness. Treating one difficulty while excluding the other fragments a life that the person experiences as a whole.

The distinction between use, harmful use, dependence and addiction is equally important. Most people who drink alcohol or use a drug will not develop addiction. Risk exists along a continuum, and the transition from use to compulsive use varies considerably between people and substances. This is one reason prevalence is difficult to measure. Treatment data capture only those who reach services; household surveys may miss people who are homeless, imprisoned or otherwise marginalised; and shame can suppress disclosure. The report is right to present its estimates as the best available picture rather than a perfect census.

Falling population consumption does not mean the crisis is over

There are encouraging trends. Overall alcohol consumption has declined over the longer term, abstention has increased and illegal-drug use among some younger groups has fallen (Forward Trust and Crest Advisory, 2026). However, population averages can conceal concentrated harm. A reduction in average consumption does not necessarily improve the circumstances of people drinking at dependent levels, while an overall decline in drug use may coexist with increasing potency, poly-drug use and mortality among those at greatest risk.

The report highlights growing treatment demand associated with alcohol, powder cocaine, cannabis and ketamine. This matters because much of the treatment system was historically designed around heroin and crack cocaine. Opioid dependence remains a critical priority, but a system built principally around one pattern of drug use can struggle to respond to people whose difficulties involve stimulants, dissociatives, cannabis, alcohol or several substances together.

Powder cocaine presents particular concerns. Its use can be normalised in some professional and social settings even though repeated use is associated with cardiovascular, neurological and mental-health harms. Combining cocaine with alcohol produces cocaethylene, an active metabolite that may prolong intoxication and increase cardiovascular toxicity (Pergolizzi et al., 2022). Ketamine can be perceived as relatively benign, yet frequent high-dose use is associated with dependence, cognitive problems and severe urinary-tract damage, including ulcerative cystitis (Morgan and Curran, 2012; Winstock et al., 2012). Meanwhile, synthetic opioids such as nitazenes create an evolving overdose threat because very high potency and unpredictable contamination can make apparently familiar drug supplies much more dangerous.

Alcohol requires equal strategic attention. It is legal, widely available and woven into social rituals, which can make escalating harm harder to recognise. The UK Chief Medical Officers advise that, to keep health risks low, adults should not regularly drink more than 14 units a week, spread across three or more days (Department of Health, 2016). This is a low-risk guideline, not a boundary between safety and danger. Alcohol contributes to liver disease, cancers, cardiovascular disease, injuries and mental-health difficulties, and the overall burden extends well beyond conditions recorded as wholly attributable to alcohol (GBD 2016 Alcohol Collaborators, 2018; Burton and Sheron, 2018).

Crucially, a person who may be physically dependent on alcohol should not be encouraged simply to stop abruptly without appropriate assessment. Alcohol withdrawal can cause seizures, delirium and death. NICE recommends assessment of dependence, withdrawal risk, co-occurring conditions and social circumstances, with medically assisted withdrawal when indicated (NICE, 2011a; 2011b). The safest first step may therefore be urgent medical advice rather than an unsupported attempt at abstinence.

Addiction follows the contours of inequality

The Forward Trust report documents a recurring social gradient: the burden of addiction and related death falls disproportionately on communities already experiencing deprivation. This pattern is especially stark in Scotland, where people in the most deprived areas were 12 times as likely to die a drug-misuse death in 2024 as those in the least deprived areas (National Records of Scotland, 2025a).

Poverty does not automatically cause addiction, and affluent people are not protected from it. However, material disadvantage can increase exposure to chronic stress, insecure housing, violence, limited opportunity and reduced access to supportive resources. Once harmful substance use develops, it can further destabilise health, income, housing and relationships. The result is not a simple one-way causal chain but a mutually reinforcing system of disadvantage (Galea and Vlahov, 2002; Marmot et al., 2020).

Homelessness illustrates this circular relationship. Substance use can contribute to rent arrears, relationship breakdown and eviction, while homelessness can intensify substance use as people cope with trauma, danger, isolation and survival. The Advisory Council on the Misuse of Drugs concluded that homelessness and drug-related harm are intertwined and recommended accessible, psychologically informed and housing-linked responses (ACMD, 2019). Requiring somebody to resolve addiction before they qualify for stable accommodation can therefore remove one of the foundations that makes recovery possible.

Employment is similarly both an outcome and a recovery resource. The report notes high levels of unemployment and long-term sickness among people entering treatment. Yet work can provide structure, identity, social connection, financial security and purpose when it is safe and realistic. Vocational support should not be reserved until a person is deemed “fully recovered”; it can form part of the recovery process itself. The same principle applies to education, meaningful activity and community participation.

This wider set of personal, social and community resources is often described as recovery capital (Cloud and Granfield, 2008). Clinical treatment can help reduce craving, manage withdrawal and change behaviour, but recovery is harder to sustain without safe housing, supportive relationships, hope, belonging and opportunities to build a valued identity. Longitudinal research suggests that social networks and recovery-supportive environments are closely associated with remission and quality of life (Laudet and White, 2008; Best et al., 2012).

Families experience addiction too

The effects of addiction rarely stop with the person using alcohol or drugs. Partners may live with fear, secrecy, financial instability or repeated crises. Parents can become exhausted by attempts to protect an adult child. Children may experience inconsistency, conflict, neglect or caring responsibilities beyond their years. The report cites a longstanding estimate that between 250,000 and 400,000 UK children live with a parent experiencing drug addiction, while the number affected by parental alcohol problems is likely to be considerably larger (ACMD, 2003; Forward Trust and Crest Advisory, 2026).

It is important not to stereotype families or assume that every parent with a substance-use disorder is neglectful. Many work extremely hard to protect their children. Nevertheless, parental substance problems can increase the risk of adverse experiences and may affect emotional security, school attendance and later health. Harms can also continue across generations when shame prevents honest conversation or when children learn to organise family life around unpredictable drinking or drug use.

Families need support in their own right, not only instructions on how to manage the person using substances. Research on affected family members describes substantial psychological and physical strain (Orford et al., 2013). Family-focused approaches can improve coping and, in some circumstances, help engage the person with addiction in treatment. The five-step method, behavioural couples therapy and Community Reinforcement and Family Training are examples of structured approaches with evidence of benefit, although suitability depends on safety and individual circumstances (Copello et al., 2009; Powers, Vedel and Emmelkamp, 2008; Roozen et al., 2010).

Where domestic abuse, coercion or child safeguarding concerns are present, family involvement must never override safety. Addiction may increase risk in some situations, but it does not excuse abuse. Effective services need clear safeguarding practice alongside non-judgemental support.

Stigma delays help and worsens care

One of the report’s strongest recommendations is to tackle shame and stigma. This is not merely about being polite. Stigma can influence whether people disclose problems, whether families seek advice, how professionals respond and whether decision-makers invest in services.

A systematic review found that negative attitudes among health professionals towards people with substance-use disorders were associated with reduced empathy, lower expectations of recovery and poorer-quality care (van Boekel et al., 2013). Other reviews identify anticipated judgement, discrimination and self-stigma as barriers to treatment seeking (Livingston et al., 2012; Hammarlund et al., 2018; Camacho-Ruiz et al., 2024). Even terminology matters: experimental research has found that referring to someone as a “substance abuser” can elicit more punitive attitudes than describing a person as having a substance-use disorder (Kelly and Westerhoff, 2010).

Stigma is particularly damaging because it can convert an emerging, treatable problem into a concealed crisis. People may postpone seeking help until relationships, employment or health have deteriorated severely. Some avoid services because they fear being labelled, losing professional standing or triggering involvement from statutory agencies. Women, parents, older adults, ethnic-minority communities, LGBTQ+ people and professionals may face distinct barriers that generic pathways fail to recognise.

The report also notes that women and people from some minority ethnic backgrounds appear underrepresented in treatment, while the evidence explaining these gaps remains incomplete. Underrepresentation must not be misread as lower need. Trust, cultural competence, childcare, privacy, previous discrimination, language and the perceived relevance of services may all influence access. Co-design with communities and people with lived experience is therefore essential.

Replacing stigma with understanding does not minimise harm or remove personal responsibility. It creates the conditions in which responsibility can be exercised. A person is more likely to examine their behaviour honestly when the conversation combines compassion, clarity and realistic hope.

Treatment works, but it must match the person and the risk

No single intervention is sufficient for every form or stage of addiction. Effective treatment begins with assessment: what is being used, how much and how often; dependence and withdrawal risk; physical and mental health; prescribed medication; previous attempts to change; suicidality and safeguarding; relationships, housing and employment; and the person’s own goals.

For opioid dependence, opioid agonist treatment with methadone or buprenorphine is associated with substantial reductions in mortality, particularly while people remain in treatment (Sordo et al., 2017). Risk rises after leaving treatment and following release from prison, when reduced tolerance can make relapse fatal (Merrall et al., 2010). Naloxone availability and overdose education are therefore critical harm-reduction measures, not signals that services have abandoned recovery (McDonald and Strang, 2016).

For alcohol dependence, NICE recommends a combination of medically managed withdrawal where necessary, psychological intervention and consideration of relapse-prevention medication such as acamprosate or naltrexone (NICE, 2011a). A systematic review and meta-analysis supports the efficacy of these medicines, while also showing that effects are generally modest and work best as part of broader care (Jonas et al., 2014). Baclofen, disulfiram and nalmefene may have roles in selected circumstances under appropriate medical guidance.

Psychological treatments help people understand patterns, strengthen motivation, develop coping skills and respond differently to triggers. Motivational interviewing is designed to work with ambivalence rather than confront it; meta-analytic evidence indicates small but meaningful effects across alcohol and drug problems (Smedslund et al., 2011; Magill et al., 2018). Cognitive behavioural approaches, contingency management and community reinforcement also have evidence across particular populations and substances (Dutra et al., 2008; De Crescenzo et al., 2018). Treatment should be collaborative, competently delivered and adjusted in response to progress.

Mutual-aid and lived-experience recovery organisations can add belonging, practical wisdom and long-term support. A Cochrane review found that well-facilitated mutual aid groups can improve continuous abstinence compared with some other established treatments, although mutual aid is not the preference or answer for everyone (Kelly et al., 2020). SMART Recovery and other secular or community-led options widen choice and provide alternatives to 12-step methodology.

The report rightly calls for easier access to residential, community and prison-based recovery programmes. Speed matters because motivation is not a permanent state. A complicated sequence of referrals, funding panels and repeated assessments can lose people during a rare window in which they are ready to accept help. At the same time, rapid access must not mean indiscriminate placement. Residential rehabilitation, medically supported detoxification, structured outpatient care and lower-intensity intervention meet different needs. Good matching considers severity, risk, home environment, previous treatment and personal preference.

Continuity matters just as much as entry. Recovery commonly involves setbacks. Treating recurrence as proof that somebody has failed ignores the chronic and relapsing features seen in many cases. Assertive follow-up, rapid re-engagement and continuing care can prevent a lapse becoming a prolonged return to harmful use (McKay, 2009; Dennis and Scott, 2012).

“No wrong door” must become normal practice

People with co-occurring mental-health and substance-use difficulties frequently encounter service boundaries: mental-health support may be deferred until substance use stops, while addiction services may judge the mental-health need too complex. Such sequencing is clinically unrealistic and can leave people at greatest risk with the least coordinated care.

NICE recommends that existing services adapt to co-occurring needs, avoid excluding people solely because of substance use, share information appropriately and agree joint care and risk-management arrangements (NICE, 2016). England’s Co-occurring Mental Health and Substance Use Delivery Framework reinforces the principles that meeting these needs is “everyone’s job” and that people should experience “no wrong door” (DHSC and NHS England, 2025).

In practice, this means routine, proportionate screening; shared formulation; named responsibility; timely communication; and attention to suicide risk, overdose, withdrawal, medication interactions and safeguarding. It also means recognising that progress in one area can enable progress in another. Improved mental-health care may reduce reliance on substances, while stabilising substance use may make psychological therapy safer and more effective.

Policy choices can reduce harm at population level

Individual treatment alone cannot counter an environment that continually increases risk. The Forward Trust report calls for reliable treatment funding, stronger prevention, political leadership on deaths, better criminal-justice pathways and action on cheap alcohol.

Minimum unit pricing offers an important example. An evaluation using controlled interrupted time-series methods found that Scotland’s policy was associated with a 13.4% reduction in deaths and a 4.1% reduction in hospital admissions wholly attributable to alcohol, with the greatest reductions among men and people living in the most deprived areas (Wyper et al., 2023). No policy is a complete solution, and effects require continuing evaluation, but price is one of the strongest evidence-based levers for reducing alcohol harm (Burton et al., 2017).

Drug policy must balance enforcement with public health. Restricting supply is important, particularly against organised crime and dangerous adulteration, but enforcement by itself cannot resolve dependence or the social conditions that sustain harmful markets. The 2021 English drugs strategy restored investment after a decade in which local treatment systems had been weakened, following Dame Carol Black’s conclusion that the system was “not fit for purpose” (Black, 2020; HM Government, 2021). Funding needs to be stable enough to retain skilled staff, commission psychologically and medically informed care and build partnerships rather than repeatedly reconstruct short-term projects.

The criminal-justice system is a particularly important point of intervention. High levels of substance need in prison, the danger of illicit and synthetic drugs, discontinuity between custody and community, and the sharp mortality risk after release make fragmented care unsafe. Pre-sentence reports can identify treatment needs and support appropriate community alternatives. In custody, evidence-based treatment should be equivalent to community care, and release planning should include medication continuity, naloxone, accommodation, benefits, identification and an appointment that is more than a telephone number on a discharge sheet.

Commissioning should also measure what matters. Numbers assessed or entering treatment are useful, but they do not alone show whether people are safer or living better lives. Outcomes should include mortality, non-fatal overdose, retention, substance use, physical and mental health, housing, family wellbeing, employment, quality of life and equitable access. Metrics must avoid incentivising services to select people most likely to produce an uncomplicated “successful completion”.

What the report means for people questioning their alcohol or drug use

National strategy can feel distant from a person wondering whether their own drinking or drug use has crossed a line. Yet the report offers several practical messages.

First, a problem does not have to resemble somebody else’s crisis to deserve attention. Dependence is not defined by a particular job, age, appearance or daily quantity. Increasing tolerance, loss of control, secrecy, repeated failed attempts to cut down, withdrawal symptoms, using to cope, and continuing despite harm are all reasons to seek an assessment.

Second, earlier help generally creates more options. Waiting for a dramatic “rock bottom” can expose people and families to preventable injury, illness, debt, relationship loss or criminal-justice involvement. A confidential conversation can clarify risk and appropriate next steps without committing somebody to a predetermined programme.

Third, recovery is not one standardised journey. For some, immediate medically supported abstinence is necessary. Others may begin with harm reduction, motivational work or a planned reduction following medical assessment. Some need residential care; many can be treated safely in the community. Personal goals matter, but they should be considered alongside clinical risk and the evidence about what is realistically safe.

Finally, families do not need to wait until their loved one accepts treatment before seeking guidance for themselves. Support can help relatives communicate more effectively, set boundaries, reduce enabling behaviours, plan for emergencies and protect their own wellbeing.

From national concern to practical hope

Addiction in the UK provides no basis for complacency. Deaths remain at or near record levels, new drug threats are emerging, alcohol harm is deeply entrenched and treatment access is uneven. The impact is concentrated among people and communities with the fewest protective resources, but it reaches every social group.

The report also resists fatalism. The UK retains experienced treatment providers, mutual-aid communities, lived-experience organisations, established clinical guidance and a growing recognition that fragmented responses do not work. Evidence supports medications, psychological therapies, harm reduction, family interventions, continuing care and population-level measures. The task is to make these elements accessible, connected and responsive to changing patterns of need.

The most important cultural change may be the simplest to express: addiction should be met neither with condemnation nor with minimisation. It requires honest recognition of risk, humane treatment and confidence that change is possible. When a person asks for help, the system should respond quickly. When difficulties recur, the door should remain open. When families are affected, their needs should be recognised. And when thousands of preventable deaths occur each year, addiction must be treated as a national priority rather than a private source of shame.

If you are concerned about your own alcohol or drug use, or that of someone close to you, seek professional advice. If there may be physical dependence on alcohol or sedative drugs, do not stop abruptly without medical guidance. In an emergency, severe withdrawal, suspected overdose or immediate risk to life, call 999.

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