“I ended up living under a bush in a park in Brighton for five months. It was the nadir of 20 years of alcoholism. I’d become homeless, and I knew that something had to change otherwise I was going to drink myself to death. I decided that I had to go to rehab.”
James Howard started drinking as a teenager. During his 20s, he was detained in hospital under the Mental Health Act on three separate occasions, suffering from alcoholic psychosis. When he was 33, he decided he needed treatment.
“I was on the waiting list for rehab for a year and I was clearly killing myself. But ultimately I just could not get a place. I got to the point where I didn’t see any hope at all of getting into rehab or any form of treatment.”
Brighton council says that while it cannot comment on individual cases, “when people are assessed as needing residential rehabilitation, we make sure this service is offered to them as quickly as possible”.
Publicly funded drug and alcohol detox and rehab programmes are offered by NHS units or other providers, such as charities, that help patients whose treatment is paid for by local authorities.
But since 2013 local authorities have cut overall funding for alcohol and drugs treatment by £300m. During the same period the number of people accessing publicly funded detox and rehab services for alcohol has almost halved, and almost half of the total of the approximately 80 units offering these services have closed, the BBC has discovered.
The latest figure for alcohol-related deaths from the Office of National Statistics – 9,214 in 2016 – is the highest since records began, in 1994.
Public Health England estimates there are at least 595,000 dependent drinkers in need of treatment, but less than one in five receives it.
Frank also has had problems with alcohol since he was a teenager.
“I was never offered publicly funded residential rehab. I’d been run over by a car in a blackout from drinking. My friends thought I was dead. I was getting injured a lot. I’ve attempted to take my life a couple of times. My parents definitely thought I was going to die, and I did too.”
Frank saw no option but to pay for a private rehab. But his parents had to use all their savings for their retirement to send him there. “They sacrificed their future to save the life of their son. It does fill me with a lot of guilt and shame.”
The BBC has also obtained figures from most private rehabs, which show an average rise of over 100% in their private alcohol patients since 2013.
The number of private rehabs has risen by almost 70% since 2012.
Conservative MP Fiona Bruce, who chairs the All Party Parliamentary Group on Alcohol Harm, described these figures as “extremely concerning”.
“The increase in private providers and the parallel decrease in public providers for alcohol treatment is a really serious issue because it’s a matter of social justice that people should be able to access help when they need it not according to their pocket.”
But there are also concerns about the quality of private rehabs.
At the end of last year, the Care Quality Commission published a report describing almost two-thirds of independent providers of residential detox, the vast majority run by private companies, as unsafe.
“We’re facing a crisis that isn’t recognised or being addressed by government,” says Ms Bruce.
“Over the last decade, we’ve seen alcohol-related hospital admissions doubling and we’ve seen alcohol-related deaths increasing.”
She adds: “There are 1.5 million dependent or higher-risk drinkers and two million children living in homes where alcohol is an issue.”
Alcohol-related hospital admissions are now running at their highest levels ever – 1.1 million a year.
“All of this is having an impact on the NHS being able to treat other patients,” Ms Bruce says.
“[In] accident and emergency centres on Saturday night, figures show, [it] can be as much as 80% of the admissions are alcohol-related.
“We need a national alcohol strategy.”
Alcohol treatment is the most successful form of detox and rehab treatment, with 61% of problem drinkers completing their course free of dependence compared with only 26% of opiate addicts, according to a report by Public Health England.
James eventually got a bed funded by public donations, at a Salvation Army Rehabilitation Centre. He has been clean now for almost two years and has never relapsed since he first went into rehab.
“I’ve been back at work for six months, working in translation, which I got a degree in, and have moved into a new flat.
“Without that bed in rehab, I would have drunk myself to death. I would be dead.”
The Department of Health said: “We are investing more than £16bn in local government public health services.
“We are putting in place new higher duties to target cheap, high-strength cider and looking at what further support we can provide to families to tackle alcohol harms.”
Hear Caroline Turriff’s full report on BBC Radio 4’s World at One programme.