Area of Research: Addictions
Section 1: Summary of main strands/themes for research
Addiction is a major public health issue. Addiction is defined as having no control over doing, taking or using something to the point where it could be harmful. This PRU will seek to improve the evidence base for addictions policy, particularly tobacco, alcohol, drugs and gambling, but other addictions will be in scope.
The programme of research will be developed in close collaboration with the Department of Health and Social Care (DHSC), and will contain a range of research themes which may include:
- Understanding the determinants of addictive behaviours and dependencies. This may include investigating the psychosocial factors that put people at greater risk of addiction and identifying the groups that may benefit most from early intervention.
- The role of industry, including understanding industry’s use of digital platforms, social media and marketing to influence behaviour, and how these platforms can be used as effective policy interventions to target individuals.
- Investigating the health and wider societal impacts of addictive behaviours, including the impact on affected others. This may extend beyond dependency to consider the harm associated with low and moderate usage, and as a gateway to more dependent behaviour.
- Identifying effective public health interventions to prevent and treat addiction (e.g., public health messaging, regulation, treatment etc.), and optimising their effects in different populations to reduce health inequalities.
- The optimal design of integrated services to tackle addiction, including how to ensure that treatment pathways address mental and physical health alongside addiction recovery, workforce morale and skill set.
- Understanding the barriers and facilitators to policy implementation, including the collation of natural experimental evidence and learnings from other countries in preventing and treating addictive behaviours.
- Modelling future trajectories on prevalence and cost implications under a variety of different scenarios, including consideration of the interactive effects between different addictive behaviours and co-morbidities.
- Evaluating the impact of past and current initiatives to demonstrate impact and influence the design of future policy design and spending decisions.
To note, the unit’s focus will be on policy related research including identifying the problem, identifying what works on prevention, treatment and recovery. It will not focus on biomedical research.
Section 2: Details of policy context and background
In October 2021, the Office for Health and Improvement and Disparities (OHID) was formed, with the intention of tackling health disparities across the UK. OHID also works to prevent health conditions from developing, with the aim of reducing pressure on the health and care system.
Drugs - In December 2021, the Government published its 10-year Drug Strategy which aims to reduce the demand for drugs and improve treatment services. Local authorities have commissioning responsibility for drug and alcohol treatment services, and generally commission them together. The Drug Strategy has committed £532m to improving these services over the next three years. The PRU will be well-placed to inform future delivery planning by local authorities as well as national policies and resources to support local authorities.
Tobacco - The UK government has adopted a distinctive approach to reducing tobacco attributable death and disease by encouraging smokers to switch to less harmful nicotine products. The UK approach builds on the internationally accepted “Six Strands” of tobacco control and implemented most of the measures recommended in the Framework Convention for Tobacco Control. The current Tobacco Control Plan (2017-2022) provides an overarching strategic focus and direction for tobacco policy, with a strong focus on tackling inequalities in smoking rates in vulnerable groups. The NHS Long Term Plan (LTP) (2019) reaffirmed the Government’s commitment to treat tobacco dependency in all smokers admitted to NHS Hospitals by 2023/24, backed by a £150 million investment (over four years). There were also commitments for pregnant women and their partners, as well as long-term users of specialist mental health services. In the 2019 Prevention Green Paper, DHSC announced an ambition to be Smokefree by 2030. More recently, the Khan Review made 15 recommendations with four of those critical to achieve the Smokefree 2030 ambition.
Gambling - The NHS Long-Term Plan outlined the government’s commitment to open 15 specialist gambling clinics by 2023/24, supported by £15 million of additional funding. Beyond 2023/24, NHS England and Improvement has committed to annual investment of £6 million to support the clinics. OHID is undertaking a review of the current treatment system in England for adults experiencing harmful gambling. The findings will provide vital evidence to support improvement of the current provision. As the lead government department for gambling policy and regulation, the Department for Digital, Culture, Media and Sport (DCMS) are currently undertaking a review of the Gambling Act (2005). In September 2021, PHE published the Gambling-related Harms Evidence Review which identifies where further research is required.
Alcohol – Alcohol use is a leading lifestyle risk factor for preventable disease and the UK government has a programme of work underway to address alcohol-related health harms and their impact on life chances. As part of the NHS Long Term Plan, NHS England and Improvement is investing in an ambitious programme to put in place or optimise existing specialist Alcohol Care Teams in non-specialist acute hospitals with the highest need, with £27m investment over four years. Through the Children of Alcohol Dependent Parents programme, the government provided national funding to local authorities to test new and creative approaches to reach and support families whose lives have been affected by alcohol. In the Prevention Green Paper, the Department announced its ambition to help consumers switch to alcohol-free and low-alcohol alternatives, to support people to reduce their alcohol consumption. In the 2021 Budget, the Chancellor announced a comprehensive set of alcohol duty reforms, which, subject to consultation, will come into force in February 2023.
Section 3: Justification for research topics
The harms associated with addiction are substantial, and more must be done if government is to achieve its ambition to increase healthy life expectancy by five years by 2035 and reduce health inequalities.
While smoking rates have fallen to their lowest on record, 64,000 people are killed by smoking each year and it remains the single biggest cause of preventable illness and death. The harms are not felt evenly across the country, with prevalence in Burnley 4.5 times higher than in Exeter, for example.
Over half of adults report participation in gambling activity in the past twelve months, and a significant number of children are participating despite controls designed to protect them. Nearly 250,000 adults experience problem gambling, and a further 1.6 million reach the threshold for elevated risk exposing them to a host of physical and mental health harms, as well as a range of other impacts on their lives and on the lives of others.
Alcohol use is also one of the most important risk factors driving preventable mortality, and over a third of deaths occurred in the most deprived fifth areas in England. Alcohol-related and drug-related deaths made up almost 20 per cent of the difference in avoidable mortality between males living in the most and least deprived areas in England in 2019.
Many of these behaviours, often co-occur with a range of health inequalities such as mental ill health, homelessness and rough sleeping, and contact with the criminal justice system. These challenges were highlighted in Dame Carol Black’s recent drugs review calling for further research. The report also noted the lack of research infrastructure within local authorities, and that current service models often do not provide the stability, expertise or right staff mix to undertake high quality research.
The cost of addiction is significant. Estimated annual societal costs: smoking (£17bn); gambling (£1.3bn); alcohol (£21bn); and drug misuse (£19bn). These are behaviours are promoted by profitable industries and often marketed at the most vulnerable members of society. Government regulation has acted to limit this to an extent, but the research topics identified will increase our understanding and ability to take further action to prevent and treat the associated harms.
Section 4: Other related research activity of which the Unit will need to be aware
The NIHR has a range of projects on areas such as smoking, drinking, drug use and gambling. Other funders of health research, such as UKRI, are also investing in research in this area. Applicants should demonstrate that they understand the unique contribution of this new programme of work and the audience for outputs.
The Unit will be expected to develop links with the other relevant PRUs, such as the Public Health, Mental Health and Behavioural Science units. It should also complement and make links, as appropriate, with the NIHR Public Health Programme and the NIHR School for Public Health Research.
Additional activities to be aware of:
- Drug Strategy Innovation Fund – a £5m pot aiming to fund test and learn projects that will increase the evidence base around reducing the demand for recreational drugs.
- Addiction Mission – an Office for Life Sciences (OLS) led initiative, aiming to enhance the UK-wide research environment and incentivise the development of innovative and effective solutions for treatment, recovery, and harm reduction.
- OHID commissioned the University of Sheffield to estimate treatment need and levels of those amenable to treatment for harmful gambling, at both national and local levels, as well treatment thresholds for harmful gambling.
- PHE (now OHID) e-Delphi study to better understand measures which could help prevent and reduce gambling-related harms.
GambleAware launched a £4million Gambling Harms Research Centre hosted at Bristol University (funded through voluntary industry contributions). - NICE are currently developing clinical guidelines for the treatment of harmful gambling, expected to complete in 2024.
- The UK Prevention Research Partnership (UKPRP) has funded the SPECTRUM (Shaping Public Health Policies To Reduce Inequalities And Harm) research collaborative on unhealthy commodities, specifically alcohol, tobacco and food. Other UKPRP consortia may also be relevant.
Section 5: Other issues relevant to this programme of research
The PRU will be required to engage with other government departments, including HM Treasury, the Home Office, the Department for Digital, Culture, Media & Sport, the Department for Education, and the Department for Levelling Up, Housing and Communities.