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Topic on a Page - Substance Misuse

Data Sources:

Alcohol Support Pack

Alcohol Concern:

Apps and Tools

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

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

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 (December 2016)

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 Advice: Tackling drug use [LCB18] Published: May 2014

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:

 

New topic: June 18

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 6,807 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 Concern)

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 habit. It is estimated there are 3100 opiate and crack users in Lincolnshire, with only 58% seeking treatment (Source: PHE). There is also the growing issue of new psychoactive substances which although much lower in numbers are having a significant impact on society's view of substance misuse.

Nationally and locally drug related deaths 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 recommissioned its alcohol and drug treatment services in 2016 enabling a modern, more streamlined structure to meet local needs and available budget. This has made portraying a true picture of treatment for this JSNA topic problematic. In addition a performance drop is experienced during any recommissioning exercise due to staff changes and client transfers which can give an incomplete picture of performance when analysing data in isolation.

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. There has been no indication that this document will be refreshed following issue of the new drug strategy.

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 the Lincolnshire Joint Health and Wellbeing Strategy priority to 'support people to drink alcohol sensibly', within the promoting healthier lifestyles theme. 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

Prevalence - Drugs

  • The latest prevalence data estimates there to be 3,100 opiate and crack users in Lincolnshire, 58% of which are in treatment. This is equivalent to 6.9 people in every 1,000 residents and is comparatively lower than the national rate of 8.6 per 1,000.
  • Published prevalence estimates are not currently available at District level.
  • Broken down by age group; prevalence of opiate and crack use in Lincolnshire is highest amongst those aged 25-34 years (14.6 per 1,000), which is consistent with the East Midlands rate (14.3 per 1,000) and higher than in England (12.4 per 1,000).
  • There are significantly more male opiate users (10 per 1,000) than female users (3 per 1,000)

Source: Public Health England, Opiate and crack cocaine use: prevalence estimates for local populations, 2014/15, OCU prevalence

Hospital admissions - Drugs

  • Hospital admissions for drug related mental and behavioural disorders are significantly lower in Lincolnshire (110 per 100,000) than seen regionally (129 per 100,000) or nationally (148 per 100,000). 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.
  • By comparison, admission rates for poisoning by illicit drugs are much lower than for drug related mental and behavioural disorders. Comparatively, Lincolnshire rates (24 per 100,000) are lower than the East Midlands and England rates (27 per 100,000), and rates among men (26 per 100,000) are marginally higher than those for women (22 per 100,000).

Source: NHS Digital, Statistics on Drug Misuse

Mortality - Drugs

  • Between 2014 and 2016, there were 51 deaths as a result of drug misuse in Lincolnshire, which equates to 2.4 in every 100,000 residents. This is lower than both the regional and national rates of 2.9 and 4.2 per 100,000.
  • The highest rates of drug related deaths were in Lincoln (4 per 100,000) and Boston (3.6 per 100,000).
  • The Statistics on Drug Misuse in England report showed that in 2015, 79% of drug related deaths were due to accidental poisoning by drugs, medicaments and biological substances.
  • The same report showed that 60% of all drug related deaths were people aged between 30 and 49, and 74% of all deaths were men.

Source: NHS Digital, Statistics on Drug Misuse

Trends - Drugs

  • Hospital admissions for drug related mental and behavioural disorders have decreased by 15.6% between 2013/14 and 2015/16, which demonstrates a smaller decrease than in the East Midlands (23%) and England (18.8%).
  • Over the same period; admission rates for poisoning by illicit drugs had fallen by 17.8%, while regional and national rates had risen by 7.7% and 6.6%.
  • Drug related deaths have remained relatively static. In 2012- 14, there were 54 drug related deaths (a rate of 2.6 per 100,000) which rose to 58 (2.8 per 100,000) in 2013-15 and then dropped to 51 (2.4 per 100,000) in 2014-16.

Source: PHE, Public Health Outcomes Framework

Hospital admissions - Alcohol

  • The latest hospital admission rates for 2016/17 show that in Lincolnshire, more men (741 per 100,000) were admitted to hospital as a result of alcohol related causes than women (439 per 100,000).
  • Hospital admissions are comparably lower and therefore better in Lincolnshire (591 per 100,000) than across the wider East Midlands (661 per 100,000) and England (636 per 100,000).
  • When we look at alcohol related admissions within district authorities, admission rates are highest in Lincoln (702 per 100,000), Boston (696 per 100,000) and East Lindsey (644 per 100,000). These district rates are higher than the regional and national averages. North Kesteven (528 per 100,000) and South Kesteven (516 per 100,000) have the lowest admission rates across the county.
  • Alcohol specific admissions for under-18s are generally low across the county with all areas below the national average (34.2 per 100,000). Admissions are highest among young people in South Kesteven (33.7 per 100,000) and East Lindsey (33.4 per 100,000) and lowest in North Kesteven (16.5 per 100,000) and Lincoln (14.8 per 100,000).
  • Admissions to hospital for alcoholic liver disease are significantly lower in Lincolnshire than seen regionally and nationally. At district level, rates are highest in Boston and East Lindsey, particularly among male residents.
  • Hospital admissions for mental health disorders resulting from alcohol use are significantly lower across the county (39 per 100,000) however Lincoln (61 per 100,000) is nearer the regional and national equivalents (77 and 73 per 100,000).

Source: PHE, LAPE

Mortality - Alcohol

  • Between 2014 and 2016, deaths either partly or entirely caused by alcohol consumption were lower in Lincolnshire (43.7 per 100,000) than England (46 per 100,000); however those in Lincoln and East Lindsey were significantly higher than the national average at 57.2 and 53.8 respectively.
  • Men account for almost 70% of alcohol related mortality in Lincolnshire, with Lincoln (84.7 per 100.000) and East Lindsey (77.8 per 100,000) showing the highest rates compared to the lowest in South Kesteven (50.5 per 100,000).
  • Between 2014 and 2016, deaths directly caused by alcohol were lower in Lincolnshire (6.7 per 100,000) compared to the national equivalent (10.4 per 100,000).
  • Mortality from chronic liver disease, which is heavily influenced by alcohol consumption and is considered preventable, is lower in Lincolnshire (12.2 per 100,000) than nationally (16.1 per 100,000). However, Lincoln (16.3 per 100,000) is slightly above the national average compared to North and South Kesteven (10 and 10.6 per 100,000).

Source: PHE, LAPE

Trends – Alcohol

  • Trends in hospital data show that alcohol specific admissions in Lincolnshire have fallen by 15.9% from 412 (per 100,000) in 2013/14 to 346 per 100,000 in 2016/17, a greater decrease than seen regionally (1.7%) and nationally (3.6%).
  • Alcohol specific admissions for under-18s in Lincolnshire have seen a decline of 41.8% from 44 per 100,000 in 2011/12-13/14 to 26 per 100,000 in 2013/14-15/16.
  • Alcoholic liver disease admissions rose by a quarter in Lincolnshire in the three years between 2013/14 and 2015/16. By comparison, regional and national rates only increased by 20.1% and 12% respectively.
  • Three year pooled mortality rates related to alcohol in Lincolnshire had risen by 15.5% from 37.8 per 100,000 in 2012-14 to 43.7 per 100,000 in 2014-16. Despite national rates being higher, the trend shows a 1.1% rise over the same period.
  • Alcohol specific mortality has risen by 17.9% for women in Lincolnshire, while rates have fallen by 7% for men. Nationally, rates have risen for both, by 1.5% for men and 2.4% for women.
  • Mortality from chronic liver disease increased by 4% between 2012-14 and 2014-16, which is comparable to the national increase of 4.5%.
  • Alcohol related road traffic accidents are higher than the national average in all areas of Lincolnshire, but East Lindsey and South Holland are significantly higher than other districts being 53% and 49% higher than the national average.

Source: PHE, LAPE

Treatment for substance misuse (adults aged 18 and over)

  • Between 1st April 2016 and 31st March 2017, 2,935 adults were in treatment in Lincolnshire for substance misuse. Of these, 61% presented for opiate abuse and 27% for alcohol misuse, 7% for non-opiate abuse and 6% for alcohol and non-opiate combined.
  • Of the 2,935 adults in treatment, 37% were new presentations within the year and not subject to a re-admission.
  • Opiates are the most common substance (33%) cited by clients in treatment, followed by alcohol (29%) and cannabis (12%). Only 1% of clients cited Novel Psychoactive Substances (NPS) as the substance they are in treatment for.
  • Over two thirds of adults in treatment (69.2%) were men and the majority admitted were from a White British background (92.5%). Over half (50.9%) of adults in treatment in 2016/17 were aged between 35 and 49.
  • Successful completion rates for adults vary on the presenting substance type. Completion for alcohol treatment was highest in 2016/17, at 36%, followed by non-opiates at 29.9% and opiates at 5.9%, 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 7.1%.
  • Of those who have completed their course of treatment for alcohol misuse, 6.2% re-presented within 6 months, 13.6% re-presented for non-opiate abuse and 17.6% re-presented for opiate abuse.
  • In 2016/17, waiting times to commence treatment were comparable with the national average with 99% starting within 3 weeks of referral.
  • 11% of all referrals come through a criminal justice route which is consistent with previous report periods.

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 223 young people (under 18) in treatment for substance misuse in 2016/17, of which 141 (63.2%) were new presentations.
  • During 2016/17; 149 young people exited their treatment, of which 81% were planned and in line with treatment objectives and 19% were unplanned, whereby the client dropped out, declined treatment or was remanded in custody.
  • Drug use is very different among young people with 91% of young clients citing cannabis, 53% alcohol and 17% NPS as the problematic substance.
  • Of the 223 young people 141 had highlighted vulnerabilities, of which 79% were poly drug users, 26% had been involved in anti-social behaviour or criminal acts and 23% divulged issues with self-harm. In addition 23% had experienced some form of child safeguarding issue as either a looked after child (LAC), a child in need (CIN) or on a child protection plan (CPP).

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.

  • Within Lincolnshire the total numbers of adults in treatment for substance misuse (alcohol, opiates and non-opiates) fell by 13.1% from 3,378 in 2014/15 to 2,935 in 2015/16.
  • During the same period, the numbers of new presentations within each 12 month period fell by 29.3% from 1,568 in 2014/15 to 1,109 in 2016/17.
  • Successful completions for opiate treatments fell from 6.9% in 2014/15 to 5.9% in 2016/17, however, there has been a 6.3% decline in clients re-presenting within 6 months for opiate treatment from 23.9% in 2014/15 to 17.6% in 2016/17.
  • Re-presentations within 6 months for non-opiates has increased by 9% from 4.6% in 2014/15 to 13.6% in 2016/17.
  • There was an 8.8% increase in the number of young people entering substance misuse treatment services, from 205 in 2014/15 to 223 in 2016/17.
  • There has been a 20% increase in the number of exits from treatment over the past three years. Planned exits have risen by 28.7%, while unplanned exits have fallen by 6.7%.

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 or 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 for alcohol related liver disease at 118 per 100,000 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, are more at risk of alcohol 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, choosing; 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.

Service user quotes from the recover 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


A Needle Syringe Programme is also provided by Addaction. This aims to reduce the transmission of blood-borne viruses and other infections caused by sharing injecting equipment; including HIV, and hepatitis B and C. The service also offers advice to reduce the harm caused by injecting drugs and access to treatment services. There are currently 18 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 aims to build a recovery community across the county offering peer support and mutual aid to complement existing Alcoholics, and Narcotics Anonymous (AA and NA). Its 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 42 people access the academy and 92 the recovery community each month.

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.”


Family and Carer services are a vital part of any recovery programme. Evidence shows that those using alcohol and drugs have a better recover 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 and Skegness there are Community Alcohol Partnerships (CAP) which bring together local retailers & licensees, trading standards, police, public health, education providers and other local stakeholders to tackle the problem of underage drinking and associated anti-social behaviour. Both are looking 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.

Unmet Needs & Gaps

  • Development of a new governance structure for treatment services to bring key partners together and enable service level feedback and performance improvements where appropriate.
  • 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 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 (ULH) to access the various data sets they have and improve partnership working.
  • Data regarding the usage and needs of Novel Psychoactive Substances (NPS) users should be developed to enable an accurate picture of this constantly changing area of concern.
  • More information 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 needs 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 and providers needs to improve in line with Drug misuse and dependence UK guidelines on clinical management and the Five Year forward View for Mental Health

Wider 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.

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.

There is a 25% reduction rate for 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 2014 -16 there were 6,803 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 currently ring fenced 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.

In 2016/7 there were 14,398 hospital admissions directly linked to alcohol, which is 1,811 per 100,000 population; although this is below the national average of 2,185 it is still a significant number. There were also 348 alcohol related mortalities and 51 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 novel psychoactive substances create, and the harm being seen from alcohol use goes up year on year. Heroin remains the drug of choice for illicit drug users behind the 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 2018-19 and LAPE)

What is coming on the horizon?

  • During 2017 a new national drug strategy and clinical guidelines were issued, we need to ensure all services commissioned meet these guidelines and are fully compliant with NICE and Care Quality Commission (CQC) guidance.
  • 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.
  • New guidance on preventing young people becoming substance misusers are expected during 2018.
  • Commencement of NHS CQUIN 9 across acute health providers during 2018 requires everyone in hospital to be screened for alcohol use. This could significantly increase referrals from the hospital settings across the county.

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 prevention programme picking up on key inequalities including those along the east coast and Lincoln as well as drink and drug driving.
  • Analyse new treatment system to ensure compliance with new guidelines.
  • Analyse new recovery service to ensure value for money is being achieved.
  • Work closely with Children's services to implement the hidden harm training to all frontline staff.
  • Develop a new governance structure for substance misuse services to include a group where partners can provide feedback on service performance and potential areas for development.
  • Work closely with NHS providers to ensure CQUIN 9 is implemented in all hospitals
  • Develop the offer available to low level drinkers who require brief interventions only and who may not wish to access more traditional treatment services.

 

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

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