This study examined how treatment and recovery services are integrated with physical and mental health services following additional funding from England's drug strategy. Findings show wide variation in the extent and type of integration across local areas. While some progress has been made, more needs to be done to strengthen collaboration and achieve effective, person-centred care.

Integrated care for people who use alcohol and/or other drugs

A case study analysis of the current landscape in England

William D. Phillips, Jessica Dawney, Emily Hutton, Avery Adams, Lucy Strang, Katherine I. Morley, Nicola Kalk, Jennifer Bostock, Andrew Jones, Tom Ling, et al.

ResearchPublished Apr 22, 2026

Cover: Integrated care for people who use alcohol and/or other drugs
Download PDF
Additional Downloads

Includes Annex A. Implementation Research Logic Model

People who use alcohol and/or other drugs frequently experience co-occurring mental and physical health problems, yet these needs are often addressed separately, resulting in fragmented care. The UK government's 10-year drug strategy sought to improve integration between treatment and recovery services and wider health services, supported by the Supplementary Substance Misuse Treatment and Recovery Grant (SSMTRG). This study examined the early impact of the SSMTRG on service integration, identifying barriers, facilitators, and examples of good practice.

We collected data from staff and people who use treatment and recovery services across ten treatment and recovery services, through 185 interviews, 44 workshops and focus groups, and we also reviewed local authority spending plans.

Findings revealed substantial variation in integration across local areas, influenced by differences in resources, local contexts, and existing inter-service relationships. Five models of integration were identified: single point of access, embedded workers, joint planned care, leveraging external support, and building in-house expertise. However, progress has been constrained by limited incentives, delayed policy frameworks such as the Mental Health Joint Action Plan, short-term funding, workforce pressures, and persistent stigma within health services.

The study recommends providing clear national guidance and real-world examples, introducing ring-fenced and long-term funding, and developing metrics to monitor integration. Strengthening relationships between local authorities, Integrated Care Boards, and treatment providers, alongside comprehensive training for staff, is also critical to achieving meaningful and lasting integration of treatment and recovery services and broader mental health and physical health services.

Key Findings

There is substantial variation in what services are offering across different local areas

  • While certain activities - such as embedding treatment and recovery staff in broader health services to encourage inward referrals - are relatively consistent across local areas, other initiatives are more localised. This is driven by variations in the stage of development of different services, differences in resourcing and local context, and the varying strength of existing relationships and connections.

We identify five models of integration for treatment and recovery services and an optimal example of an integrated care pathway.

  • We conceptualise the following models to help policymakers think about how to monitor, evaluate and communicate about service integration going forward:
  • Model 1 - single point of access
  • Model 2 - embedded workers
  • Model 3 - joint planned care
  • Model 4 - leveraging external support
  • Model 5 - building in-house expertise

The absence of adequate incentive systems has significantly hampered the depth and sustainability of service integration.

  • The delayed implementation of policy levers has hampered service integration. Without a dedicated policy framework or ring-fenced funding, NHS services have little incentive to engage in integration efforts, with most activity initiated by treatment and recovery services.

There are other prominent barriers that need to be addressed.

  • Many treatment and recovery services are struggling to meet even basic needs due to high caseloads. Limited, short-term and inconsistent funding compounds these problems, making long-term planning and integration very difficult. Stigma, especially within mental health services, also remains a major barrier.

Recommendations

Central government should:

  • Facilitate the dissemination and implementation of the co-occurring mental health and substance use delivery framework
  • Identify priority interventions for service integration
  • Explore ring fenced, longer-term funding for integrating services
  • Examine ways in which integration efforts could be measured and monitored.

ICPs should:

  • Consider establishing a dedicated role for treatment and recovery services.

Treatment and recovery services should:

  • Provide basic mental health training to screen for and deliver mental health interventions
  • Strengthen relationships with other health services.

ICPs and treatment and recovery services should:

  • Ensure training on substance use is implemented across all healthcare settings, prioritising mental health services.

Topics

Document Details

Citation

Chicago Manual of Style

Phillips, William D., Jessica Dawney, Emily Hutton, Avery Adams, Lucy Strang, Katherine I. Morley, Nicola Kalk, Jennifer Bostock, Andrew Jones, Tom Ling, Tim Millar, Joanne Neale, John Strang, Jon Sussex, and Jennifer Newbould, Integrated care for people who use alcohol and/or other drugs: A case study analysis of the current landscape in England. Santa Monica, CA: RAND Corporation, 2026. https://www.rand.org/pubs/research_reports/RRA4735-5.html.
BibTeX RIS

Research conducted by

This work was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme and conducted by RAND Europe.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.