Drug and alcohol support for people experiencing rough sleeping or at risk: what £262m achieved across 83 areas

Ipsos in the UK, working in partnership with Groundswell and Dr Stephen Green of Sheffield Hallam University, has completed an evaluation of the Rough Sleeping Drug and Alcohol Treatment Grant (RSDATG) and has now published its findings. The evaluation was commissioned by the Office for Health Improvement and Disparities (OHID) and the Ministry of Housing, Communities and Local Government (MHCLG). 

The Grant aimed to improve drug and alcohol outcomes (such as engagement with treatment) among people experiencing rough sleeping or at risk; reduce rough sleeping; and cut drug- and alcohol‑related deaths amongst this group.

Substance use is both a cause and consequence of rough sleeping. To respond, the government invested up to £262m (2021–2025) in the Rough Sleeping Drug and Alcohol Treatment Grant (RSDATG) for the 83 local authorities in England with the highest need. The Grant was intended to improve drug and alcohol treatment and recovery services for people experiencing or at risk of rough sleeping. It was designed to be flexible, to build on existing services and fill gaps. 

Funding from the Grant enabled services to:

• Reach people and keep them engaged: small caseloads, assertive outreach and in‑reach, flexible drop‑ins and rapid scripting brought services to people instead of expecting attendance at fixed appointments.
• Provide safer, trauma‑informed practice: consistent relationships, harm‑reduction (Naloxone, drug alerts, needle exchange), and practical wraparound (help with people’s physical and mental health, obtaining ID documents, GP registration, advocacy, and access to housing).
• Connect more effectively: multi‑disciplinary teams (MDTs), co‑location and information‑sharing improved pathways between drug and alcohol services, housing, health and criminal justice.

What we found

• 19,614 people were supported by RSDATG-funded services in 2024/25. 31% were sleeping rough and 69% were at risk (reflecting a shift to prevention).
• 85% of those engaged were in treatment. Around half of this group had not been in treatment at the point of engaging with RSDATG-funded services. Services reported stronger sustained engagement and faster re‑engagement after drop‑out for people with higher levels of need.
• Access to drug and alcohol treatment improved in both funded and non-funded areas over the lifetime of the grant. In RSDATG areas, an additional uplift above the national trend emerged after 2.5 years, reflecting early workforce and capacity constraints.
• Many areas prioritised safety, harm reduction and stability as meaningful progress toward recovery. Over the year to June 2025, 1,273 people completed treatment after engaging with RSDATG support, with a further 2,611 substantially reducing or stopping problematic use.
• Grant spending largely focused on community-based treatment or wraparound support rather than detox and rehab. However, the number of people accessing detox and rehab grew over time to around the level anticipated at the outset, as pathways matured and aftercare improved in some areas.
• Despite rising risks around synthetic opioids, areas consistently reported that RSDATG reduced or slowed increases in drug‑related deaths through outreach, rapid scripting, Naloxone distribution and safer use messaging.
• Collaboration deepened (facilitated by regular MDTs, and co‑location); trauma‑informed practice spread; and local understanding of complex needs improved.
• There were widespread reports that people using substances were being turned away by mental health services, despite many areas using funding for ‘dual diagnosis’ workers to focus on this issue. This unmet need for mental health support represented a significant barrier to recovery.
• Acute shortages of suitable (especially ‘dry’ and women‑only) accommodation prevented the grant from having a greater impact on housing outcomes.
• RSDATG provided intensive, specialist support for people with complex and high levels of need. The need for ongoing support for these vulnerable individuals from a range of services, and relatively low treatment completion rates, imply a lower benefit-cost ratio than initially calculated. However, the programme delivered clear equity gains by bringing a higher‑need cohort into treatment and strengthening local systems — with a strong moral and public health case for sustained support.
   

Implications for policy and practice

Commissioners can expect the greatest impact from: 

• Maintaining outreach‑led, trauma‑informed specialist teams
• Embedding MDTs and data‑sharing
• Investing in move‑on, abstinence‑supported housing
• Communicating and reinforcing NICE guidance on co‑occurring conditions to improve access to mental health support

The flexibility that enabled areas to tailor services to local need and existing provision was a key success factor, and should be preserved under future funding.

Technical details

Our evaluation fieldwork involved 533 interviews across nearly all funded areas, including 26 in-depth area studies. We interviewed service users, commissioners, and managers and staff from services that received funding or worked with funded services. We also analysed data submitted by local authorities to OHID and to the National Drug Treatment Monitoring System (NDTMS); and produced a cost‑consequence assessment for 10 areas. This provided a comprehensive view of implementation, outcomes and value.

Thank you to the contributors: Carmela Carrea, Akshay Choudhary, Catherine Crick, Michael Lawrie, Taisie Lewis, Richard Lloyd and Laura Tuhou.