Drug and alcohol support for migrants experiencing homelessness

Anyone can access the following drug and alcohol services for free. It does not matter what immigration status someone has, what nationality they are, or how long they have been in the country.

Providers cannot charge for these services or refuse access because of someone's immigration status. This is set out in NHS overseas visitor charging rules.

• Tier 1: Information, advice, screening and assessment
• Tier 2: Harm reduction (such as needle exchange), overdose prevention, brief interventions, outreach
• Tier 3: Specialist assessment, care planning, prescribing (including opioid substitution therapy — medication to reduce dependence on opioids such as heroin), community detox, structured day programmes

Unlike tier 1, 2 and 3 services, inpatient detox and residential rehab are not free to everyone.

These services are classed as NHS secondary care — specialist treatment that goes beyond what a GP or community service provides. Free access depends on whether someone is 'ordinarily resident' in the UK. This means they have chosen to live in the UK on a settled, long-term basis — not just that they are physically present here. Whether someone meets this test depends on their immigration status.

Even where a client is eligible, getting funding for residential rehab can be difficult in practice. Funding usually comes from local authority public health budgets, and many migrants are not entitled to the housing-related funding that supports the residential element.

The toolkit contains flowcharts to help you work out whether your client is eligible for drug and alcohol treatment, and which services they can access. There is a flowchart for each immigration status, covering EEA (European Economic Area) nationals, non-EEA nationals, asylum seekers, refugees, and people with different forms of leave to remain.

How to use it:

1. Start by identifying what type of support the client needs — tier 1–3 community services, or inpatient detox or residential rehab.
2. For inpatient detox or rehab, identify the client's immigration status and follow the relevant flowchart.
3. If the client's immigration status is unclear or they cannot demonstrate it, follow the guidance on seeking immigration advice.

Do not make assumptions about a client's immigration status — always assess case by case.

If a drug or alcohol service appears to be refusing or restricting access without good reason, use the toolkit to challenge that decision. NHS staff and local authority workers do not always have a full understanding of what migrants are entitled to.

More toolkit resources

Watch a video walkthrough of the toolkit in practice

Webinar slides: Accessing drug and alcohol services

Further resources: Accessing drug and alcohol services

Migrants experiencing homelessness are more likely than most groups to develop problems with drugs or alcohol. The reasons are rooted in experience, not background.

Trauma is one of the main causes. Many migrants have experienced violence or persecution before arriving in England or Wales. After arrival, poverty, isolation, and the stress of an uncertain immigration status can make things worse.

Rates of PTSD, depression, and anxiety are much higher among migrants who have fled conflict or persecution, than they are in the general population. These conditions often occur alongside drug or alcohol misuse. Each one can make the other harder to treat.

Even among people with high levels of need, migrants are one of the groups least likely to seek help. Fear of immigration consequences, language barriers, distrust of services, and stigma all play a part.

Knowing this context will help you support clients more effectively — and challenge other services when they are wrong about what migrants are entitled to.

Eligibility is only part of the picture. Even when a client has the right to access a service, other barriers can get in the way.

• Language. Many migrants may have limited or no English. Use telephone or video interpretation services for conversations about substance use. Do not use family members or community contacts as interpreters for sensitive topics like this. Multilingual leaflets you can share directly with clients are available on this page.
• Trust. Some clients may not trust services that involve official processes, especially if they have been harmed or criminalised by authorities in the past. Build rapport before raising substance use directly. Make clear that accessing drug and alcohol treatment does not trigger immigration checks or enforcement action.
• Stigma. Attitudes towards alcohol and drug use vary across cultures. Some clients may not see their use as a problem, or may feel too ashamed to talk about it. Use non-judgmental language and a trauma-informed approach.
• Documentation. Clients without documents, a fixed address, or a GP may think they cannot access services. Using the information in the toolkit about free services can help to reassure them.
• Fear of status implications Some clients may worry that seeking help for substance misuse could affect an immigration application or asylum claim. Take this seriously and seek specialist advice where needed.

These leaflets explain access to drug and alcohol treatment and support in plain language. They are designed to be shared directly with clients.

• NHS entitlements: migrant health guide — GOV.UK Official guidance on NHS entitlements for migrants in England, including GP registration and overseas visitor charging
• Overseas visitor charging regulations guidance — GOV.UK DHSC guidance for NHS providers on implementing the overseas visitor charging regulations, including case studies on drug and alcohol services
• Guidance on patient registration for GP practices — BMA Includes specific guidance on registering homeless patients and overseas visitors
• Safe Surgeries initiative — Doctors of the World Resources and training to help GP practices register people without documents or proof of address
• NRPF Network Guidance for local authorities and practitioners on supporting people with no recourse to public funds, including Care Act eligibility
• Praxis Specialist support organisation for migrants — second-tier advice for practitioners
• Migrant Help National charity providing advice and guidance to asylum seekers and migrants
• Adult substance misuse treatment statistics 2023–24 — GOV.UKNational data on adults in treatment, including housing status