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W3C Compliance

6.6.2 Substance Misuse

SCOPE OF THIS CHAPTER

This chapter highlights Merton Council’s commitment to supporting families, children and young people to prevent and manage risk in relation to drug and alcohol use. It identifies the considerable additional risks – particularly for young people – provides a number of relevant links together with some alternative strategies to the ‘scare tactics’ which are the least helpful way of changing hearts and minds.

RELEVANT LINKS

RELEVANT GUIDANCE

This chapter was added to the manual in May 2017.


Contents

  1. Alcohol and Drug Use
  2. Identifying Alcohol Use in Young People
  3. Young People Identified as Drinking Hazardously or Harmfully
  4. Children and Young People Assessed as Vulnerable to Drug Misuse
  5. Alcohol Use and Adults
  6. Adults Assessed as Vulnerable to Drug Misuse
  7. People at Risk of Using Drugs
  8. Making Every Contact Count (MECC)


1. Alcohol and Drug Use

Alcohol dependence and harmful alcohol use are associated with increased risk of physical and mental health conditions including gastrointestinal disorders (in particular liver disease), neurological and cardiovascular disease, depression and anxiety disorders and ultimately, premature death. It is estimated that 24% of people aged between 16 and 65 in England consume alcohol in a way that is potentially or actually harmful to their health or well-being. Alcohol dependence affects between 3% and 6% of people. Brief interventions can be effective in reducing drinking in hazardous and harmful drinkers, but people with alcohol dependence and some harmful drinkers will require more specialist alcohol services.

Alcohol misuse is also problematic in children and young people, with over 18,000 children and young people receiving specialist substance misuse treatment interventions including alcohol-related problems each year. While the numbers of young people accessing treatment services nationally are decreasing those that require treatment those who are drinking are drinking more.

Drug misuse and drug dependency are known causes of premature mortality, exacerbate existing health conditions and contribute to poorer social and well-being outcomes for families. In 2014/15, there were over 8,000 hospital admissions with a primary diagnosis of drug related mental health and behavioural disorders and over 14,000 hospital admissions with a primary diagnosis of poisoning by illicit drugs. Deaths related to drug misuse are on the increase. In 2014 there were over 2,000 drug related deaths, an increase of 15% on 2013 and 44% higher than in 2004. In 2015/16, around 1 in 12 (8.4%) adults aged 16 to 59 had taken an illicit drug in the last year in England and Wales, equating to around 2.7 million people.

Health related behaviour surveys in schools demonstrate that 15% of pupils had ever taken drugs, 10% had taken drugs in the last year and 6% had taken drugs in the last month. The prevalence of drug use also increased with age. For example, 6% of 11 year olds said they had tried drugs at least once, compared with 24% of 15 year olds. Prevalence surveys suggest that young people are more likely to have taken cannabis (6.7%) than any other drug (2.9%). Over one quarter of 15 year olds report being offered cannabis and 11% has actually tried it. Of those who had tried it 83% did so in the last year and of these, 43% had done so in the last month. 9% thought it was OK to try cannabis and 5% thought it was OK to use it at least once / week. The number of young people receiving treatment for cannabis use is on the increase with 86% reporting it as their primary drug of choice and 51% reporting alcohol as their drug of choice. The 2015/16 crime survey for England and Wales estimates that one in 40 (2.6%) young people aged 16 to 24 have taken a New Psychoactive Substance (NPS) in the last year with more men than women taking these substances.

Evidence suggests that a number of risk factors (vulnerabilities) increase the likelihood of drug, alcohol or tobacco use. The more risk factors in a person’s life, the more likely they are to use substances. Risk factors for young people include experiencing abuse and neglect, failing to attend/reduced school attendance, offending behaviour, early sexual activity, anti-social behaviour and being exposed to parental substance use. Evidence clearly suggests that generic approaches that build resilience and ensure informed decision making are the most effective in preventing substance use. The least effective approaches are those which use scare tactics and images, provide knowledge only, using ex-users and police as educators in isolation of a wider preventative approach and non-evidenced-based peer mentoring schemes. Please see MSCB Training Brochure to access local training on substance misuse.


2. Identifying Alcohol Use in Young People

Any professional with a safeguarding responsibility and who regularly comes into contact with children and young people have a responsibility to identify and support those who are thought to be at risk from their use of alcohol. Professional judgement should be used to routinely assess the ability of these children and young people to consent to alcohol-related interventions and treatment. Some will require parental or carer involvement. Professionals should endeavour to obtain a detailed history of their alcohol use including background factors such as family problems and instances of safeguarding concerns and/or under-achievement at school. Appropriate course of action may include empathy and provision of an opinion about the significance of their drinking and other related issues that may arise. In other cases, more intensive counselling and support may be appropriate. Refer to the local Young Person's Substance Misuse Care Pathway to frame your questions.

If there is a reason to believe that there is a significant risk of alcohol-related harm, consider referral to child and adolescent mental health services, social care or to young people's alcohol services for treatment, as appropriate: Merton Young Person's Risk and Resilience Service (Catch22). This service also offers consultancy and advice if you are unsure what course of action to take.

Conducting a validated alcohol screening questionnaire with young people can inform your assessment and discussion with young people with regard to their alcohol use. Catch22 have developed a young people friendly alcohol screening tool that is used locally with children and young people. Contact them direct for copies of this tool. Key groups that may be at an increased risk of alcohol-related harm include those:

  • Who have had an accident or a minor injury;
  • Who regularly attend genito-urinary medicine (GUM) clinics or repeatedly seek emergency contraception;
  • Involved in crime or other antisocial behaviour;
  • Who are regularly absent from education;
  • At risk of self-harm;
  • Who are looked after;
  • Involved with child safeguarding agencies.

When broaching the subject of alcohol and screening, ensure discussions are sensitive to the young person's age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs. The discussions should also take into account their particular needs (health and social) and be appropriate to the setting. Routinely assess the young person's ability to consent to alcohol-related interventions and treatment. If there is doubt, encourage them to consider involving their parents in any alcohol counselling they receive.


3. Young People Drinking Hazardously or Harmfully

Professionals identifying young people as drinking hazardously of harmfully should offer extended brief intervention sessions. This includes the provision of information on local specialist treatment services.


4. Children and Young People Vulnerable to Drug Misuse

Children and Young people assessed as vulnerable to drug misuse may benefit from specialist substance misuse treatment interventions and/or skills training. Skills training can be delivered as part of activities designed to increase resilience and reduce risk and enables the development of a range of personal and social skills, including:

  • Listening;
  • Conflict resolution;
  • Refusal;
  • Identifying and managing stress;
  • Making decisions;
  • Coping with criticism;
  • Dealing with feelings of exclusion;
  • Making healthy behaviour choices;
  • Developing and maintaining healthy relationships.

Personal and social skills training for children and young people who are Looked After or are care leavers should also put particular emphasis on how to deal with feelings of exclusion. Skills training for foster carers should also include using behaviour reinforcement strategies.


5. Alcohol Use and Adults

Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with people who may be at risk of harm from the amount of alcohol they drink, have a responsibility to identify problematic and/or harmful drinking. While alcohol screening for everyone is not practical or feasible professionals should routinely carry out alcohol screening as an integral part of practice, particularly with individuals at increased risk of Significant Harm including those:

  • At risk of self-harm;
  • Involved in crime or other antisocial behaviour;
  • Who have been assaulted;
  • At risk of Domestic Violence and Abuse;
  • Whose children are involved with child safeguarding agencies with drug problems.

When broaching the subject of alcohol and screening, ensure the discussions are sensitive to people's culture and faith and tailored to their needs. Complete a validated alcohol questionnaire with the adults being screened such as the Alcohol Use Disorders Identification Test Consumption (AUDIT - C) or ask them to complete it themselves.

Do not offer simple brief advice to anyone who may be dependent on alcohol, but, refer them for specialist treatment. If someone is reluctant to accept a referral, offer an extended brief intervention and use professional judgement as to whether to revise the AUDIT scores downwards when screening:

  • Women, including those who are, or are planning to become, pregnant;
  • Younger people (under the age of 18);
  • People aged 65 and over;
  • People from some black and minority ethnic groups.

If in doubt, consult relevant specialists such as Engage Merton (Community Drug and Alcohol Recovery Services). Work on the basis that offering an intervention is less likely to cause harm than failing to act where there are concerns.


6. Adults Assessed as Vulnerable to Drug Misuse

Adults who are assessed as vulnerable to drug misuse should be offered the following:

  • Clear information on drugs and their effects;
  • Advice and feedback on any existing drug use;
  • Information on local services and where to find further advice and support.

Offer information and advice both verbally and in writing. Provide advice in a non-judgemental way and tailor it to the person's preferences, needs and level of understanding about their health. Ensure that information and advice is delivered in line with NICE's Guidelines on general and individual approaches to behaviour change.


7. People at Risk of Using Drugs

Information about drug use can be provided in settings where groups who use drugs or are at risk of using drugs may attend, this could include:

  • Nightclubs or festivals;
  • Wider health services, such as sexual and reproductive health services or primary care;
  • Supported accommodation or hostels for people without permanent accommodation;
  • Gyms (to target people who are taking, or considering taking, image- and performance-enhancing drugs).

Provide information in different formats, including web-based information (such as digital and social media) and printed information (such as leaflets). Provide information on:

  • Drugs and their effects (for example, on NHS Choices);
  • Local services and where to find further advice and support;
  • Online self-assessment and feedback to help people assess their own drug use.


8. Making Every Contact Count (MECC)

Making changes such as stopping smoking, improving diet, increasing physical activity, losing weight and reducing alcohol consumption can help people to reduce their risk of poor health significantly. Making every contact count (MECC) is an approach to behaviour change that utilises the millions of day to day interactions that organisations and people have with other people to encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations. For more information regarding MECC, including resources go to: Making Every Contact Count (NHS England).  

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