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Topic on a Page - Substance Misuse

Data Sources:

Office for National Statistics (ONS):

Data: Deaths related to Drug poisoning (includes Local Authority Districts)

Alcohol Related Deaths in the United Kingdom Registered in 2017

Statistics on drug misuse England 2018

Public Health England (PHE):

Public Health England: Public Health Profiles

Data Profiles: Liver Disease

Data Profiles: Mental Health, Dementia, and Neurology

Data Profiles: Substance Misuse

Data Profiles: Suicide Prevention

Service User Involvement Guide Published: September 2015

National Treatment Agency for Substance Misuse

National Treatment Agency: JSNA Support pack

Opiate & Crack Cocaine Use: prevalence estimates by local area

Supporting Information:

Lincolnshire County Council:

Lincolnshire Alcohol and Drug strategy 2014-2019

Substance Misuse Health Needs Assessment (2015) Full Report

Substance Misuse Health Needs Assessment (2015) Summary Report

Alcohol Health Needs Assessment (2014)

Lincolnshire Needs Assessment of Young Persons Substance Misuse Treatment Services Published: September 2013

Lincolnshire Community and Prisons Drug Misuse Needs Assessment (2011/2012)

Lincolnshire Needs Assessment of Community Drug Treatment

Drug related deaths and hospital admissions in Lincolnshire (October 2017)

Public Health England (PHE):

Alcohol Learning Resources

Alcohol and drugs prevention, treatment and recovery: Why invest? (February 2018)

Alcohol, drugs and tobacco: commissioning support pack

Health Matters: preventing ill health from alcohol and tobacco use (October 2017)

Problem parental alcohol and drug use: A toolkit for local authorities

The Public Health Burden of Alcohol evidence review (2018)

Safeguarding children affected by parental alcohol and drug use - Guidance

NHS Evidence:

Alcohol Misuse Prevention

Alcohol

Drug Misuse

Substance Misuse Prevention

Addiction

Cannabis

Crack Cocaine

NPS

Opiates

National Institute for Care and Health Excellence (NICE):

NICE Pathway: Alcohol-use Disorders Overview

NICE Guidance: Lifestyle and wellbeing: Alcohol

Liver Disease [QS152]

HIV testing: encouraging uptake [QS157] September 2017

NICE Quality Standard: Drug use disorders in adults [QS23] Published: November 2012

NICE Pathway: Drug Misuse

NICE Pathway: Needle and Syringe Programmes

Drug Misuse Prevention: Targeted Interventions [NG64] 2017

NICE Quality Standard: Drug misuse prevention [QS165] Published: March 2018

Local Government Association (LGA):

A Councillor's Guide to Tackling New Psychoactive Substances Councillor Briefing Published: January 2015

Government Policy:

2017 Drug Strategy Published July 2017

Government Policy: Harmful drinking (2010 to 2015) Refreshed: May 2015

Policy Updates: What the Government is doing about harmful drinking

Resources: Reducing drugs misuse and dependency

Putting full recovery first: Recovery roadmap Published: March 2012

Joseph Rowntree Foundation:

Alcohol

Substance Misuse

Drugs

Institute for Alcohol Studies:

Institute for Alcohol Studies

Institute of Alcohol Studies: Alcohol and Mental Health: Policy and Practice in England Published: April 2018

University of Lincoln:

Investigation into the Prevalence of Mental Health Disorder and Patterns of Health Service Access in a Probation Population

European Monitoring Centre for Drugs and Drug Addiction:

European Monitoring Centre for Drugs and Drug Addiction: Best Practice Portal

Linked Topics:

 

Topic last reviewed: Aug-19

JSNA Topic: Substance Misuse

Background

Substance misuse is the harmful use of drugs and/or alcohol for non-medical purposes. People often think this refers to illegal drugs; however, legal substances may also be misused, such as alcohol and prescription medications.

Alcohol can play a positive role in society and is an integral part of our culture. However, it is estimated that 10.4 million adults are drinking at levels that pose some risk to their health (Source: PHE). Locally it is estimated there are 6,746 dependant drinkers with many more drinking at hazardous and harmful levels, so although alcohol can play a positive role it also plays a major role in ill health, crime and disorder, domestic violence, teenage pregnancy, family breakdown and anti-social behaviour which impact upon our society and economy.

Alcohol misuse contributes significantly to many health conditions, wholly or partially, due either to acute alcohol intoxication or to the toxic effect of alcohol misuse over time. The resulting health conditions include cardiovascular conditions, cancers, liver disease, depression, pancreatitis and accidental injuries. The risk of ill health increases exponentially as regular consumption levels increase. Most of these harms are preventable. Alcohol harms are estimated to cost the NHS around £3.5 billion annually. (Source: Alcohol Change UK)

The range of problems drug misuse creates is a cause of major public concern; it impacts on the individuals who use them and also on personal relationships and family life. Communities can be affected by higher crime and anti-social behaviour with the results costing taxpayers millions every year to deal with associated health problems and to tackle the crimes committed by some users to fund their drug use. It is estimated there are 3,241 opiate users in Lincolnshire, with only 55% seeking treatment (Source: PHE). There is also the growing and illegal use of novel psychoactive substances which although much lower in numbers are having a significant impact on society's view of substance misuse.

Nationally and locally deaths from illicit drug use are increasing as the heroin using population gets older and more complex combinations of drugs are consumed, while the rise in prescribed opiates and associated pain killers has made some controlled drugs more available on the illicit market.

Lincolnshire commissioned its alcohol and drug treatment services in 2016 enabling a modern, more streamlined structure including a new recovery service to meet local needs and available budget. These services are now established and performance stabilised following the commissioning activity. Priorities have been set to reduce the number who re-present to treatment after discharge as this gives the best indication of long term recovery. Recent performance has been good with opiate re-presentations at 12.9% compared to a national average of 17% and alcohol re-presentation 3.3% compared to 8.2% nationally. (Source: NDTMS).

Context

National Strategies, Policies & Guidance

The most recent National Drug Strategy was published in 2017; this builds on the previous strategy by retaining the three main themes of Reducing Demand, Restricting Supply and Building Recovery while adding a new fourth priority of Global Action. The document concentrates on drugs but does say many elements can be related to both drugs and alcohol.

The strategy puts a greater emphasis on prevention, and prevention of escalation of drug use for all ages as well as building resilience and confidence among young people. Recovery remains a strong focus of the strategy by improving treatment quality and outcomes for different user groups by ensuring the right interventions are given to people according to their need. It also seeks to ensure newly commissioned services are joined up with a wide range of services including housing, mental health and employment services that are essential to supporting every individual to live a life free from drugs. To reduce demand the strategy aims to adapt approaches by reflecting changes in criminal activity and using partnership working to tackle drugs alongside other criminal activity. The new global action priority will see the government taking a leading role in driving international action by sharing best practice and promoting evidence based approaches to preventing drug harms.

New guidance for substance misuse treatment services was published in 2017 with the release of the Drug Misuse and Dependence: UK Guidelines on Clinical Management, this builds on the 2017 strategy theme of the right treatment at the right time by providing a comprehensive guide for all those working in drug treatment. This builds on the previous 2007 guidelines by taking into account changes in legislation, especially around New Psychoactive Substances and the introduction of non-medical prescribers. The guidelines also build on the priorities identified in the 2017 Drug Strategy by placing an increased focus on an integrated recovery journey through treatment including a greater emphasis on mutual aid programmes and peer support.

The Government's Alcohol Strategy 2012 focuses on the importance of preventing and reducing the impact of alcohol on crime and disorder, as well as health. The strategy prioritises the prevention of alcohol-related harm by reducing the number of people drinking to excess and making "less risky" drinking the norm. This document is due to be refreshed but no current timescale for publication is currently available.

The National Institute for Health and Care Excellence (NICE) published Alcohol-use disorders: diagnosis and management in 2011, this brought together three previous guidance documents and gives direction for NHS and other specialist providers on the identification, referral and treatment for young people and adults.

Local Strategies & Plans

The Lincolnshire Alcohol and Drug strategy 2014-2019 supports people to drink alcohol sensibly'. The strategy has three main themes:

  • Promoting responsible drinking and preventing alcohol and drug related harm
  • Tackling alcohol and drug related crime and anti-social behaviour
  • Delivering high quality alcohol and drug treatment systems

These themes are key priorities for Public Health, reflecting the impact that drugs can have on communities and stressing the importance of partnership working in the future.

The strategy makes reference to the importance of effective partnerships and cooperative and collaborative working in all associated areas of delivery including treatment, education and policing.

What is the picture in Lincolnshire?

What the data is telling us?

Unless otherwise stated, data has been age and sex standardised and presented as a rate per 100,000 of the resident population.

Prevalence - Drugs

  • The latest prevalence data estimates there to be 3,669 opiate and crack users in Lincolnshire. This is equivalent to 8.07 people in every 1,000 population (aged 16 to 64) and is comparable to the national rate of 8.85 per 1,000.
  • Published prevalence estimates are not currently available at District level.
  • Broken down by age group, the rate of opiate and crack users in Lincolnshire is highest among the 25-34 year age group (13.39 per 1,000); followed by the 35-64 year age group (8.09 per 1,000) and 15-24 year age group (2.74 per 1,000).There are no significant differences compared to national rates.

Source: Public Health England, Opiate and crack cocaine use: prevalence estimates for local populations, 2016/17, OCU prevalence

Hospital admissions - Drugs

  • In 2017/18, 685 people in Lincolnshire were admitted to hospital for drug related mental and behavioural disorders, which equates to 102 per 100,000 populaton. This is significantly lower than the regional and national rates of 132 and 157 per 100,000 populaton. Admission rates are significantly higher for men than women and this is consistent for all geographies.
  • Published drug related hospital admissions are not currently available at district level.
  • Admission rates for poisoning by illicit drugs in Lincolnshire are lower than national and regional rates at 27 per 100,000 population compared with the East Midlands 32 per 100,000 and England rates of 31 per 100,000. Rates among women (28 per 100,000) are marginally higher than those for men (27 per 100,000).

Source: NHS Digital, Statistics on Drug Misuse 2018 (November update)

Mortality - Drugs

  • Between 2015 and 2017, there were 60 deaths as a result of drug misuse in Lincolnshire, which equates to 2.9 in every 100,000 populaton. This is lower than both the regional and national rates of 3.3 and 4.3 per 100,000.
  • The Statistics on Drug Misuse in England report showed that in 2017, 80% of drug related deaths related to illegal drug misuse were due to accidental overdoses.
  • The same report showed that 32% of all drug related deaths were people aged between 40 and 49, and 72% of all deaths were men.

Source: NHS Digital, Statistics on Drug Misuse 2018 (November update), PHE, Public Health Outcomes Framework

Trends - Drugs

  • Hospital admissions for drug related mental and behavioural disorders have increased from 95 per 100,000 population in 2016/17 to 102 per 100,000 in 2017/18. This mirrors the increase seen both regionally and nationally in the same period.
  • Hospital admissions for poisoning by illicit drugs have increased in Lincolnshire from 22 per 100,000 population in 2016/17 to 27 per 100,000 in 2017/18. Regional and national rates have also increased during the same period.
  • Drug related deaths have increased since 2014-16 but remain lower than the national average. In 2014-16, there were 51 drug related deaths (a rate of 2.4 per 100,000) which rose to 60 (2.9 per 100,000) in 2015-17.

Source: PHE, Public Health Outcomes Framework

Prevalence - Alcohol

  • The latest prevalence data (2016/17) estimates there to be 6,746 dependent drinkers in Lincolnshire. This is equivalent to 11.2 people in every 1,000 population and is lower than the national rate of 13.5 per 1,000.
  • In 2016/17 814 people received treatment for alcohol dependence this is 12% of the dependent population.

Source: PHE, Adults - alcohol commissioning support pack 2019-20

Hospital Admissions - Alcohol

  • The latest hospital admission rates for 2017/18 show that in Lincolnshire, more men (744 per 100,000) were admitted to hospital as a result of alcohol related causes than women (453 per 100,000) however this gap has narrowed by 17 per 100,000 over the last 12 months with the number of males dropping slightly and women rising by 14.
  • Hospital admissions are comparably lower and therefore better in Lincolnshire (591 per 100,000) than across the wider East Midlands (669 per 100,000) and England (632 per 100,000).
  • When we look at alcohol related admissions within district authorities, admission rates are highest in Boston (713 per 100,000), Lincoln (677 per 100,000) and East Lindsey (639 per 100,000). These district rates are higher than the regional and national averages. North Kesteven (532 per 100,000) and South Kesteven (527 per 100,000) have the lowest admission rates across the county.
  • In 2017/18, alcohol specific admissions for under-18s were generally low across the county with all areas below the national average (32.9 per 100,000). Admissions are highest among young people in South Kesteven (28.7 per 100,000) and East Lindsey (26.4 per 100,000) and lowest in South Holland (15 per 100,000) and Boston (14.3 per 100,000).
  • Admissions to hospital for alcoholic liver disease are significantly lower in Lincolnshire (66.6 per 100,000) than seen nationally (120.6 per 100,000). At district level, rates are highest in Boston (83.6 per 100,000) and East Lindsey (83.4 per 100,000), particularly among male residents.
  • Hospital admissions for mental health disorders resulting from alcohol use are significantly lower across the county (35.3 per 100,000) however Lincoln (49.1 per 100,000) is nearer the national rate of 69.2 per 100,000.

Source: PHE, LAPE

Mortality - Alcohol

  • In 2017, deaths either partly or entirely caused by alcohol consumption were lower in Lincolnshire (42.5 per 100,000) than England (46.2 per 100,000).
  • Men account for two thirds of alcohol related mortality in Lincolnshire at a rate of 61.3 per 100,000 population. East Lindsey has the highest male mortality rates at 72.8 per 100,000; however this is comparable to the national rate.
  • Between 2015 and 2017, deaths directly caused by alcohol were lower in Lincolnshire (7.6 per 100,000) compared to the national rate (10.6 per 100,000).
  • Between 2015 and 2017, mortality from chronic liver disease, which is heavily influenced by alcohol consumption and is considered preventable, was lower in Lincolnshire (9.7 per 100,000) than nationally (12.2 per 100,000).

Source: PHE, LAPE

Trends – Alcohol

  • Trends in hospital data show that alcohol specific admission rates in Lincolnshire have fallen from 433 (per 100,000) in 2011/12 to 333 per 100,000 in 2017/18, while regionally and nationally rates have remained similar across that same time period.
  • Alcohol specific admission rates for under-18s in Lincolnshire have seen a decline from 25.5 per 100,000 in 2014/15-16/17 to 21.6 per 100,000 in 2015/16-17/18. Rates have steadily fallen since 2006/07-08/09 where they were 59.1 per 100,000. Comparatively, regional and national rates have also fallen at a similar level.
  • Alcoholic liver disease admission rates have risen in recent years to a high of 74.1 per 100,000 in 2016/17, however rates have fallen in 2017/18 to 66.6 per 100,000. By comparison, Lincolnshire still remains significantly better than the regional and national rates, which had continued to increase in 2017/18.
  • Alcohol related mortality in Lincolnshire has remained relatively static in the past three years, from 43.4 per 100,000 in 2015, to 43.7 per 100,000 in 2016 and 42.5 per 100,000 in 2017. Regional and national rates are comparatively higher.
  • Between 2014-16 and 2015-17, there has been a 15.7% increase in the number of alcohol specific deaths in Lincolnshire, rising from 152 to 176. The majority of this increase can be seen in males, where deaths have increased from 84 to 105.
  • There has been an increase of 9% in the number of deaths from chronic liver disease in Lincolnshire, from 210 in 2014-16, to 229 in 2015-17.
  • The rate of alcohol related road traffic accidents in Lincolnshire (42.3 per 1,000) is significantly higher than the national average (26.4 per 1,000). At district level, there is variation across the county, with the highest rates seen in South Holland (57.9 per 1,000) and East Lindsey (51.9 per 1,000); while the lowest are in Boston (33.9 per 1,000) and North Kesteven (31.9 per 1,000).

Source: PHE, LAPE

Treatment for substance misuse (adults aged 18 and over)

  • Between 1st April 2018 and 31st March 2019, 2,944 adults were in treatment in Lincolnshire for substance misuse. Of these, 1,762 presented for opiate abuse and 722 for alcohol misuse, 262 for non-opiate abuse and 198 for combined alcohol and non-opiate abuse.
  • Of the 2,944 adults in treatment in 2018/19, 1,376 were new presentations within the year and not subject to a re-admission.
  • Opiates are the most common substance (31.2%) cited by clients in treatment, followed by alcohol (27.1%) and cannabis (12.4%). 2% of clients cited Novel Psychoactive Substances (NPS) as the substance they are in treatment for.
  • Over two thirds of adults in treatment (70.7%) were men and the majority admitted were from a White British background (92.1%). Over half (51.8%) of adults in treatment in 2018/19 were aged between 35 and 49.
  • Successful completion rates for adults vary on the presenting substance type: Completion for alcohol treatment was highest in 2018/19, at 36.1%, followed by non-opiates at 30.5% and opiates at 3.9%. The lower figure for opiates is due to the relapsing nature of opioid addiction which can often take a number of treatment episodes before recovery becomes realistic, the local figures are still below the national average which is 6%.
  • Of those who have completed their course of treatment for alcohol misuse, 3.3% re-presented within 6 months, 6.1% re-presented for non-opiate abuse and 12.9% re-presented for opiate abuse.
  • In 2018/19, waiting times to commence treatment were comparable with the national average with 99% starting within 3 weeks of referral.
  • 11.7% of all referrals come through a criminal justice route which is consistent with previous report periods.
  • During 2018 costs for some opiate substitution medication (Buprenorphine) increased by up to 800% causing an increase in costs to treat this client group.

Source: National Drug Treatment Monitoring System (NDTMS), NDTMS

Source: PHE commissioning support pack 2018-19

Treatment for substance misuse (young people aged under 18)

  • Treatment data shows there were 179 young people (under 18) in treatment for substance misuse in 2018/19, of which 130 (72.6%) were new presentations.
  • During 2018/19; 121 young people exited their treatment, of which 88% were planned and in line with treatment objectives and 12% were unplanned, whereby the client dropped out, declined treatment or was remanded in custody.
  • Drug use is very different among young people with 89% of young clients citing cannabis, 39% alcohol and 34% ecstasy as the problematic substance.
  • Local use of NPS is much higher (6%) than seen nationally (1%).
  • In 2016/17 of the 223 young people treated; 130 had highlighted vulnerabilities, of which 82% were poly drug users, 32% had an identified mental health treatment need, 26% were affected by domestic abuse, and 22% were involved in anti-social behaviour or criminal acts.

Source: National Drug Treatment Monitoring System (NDTMS), NDTMS

Trends - Treatment for substance misuse (adults and young people)

In this section trend data is compared over recent years, however in 2016 new treatment services were commissioned, which although comparably comprehensive carries a significantly smaller capacity than those previously commissioned, therefore the lower figures below cannot be equated to a performance decrease but a reduction in capacity following realignment of budgets, In the same respect increases seen in 2018/19 cannot all be attributed to improved performance as 2017/18 data is affected by the re-commissioning exercise

  • Within Lincolnshire the total numbers of adults in treatment for substance misuse (alcohol, opiates and non-opiates) rose by 8.9% from 2,703 in 2017/18 to 2,944 in 2018/19.
  • During the same period, the numbers of new presentations within each 12 month period increased by 10.5% from 1,245 in 2017/18 to 1,376 in 2018/19.
  • Successful completions for opiate treatments fell from 4.5% in 2017/18 to 3.9% in 2018/19; however, there has been a 6.2% decline in clients re-presenting within 6 months for opiate treatment from 19.1% in 2017/18 to 12.9% in 2018/19.
  • Between 2017/18 and 2018/19, there were slightly fewer young people entering specialist substance misuse services in Lincolnshire, falling from 182 in 2017/18 to 179 in 2018/19.
  • The total number of young people exiting treatment has seen a small decline in the past year, falling from 123 in 2017/18 to 121 in 2018/19. Of these exits, the proportion of planned exits has risen from 82% to 88%, with those young people exiting the service drug-free increasing from 32% to 37%.

Source: National Drug Treatment Monitoring System (NDTMS), NDTMS

Key Inequalities

The Lincolnshire Substance Misuse Health Needs Assessment (2015) highlighted a number of inequalities commonly associated with alcohol and drug misuse. Both alcohol and drug misuse can be associated with many risk factors including domestic abuse, tobacco use, unsafe sex and crime.

Deprivation - Inequalities are linked to areas of deprivation. In Lincolnshire, 14% of people live within the 20% most deprived areas of England. However, although this 'average' deprivation is lower than seen nationally, there are differences across the county. In Lincoln City 33% of people live within this national quintile of deprivation, followed by 27% in East Lindsey and 17% in Boston Borough. Nationally, deprivation tends to be associated with pockets of urban areas, which in Lincolnshire can be found in the areas of Lincoln, Gainsborough and Boston for example. However, with relatively poor transport and broadband infrastructure the county also suffers from areas of rural deprivation.

Age - Young adults, those aged 16-24 years, are more likely to have used drugs in the last year than older adults. However, twice as many people are admitted to hospital with alcohol related conditions aged over 65 years than those under 65, this is due to the chronic effect alcohol has on the body over time. Many of those drinking at harmful levels may be doing so for years with no symptoms which manifest in conditions requiring hospitalisation later in life. These include cardiovascular disease, cancer, cirrhosis of the liver, gout and depression.

Gender - Men are more likely to take drugs than women, with 11.8 % of men having taken drugs in the last year compared to 5.8% of women. Men are also more likely to be admitted to hospital with alcohol related liver disease at 118 per 100,000 population although this is below the national average of 150 per 100,000. Incidents for women have gone up slightly to 69.2 per 100,000; however rates for female mortality from liver disease have gone up by 22% over the last 2 years which equates to 5.1 per 100,000 which is still lower than the male rate of 6.5 or the national rate of 6.0 per 100,000 for women.

Socio-economic - People living in more deprived areas are more likely to be frequent drug users. Alcohol harm follows along a social gradient with the most alcohol related harm being experienced by lower socioeconomic groups. In contrast, alcohol related liver disease is higher among the more affluent socioeconomic groups.

Children – vulnerable children and young people, e.g. looked after children, those affected by domestic abuse, those involved in self-harm, those not in education, employment or training or with mental health issues are more at risk of alcohol and drug related harm.

Sexual orientation – high levels of drugs and alcohol use are noted within the lesbian, gay, bisexual or transgender (LGBT) adult community.

Ethnicity - adults from a mixed ethnic background were the most likely to have participated in illicit drug taking in the last year compared to other ethnic groups. The group with the lowest level of drug taking was Asian or Asian British.

Families - children of parents with a dependence on drugs or alcohol are more likely to develop an addiction than children whose parents are not alcohol or drug dependent.

Mental health – 18% of all those seeking help for opiate dependence are also receiving support from mental health services, this more than doubles for alcohol only clients at 43%, however estimates suggest that up to 75% of all those seeking treatment may have some degree of mental health problem.

Source: Lincolnshire Research Observatory, Substance Misuse HNA, 2015

Source: PHE, Public Health Profiles

Current Activity & Services

In 2017 the Safer Lincolnshire Partnership chose new priorities: Domestic Abuse, Anti-Social Behaviour, Serious Organised Crime and Reducing Offending. Although alcohol and drugs cross all these priorities they are no longer priorities in their own right. Resources previously allocated to alcohol and drugs have now been realigned with the new priorities. Control of the Substance Misuse strategy, Drug Related Death review process, dual diagnosis and the prevention agenda have all moved directorates, and the Substance Misuse Strategic Management Board that oversaw the treatment service has been disbanded. This work will now be undertaken by Public Health.

The community alcohol and drug treatment services provided by Addaction are for people of any age. Young people have their own specifically trained workers and appointments are away from main resource sites. Adult services are flexible, with appointments being available at resource sites or other community venues including some doctor's surgeries. The service accommodates both alcohol and drug clients and provides a personal recovery plan tailoring treatment to individual needs. This work may include brief talking therapies or more complex structured treatment and clinical services such as opiate substitute medication or alcohol/drug detoxification.

A Needle Syringe Programme is also provided by Addaction. This aims to reduce the transmission of blood-borne viruses and infections such as HIV, and hepatitis B and C, caused by sharing injecting equipment. The service also offers advice to reduce the harm caused by injecting drugs and access to treatment services. There are currently 19 pharmacies and 3 specialist sites across Lincolnshire. Naloxone, a drug given to those suspected of overdosing from heroin, is also now available; this can be issued to professionals, service users or their family members, to reduce the number of drug related deaths from opiate overdose.

The recovery service provided by Double Impact on behalf of Addaction commenced in October 2016. This service is building a recovery community across the county offering peer support and mutual aid to complement existing Alcoholics, Cocaine and Narcotics Anonymous (AA, CA and NA). Their academy offers accredited training packages to help those in recovery get experience and qualifications to gain employment and assist with reintegration back into society following periods of substance misuse. This service will take time to mature as the recovery community structure is volunteer based and is a new concept to Lincolnshire, currently an average of 26 people access the academy and 162 the recovery community each month.

Family and Carer services are a vital part of any recovery programme. Evidence shows that those using alcohol and drugs have a better recovery rate if a strong family support network is in place and the latest clinical guidelines recognise the stress that can be created by the caring role. Carers First are the commissioned service which can help build bridges between families and the user, and assist carers in coping with someone who is misusing alcohol and/or drugs. Please see the Carers JSNA topic for a detailed assessment of this provision.

In Boston, Skegness and Spalding there are Community Alcohol Partnerships (CAPs) which bring together local retailers and licensees, trading standards, police, public health, education providers and other local stakeholders to tackle the problem of underage drinking associated anti-social behaviour. All seek to participate in their own and organised public events primarily looking at community awareness and education of licenced premises workers. This helps target underage drinking and alcohol sales with awareness campaigns and training promoting the Challenge 25 programme and raising Public Health profiles.

A number of initiatives have developed during 2018/19 around homelessness and co-existing mental health and substance misuse which includes accommodation based and street outreach models. These are primarily in Lincoln but others are still being developed in East Lindsey and Boston, all projects are funded through short term grants from various funding streams, it is vital that these schemes are fully evaluated with key learning taken forward to inform longer term commissioning as part of a dual diagnosis pathway.

A new governance structure has been developed to oversee the substance misuse services which will be tested over the coming year; this will include two virtual groups at strategic and operational levels. It is envisaged that most business will be conducted virtually however both groups have the ability to call a physical meeting if necessary.

During 2017/18 over 500 Children's services staff were trained in hidden harm as part of the prevention initiatives for substance misuse. This training will assist front line staff to more easily identify children at risk of harm from parent or sibling substance misuse

'One You Lincolnshire' is a new service that commenced in July 2019; providing services for stop smoking, weight management, improving exercise and drinking less. The extended brief advice offered by the service is for drinkers who have a long term health condition and drink more than 14 units of alcohol per week. Up to four individual sessions and a number of digital options can be used to help reduce the amount of alcohol being consumed and reduce the harm suffered by excessive alcohol consumption.

Unmet Needs & Gaps

  • A strong and sustainable prevention programme is required; this should consider both national campaigns and local initiatives including joint projects with key partners such as Children's services and Road Safety Partnership.
  • A drug related deaths process should be developed in line with Public Health England guidance and best practice to aid learning and reduce the risk of further drug related deaths.
  • Closer working relationships should be developed with United Lincolnshire Hospitals NHS Trust (ULHT) to access the various data sets they have and improve partnership working.
  • Data collection regarding the usage and needs of NPS users should be developed to enable an accurate picture of this constantly changing area of concern.
  • Further work is required on the impact structural and financial changes have had on treatment services. This should be used to identify any gaps and developing unmet need, and inform future commissioning decisions.
  • The recovery service provided by Addaction and Double Impact needs to continue to develop the community elements of its service further to enable those still in treatment to see the positive changes that can be achieved by becoming drug or drink free.
  • Joint working between substance misuse and mental health commissioners, district councils and providers needs to improve in line with Drug misuse and dependence UK guidelines on clinical management and the NHS Long Term Plan to develop a coordinated response to co-existing mental health and substance misuse issues, especially for those who are homeless or at risk of homelessness.
  • A long term solution to the cost of some opiate substitute medication needs to be developed. Additional funds have been provided to offset the costs for 2018-20 but a long term plan to cope with the c.800% cost increase is required to avoid any reduction in treatment provision to cope with the increases. This issue will need to be locally managed as no central resources will be made available to assist the local authority.

Wider availability of data sources should be explored in order to build a more comprehensive picture of drug and alcohol misuse across the county, these should include, Fire and Rescue, Domestic Violence and Drink/Drug Driving.

Local Views & Insights

Service user quotes from the recovery service include:

Adult Service

"I may be off methadone for 7 months, but I know where you are if I ever need you. I know the door is never closed"

"I know I can slip, but I know I’m never judged here"

"Thank you so much for all your help bro, I really appreciate it. If it wasn’t for you I would not of continued in the initial stages"

"I wish I could see my worker more often"


Young Persons service

"WOW, I didn’t know alcohol was so bad! It’s everywhere. I’ll be talking to my mum about it more." Yr 7

"Not everything is focussed around drugs, you have our best interest as a key priority"

"I now know the dangers of drugs! I won’t be doing them!" Yr 9


Service user quotes from the recovery service include:

From Recovery groups

"They listened and understood where my head was and helped me turn it around"

"I liked the group because it was open, honest and welcoming"

"It has helped me realise my wrongs and to put them right"

From the Academy

"The Academy has helped me to build my confidence and reduce my anxiety and depression to the point that it is almost non-existent."

"The encouragement from my peers and the staff at Double Impact has been invaluable. To work and learn in a non-judgemental environment is fantastic and they are always on hand to help and support with any issues."

"At the End of October, I had an interview with Marks and Spencer’s and been offered a job. 3 years ago, I was using food banks and now I can shop at M&S for my Christmas dinner."


Risks of not doing something

Substance misuse services have wide reaching implications across multiple agendas, failure to provide services would potentially lead to an increase in domestic violence, anti-social behaviour and health conditions such as liver failure and heart disease. Crime would increase especially acquisitive crime such as burglary and theft.

Public Health England reports for Lincolnshire show a 25% reduction of crimes committed by those entering drug treatment and 52% for alcohol, it is estimated this prevents 40,999 crimes per year saving over £14.5m in social and economic costs. There is also a further £6.9m saving in quality years lost. This means for every £1.00 spent £3.38 is saved from the public purse before adding the additional costs borne by the NHS for liver disease, hypertension, hospital admissions and other medical conditions associated with alcohol and drugs. Therefore if nothing is done a further £16.5m will need to be found to offset the loss of services.

Between 2015 -17 there were 6,996 deaths from drug misuse in England. Should treatment services not be provided across the county the proportion of Lincolnshire residents making up this figure would certainly rise. Local and national data shows these figures are rising so it is crucial we do more with this group not less to minimise the deaths in Lincolnshire.

Funding is received as part of the Public Health Grant, if substance misuse services are not provided this funding could be lost, and Lincolnshire would not be meeting the needs of the national drug strategy or guidelines set out by NICE or the Department of Health.

During 2017/8 in Lincolnshire there were 14,857 hospital admissions directly linked to alcohol, which is 1,834 per 100,000 population; although this is below the national average of 2,224 it is still a significant number. There were also 348 alcohol related mortalities and 60 drug related deaths. More deaths could be anticipated if we do not provide services for those who are dependent on alcohol and drugs.

There is still a substantial amount of work remaining for substance misuse services to address; the constantly developing issues NPS creates, and the harm being seen from alcohol use goes up year on year. Heroin remains the drug of choice for illicit drug users behind legally available alcohol; any further reduction in service provision will put significant pressure on already struggling NHS and emergency services.

(Source: PHE commissioning support pack 2019-20, PHE commissioning support pack 2018-19 and LAPE)

What is coming on the horizon?

  • A new national alcohol strategy is overdue for release; however no date is currently available for publication and it is anticipated this may not now happen in the foreseeable future.
  • A report is expected from Public Health England into the prescribing of painkillers and medicines to treat anxiety and insomnia within Primary Care. The outcomes from this report may have implications on treatment services.
  • Further development and expansion of the recovery service as the recovery community develops.
  • NHS CQUIN 9 is now entering its second year across acute health providers this requires everyone in hospital to be screened for alcohol use and smoking. To date there has not been a significant increase in referrals from the trusts in to treatment services, however with the new 'One You Lincolnshire' service offering extended brief interventions to those eligible, new partnership working opportunities need to be explored.

What should we be doing next?

  • Develop a drug death review process to enable enquiries to be undertaken and learning to help inform partners and commissioned services where improvements in provision may be made.
  • Develop a programme of prevention activity to pick up on key inequalities for those living along the east coast and in Lincoln as well as drink and drug driving.
  • Analyse the Addaction and Double Impact recovery service to ensure value for money is being achieved.
  • Work closely with NHS providers to ensure CQUIN 9 continues to develop in all hospitals.
  • Develop the offer available from the 'One You Lincolnshire' service to low level drinkers who require brief interventions only and who may not wish to access more traditional treatment services.
  • Strategies to improve engagement with those suffering co-existing mental health and substance misuse issues will continue to develop.
  • Develop and implement a new process to cope with the increased prices of some opiate substitute medication (e.g. Buprenorphine) to enable treatment providers to meet their obligations without the loss of treatment provision.
  • Test the revised local substance misuse governance process to ensure it meets appropriate standards for all key stakeholders.

 

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If you need to contact us about this topic, please email JSNA@lincolnshire.gov.uk

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