Drugs and Alcohol Health Needs Assessment

This Health Needs Assessment examines the scale, patterns and impacts of drug and alcohol use in Wales, identifying who is most at risk, the harms experienced, and the effectiveness of current approaches and systems. It responds to gaps in national strategy, outdated guidance, rising harms, and persistent inequalities. The assessment aims to provide an evidence base for a whole-system, life-course approach covering prevention, early intervention, harm reduction, treatment, recovery, and support for affected others. The assessment considers children, young people and adults across Wales, covering both alcohol and illicit and prescribed drug use. Methods include quantitative analysis, qualitative engagement with people with lived experience, stakeholder focus groups, and review of high level evidence on prevention, early intervention, health needs and harm reduction. The findings reveal a complex and evolving landscape, with clear patterns of who is most affected, where harms are concentrated, and how emerging trends, such as changes in drug use, are shaping need across the population.

Drug misuse deaths in Wales have remained consistently high and continue to increase. Despite falling drug-related hospital admissions, people appear to be presenting later and with more severe harms, suggesting barriers to support before crisis point. Poly-drug use continues to be a major driver of fatal overdose. Drug use shows a general long-term downward trend, but rising use of crack cocaine, ketamine, and stimulants amongst certain populations is a growing concern. Alcohol use remains widespread with middle-aged adults showing the highest levels of higher-risk drinking whilst adolescents show a decline in alcohol use. Harms are strongly linked to inequality and disproportionately concentrated in areas of deprivation. Vulnerable groups, including looked-after children, people experiencing homelessness, disabled and neurodivergent individuals, LGBTQ+ individuals, and those in the criminal justice system, face elevated risk. Prevention efforts are limited; treatment access is inconsistent; stigma is widespread; and co-occurring mental health needs are poorly met.

Stakeholders reported fragmented pathways, limited crisis and out-of-hours support, lack of services for stimulant and polydrug use, barriers to primary care, insufficient recovery support, and inconsistent provision for families and affected others. Strengths include strong harm reduction foundations and growing integrated care models. Based on the evidence, the assessment sets out a series of recommendations designed to strengthen leadership and create a system-wide approach, enhance prevention and early intervention efforts, address the health needs of those who use substances, reduce harms to others, enhance efforts through data improvement, quality research and robust evaluation, and maintain a focus on harm reduction.

Overall, substance use remains a major public health challenge in Wales, causing significant preventable harm and deepening inequalities. While Wales has strong foundations in harm reduction, the current system is fragmented and reactive. Implementing the recommendations in this assessment will enable a more coordinated, equitable and compassionate approach, protecting children, supporting families, improving health outcomes and reducing avoidable deaths across Wales.