East Ayrshire alcohol and drug partnership. Alcohol and drug strategy

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1 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

2 2 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

3 Introduction East Ayrshire alcohol and drug partnership Alcohol and drug strategy

4 Something s got to change I may have a drug problem but I am still human. Drug and alcohol issues are significant contributory factors in poor health across East Ayrshire a fact recognised by national and local data. Drugs and alcohol use poses complex issues for people and their communities. The impact extends far beyond an individual s own health. The consequences affect individuals, families (particularly children) and communities - physically, financially, psychologically and socially. These issues pose a number of challenges for the East Ayrshire Alcohol and Drug Partnership. We recognise that addressing such challenges is not the responsibility of any one group. Success in delivering our aspirations for the people of East Ayrshire requires partnership working across agencies and services. Our vision: Our aims: East Ayrshire will be a place with strong vibrant communities, with a healthy and responsible attitude to alcohol, where sustained recovery from problematic alcohol and drug use is a reality. We will ensure people with alcohol and drug problems have the capacity, with support from well targeted, integrated and informed services, to pursue more rewarding and enriched lives beyond their use of alcohol and drugs; We will support people and communities in East Ayrshire so they can feel safe, included, respected and free from harm caused by alcohol and drug use; We will support children in East Ayrshire to keep them safe and protected from the effects of others alcohol and drug use; We will support vulnerable adults in East Ayrshire to protect them from the impact of alcohol and drug misuse; We will reduce the impact of alcohol and drugs on everyone in East Ayrshire and support a change in culture to one where alcohol is used responsibly; and We will encourage our communities to give positive support to those who have recovered from alcohol or drug dependency. 4 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

5 Consultation East Ayrshire alcohol and drug partnership Alcohol and drug strategy

6 The views of our service users and their families Not always person centred. One size doesn t fit all. We spoke to over 80 people who currently use a range of support services across East Ayrshire. Their views were vital in assessing how we can best meet their needs. We asked what currently works well for them, where they consider there are gaps and what outcomes they wish for themselves. We used these views to formulate this strategy. People told us that the services they currently received were good but they had issues with communications and multi agency working where they required to see multiple members of staff from different agencies. We were told that there could be better information about where to go for help and what actual help was available with respect to addiction. We also heard that peoples personal goals were to be free from addiction, stop taking methadone, access employment and in some cases, resume the care of their children. Our discussions identified the importance of peer to peer support groups and having someone to talk to. People found it particularly helpful when whoever was providing support really understood their position. We cannot underestimate the importance of building on this communication and working in partnership to address our complicated relationship with alcohol and drugs. The views of our community We need a clear no tolerance approach to alcohol and drug abuse. Take a good look at the methadone prescribing in this area - are the numbers excessive? Is there another model that would prevent the numbers of pale faced, drug addicted young people who seem to be a lost generation? There is a range of views about how people affected by problem alcohol and drug use can be best supported to address their difficulties. The wider community and local businesses expressed strong views about the impact of alcohol and drug misuse have on their lives and livelihoods. At liaison meetings between businesses in East Ayrshire and community planning partners, concerns were expressed about the perceived relatively high numbers of people accessing services provided within our town centres and the impact on their businesses. Some members of the public also consider the behaviour of these service users to be threatening. In 2010 our public consultations identified the impact of alcohol and drug misuse on health and on communities as a priority during the review of the Community Plan. In individual interviews of householders within local communities by the police, drunk and disorderly behaviour was consistently identified as a high priority for action. The supply of drugs and drug use was also a matter of concern. 6 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

7 The views of our community planning partners Professional representatives from our community planning partners expressed concerns about the wider impact that problematic drug and alcohol use has on children, young people, and social cohesion in general. While community planning partners were broadly supportive of our efforts to address the needs of drug users, they specifically emphasised the need to use early intervention and education to break the cycle of drug and alcohol problems. Our partners also recognised the Alcohol and Drug Partnership s emphasis on tackling alcohol related issues and were keen to play their part to shift the cultural acceptability of excessive and hazardous drinking. Views of elected members East Ayrshire elected members expressed concerns from businesses and communities relating predominantly to methadone and methadone dispensing around Kilmarnock town centre. They stressed the view that many drug users appear to be stuck on methadone. They wished to see more visible evidence of recovery in action and shared the view of the ADP that this recovery should be supported by a range of options and opportunities in employment, education and training. While elected members expressed concerns about the apparent proliferation of methadone prescribing, they did recognise the role of substitute prescribing and alternative pharmaceutical interventions. Like our community planning partners, elected members were concerned about the impact of drugs on families (particularly children), and the wider societal costs related to acquisitive crime. Also in common with our community planning partners, elected members recognised the scale of impact of alcohol. They endorsed action to tackle availability and access via the licensing board and police. They were also supportive of preventative action targeted at everyone from school pupils to Council employees. East Ayrshire alcohol and drug partnership Alcohol and drug strategy

8 Executive summary 8 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

9 National and local data If everyone put their heads together there would be a much more effective package of care. 1. During the last decade in East Ayrshire both alcohol and drug mortality and morbidity have been rising. 2. East Ayrshire has considerably greater morbidity than its comparator authorities. We have the fifth highest drugs prevalence in Scotland and the third highest rate in Scotland for acute hospital discharge rates with acute alcohol intoxication. 3. The impact of alcohol and drug use in East Ayrshire is considerable. Children in particular are affected by others use including during pregnancy, as a consequence of domestic abuse, and wider societal crime linked to alcohol and drugs. 4. Significant numbers of vulnerable adults are experiencing harm related to drugs and alcohol. 5. Positive work is taking place to protect vulnerable children and adults from the impact of alcohol and drugs, but we know we need to strive for continual improvement. 6. Extensive educational and prevention opportunities are available across the authority but they are currently under-utilised. In order to tackle alcohol and drug dependence, our partnership depends upon the involvement of individuals, their families/carers and communities. Our approach builds on existing strengths within communities and people themselves to achieve a positive outcome. Engaging individuals directly affected by alcohol and drug use embeds individual recovery and treatment into service activity which, in turn, helps communities to recover from the devastating and damaging effects of alcohol and drugs. We do this by: - providing a range of choices through specialist alcohol and drug services and other community based opportunities; - providing hope and supporting the aspirations of those commencing or continuing on their recovery journey; - putting service users, their families, carers and their communities at the centre of all we do, using their knowledge and experience to influence our approach; - developing a skilled and competent workforce who are care coordinators and facilitators for individuals, families and communities; - celebrating and supporting people who have moved on from problematic alcohol and drug use; - providing support to those at the start of their recovery journey; - establishing a network of community and strategic recovery champions who are visible across the whole system within all organisations, and in each locality within East Ayrshire; - working with the whole population to reduce average consumption of alcohol; - using educational opportunities for young people and adults to help them recognise the impact of their own alcohol and drug use on their families and communities; - working to reduce the stigma experienced by individuals with problem alcohol and drug use and their families; and - supporting a range of law enforcement interventions to enhance community safety and wellbeing. The links between alcohol and drug use and offending behaviour are well recognised. We work in partnership with Criminal Justice Social Work Services and the South West Scotland Community Justice Authority to address factors that contribute to a chaotic lifestyle and to challenge offending behaviour. A focus on recovery can positively reduce re-offending behaviour. East Ayrshire alcohol and drug partnership Alcohol and drug strategy

10 Background and strategic context 10 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

11 Reports commissioned by the Scottish Government consolidate the view that a radical new approach is necessary to address the needs of people affected by alcohol and drug problems. This new approach must do more than simply offer a stabilising influence and reduce alcohol and drug-related harms. It should actually enable individuals to recover from their addiction, rebuild their lives and play an active role within their family, local community and wider society. The Scottish Government Delivery Reform Group s report on the future of local partnership arrangements 1 included recommendations to improve the existing alcohol, drug delivery and accountability arrangements, to ensure better outcomes. Central to delivery and accountability was the formation of local Alcohol and Drug Partnerships which are now embedded within local planning structures via community planning partnerships. Alcohol and Drugs Partnerships are challenged to oversee the delivery of the two key national strategies: 1. The Road to recovery: A New Approach to Tackling Scotland s Drug Problem (2008) and; 2. Changing Scotland s Relationship with Alcohol: A Framework for Action (2009) These strategies stress the need to ensure that local delivery of alcohol and drugs services are effective, efficient, accountable and able to contribute to national and local outcomes. During 2010, an East Ayrshire Needs Assessment for alcohol and drug services for adults in East Ayrshire was led by the Assistant Director of Public Health from NHS Ayrshire and Arran. This identified rising trends in both alcohol and drug use in East Ayrshire over the past ten years. The Needs Assessment also concluded that a wide range of services is provided but that information on their effectiveness is limited. It also noted that commissioning and planning had been based on a functional model of treatment and care which was being reviewed to incorporate a recovery focussed model of care. This strategy sets out how the East Ayrshire Alcohol and Drug Partnership will deliver the two key national strategies for drugs and alcohol, using the 2010 needs assessment intelligence, for the benefit of people and communities within East Ayrshire. This strategy, spanning the years , builds upon the Community Planning Alcohol and Drugs Pledge and the previous Alcohol and Drug Action Team strategic plan. This Alcohol and Drug Strategy forms part of the overall East Ayrshire Community Plan. The action plan delivers local outcome 2 of the Improving Health and Wellbg Action Plan aimed at reducing alcohol and drug related harm and local outcomes 1 and 2 of the Improving Community Safety Action Plan which tackles crime and antisocial behaviour and the fear of crime and antisocial behaviour using preventative and diversionary activity. We recognise that those who use alcohol and drugs, those in recovery, and their wider communities have significant strengths and assets. Through the implementation of this strategy the Alcohol and Drugs Partnership seeks to build on these strengths and assets to improve the lives of everyone in the community. Building on these strengths and assets requires a considerable shift in emphasis for partners in East Ayrshire. We are adopting a cultural change within treatment services, increasing service providers aspirations to encourage our service users to move towards an alcohol/drug free life as active and contributing members of society. We are investing in and supporting educational and preventative initiatives which seek to break the cycle of continual alcohol and drug related problems in our communities. Unlike previous strategies, there is no assumption that having more people in treatment or even having people in treatment for longer are positive outcomes. Ultimately, the question is how many of those who seek help receive meaningful choices in a timely way? Do they receive recovery-oriented care that helps them to achieve their goals of psychological recovery (wellbeing, quality of life, coping, self-esteem and self-efficacy) and social functioning (including relationships, family engagement, training and employment and domestic arrangements)? Our Recovery Oriented System of Care requires our partnership to demonstrate a range of recovery based outcomes focussing on the assets within an individual s life, rather than on the problems which being engaged in treatment sought to minimise. 1 Scottish Government (2009) - A New Framework for Local Partnerships on Alcohol and Drugs East Ayrshire alcohol and drug partnership Alcohol and drug strategy

12 Our strategy supports the national aim of preventing drug use, encouraging the responsible use of alcohol and preventing future problem alcohol or drug use through early intervention. The Road to Recovery (2008) recognised that everyone should be aware of the consequences of drugs so that no one in Scotland uses drugs in ignorance. Changing Scotland s Relationship with Alcohol: A Framework for Action (2009) supports a shift away from a marginal approach, targeting only those drinking to harmful levels, to focusing on the wider population to reduce average consumption levels. The publication of The Road to Recovery in May 2008 and Changing Scotland s Relationship with Alcohol: A Framework for Action in March 2009 both signalled the need to ensure that local delivery of alcohol and drugs services were effective, efficient, accountable and able to contribute to national and local outcomes. Using this philosophy, our partnership developed specific outcomes which reflect our aims and will result in the commissioning of new services and projects. It will also review Service Level Agreements with existing providers. The strategy for : - describes our proactive approach to addressing the range of alcohol and drug issues in East Ayrshire, in order to reduce harm and promote recovery; - describes how we engage with people whose lives are affected by alcohol or drugs (including children affected by others alcohol/drug misuse) and use their experiences to inform our practice; - demonstrates how we work with our partners to offer well designed services to achieve our vision of a recovery oriented system of care; - demonstrates how we deliver services in an open, transparent and cost effective manner; - describes how an outcome focussed approach delivers sustainable and demonstrable change and recovery; - demonstrates how we use an upstream approach, using prevention and early intervention activities to help stem the continued increase in alcohol and drug related issues within East Ayrshire; and - supports law enforcement measures to ensure minimisation of the impact on the wider community of alcohol and drug misuse. 12 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

13 Community planning outcomes East Ayrshire alcohol and drug partnership Alcohol and drug strategy

14 Community planning incorporates a range of partners in the public and voluntary sectors working together with commerce and our local communities to better plan, resource and deliver quality services to meet the needs of people who live and work in East Ayrshire. Our aim is to make a positive impact. Figure 1 illustrates how East Ayrshire Alcohol and Drug Partnership contributes to this process FIGURE 1 Community Safety Partnership Community Planning Partnership Board Ú Life Long Learning Community Regeneration Community Health Partnership Ú Child Protection Committee Alcohol and Drug Partnership South West Scotland Community Justice Authority Adult Protection Committee Violence against Women Partnership This structure is overseen via well established East Ayrshire governance and accountability arrangements. Each partner agency ensures, through a cycle of community planning reviews, that the Alcohol and Drug Partnership Strategy tracks progress of key work stream planning set to improve outcomes for all of East Ayrshire s citizens. The planning arrangements set out the key local priorities over the next four years in accordance with the Scottish Government Concordat Single Outcome Agreement commitments and national outcome indicators; they also take account of the Child and Adult Protection Committee Business Plans, the Children and Young People s Services Plan priorities and the four year planning cycle. Our partnership has been guided by five high level national outcomes as well as local outcome 2 of the Improving Health and Wellbeing Action Plan and local outcomes 1 and 2 of the Improving Community Safety Action Plan. National outcomes Ú KEY: Direct reporting Strategic linkages 1. We live longer, healthier lives. 2. We have improved the life chances of children, young people and families at risk. 3. We live our lives safe from crime, disorder and danger. 4. We have tackled the significant inequalities in Scottish society. 5. We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others. The Scottish Government has also developed seven core outcomes specifically for delivery by Alcohol and Drug Partnerships throughout the country. These seven outcomes are detailed in the table on page???. 14 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

15 Local outcome 2: Alcohol and drug related harm reduced The vision and high level outcomes will be achieved and measured through the action plan with its five key work streams supported by a range of intermediate and service delivery outcomes. The key to successfully achieving these is an effective partnership approach with strategic links across the community planning structure. This partnership approach includes statutory services, independent sector agencies, service users, their families /carers and communities. Central to the overall vision in the delivery of the strategy and the design of recovery services is the involvement of former and current service users and members of the wider community. Legislative and policy drivers A range of legal frameworks have influenced the shape of this strategy and action plan. These include: The Misuse of Drugs Act 1971 The Children (Scotland) Act 1995 Human Rights Act 1998 Adults with Incapacity (Scotland) Act 2000 The Regulation of Care Act (Scotland) 2001 Mental Health (Care and Treatment) (Scotland) Act 2003 Licensing (Scotland) Act 2005 Adult Support and Protection (Scotland) Act 2007 Criminal Justice and Licensing (Scotland) Act 2010 This legal framework is supported by national guidance and service specific reports including: Changing Scotland s Relationship with Alcohol: A Framework for Action (Scottish Government 2009) The Road to Recovery (Scottish Government 2008) Getting Our Priorities Right: Good Practice Guidance for working with Children and Families affected by Alcohol/drug Misuse (Scottish Executive 2003) Hidden Harm (ACMD 2003) Hidden Harm (Scottish Executive 2004, 2006 Rights, Relationships and Recovery: The Report of the National Review of Mental Health Nursing in Scotland (Scottish Executive 2006) Getting it Right for Every Child (Scottish Government 2007) Ayrshire and Arran Health and Homelessness Action Plan National Outcomes and Standards for Social Work Services in the Criminal Justice System (Scottish Government (2010)) East Ayrshire Community Plan, Improving Community Safety Action Plan A Needs Assessment for Alcohol and Drug Services for Adults in East Ayrshire East Ayrshire alcohol and drug partnership Alcohol and drug strategy

16 Identifying the challenge what do we know? While the link between deprivation, poverty and problematic drug and alcohol use is complex, we know that problems associated with drugs and alcohol are more apparent and acute in communities where there are high levels of deprivation and poverty. The Scottish Index of Multiple Deprivation (SIMD) presents a picture of multiple deprivation across Scotland: in SIMD 2009, 11 (3.4%) of the 325 zones in the 5% most deprived zones in Scotland were found in East Ayrshire; East Ayrshire has a significantly higher than average proportion of the population who are considered to be income deprived; and East Ayrshire has seen an increase in the percentage of their data zones in the 15% most health deprived since 2006; Also: life expectancy in East Ayrshire is lower than the Scottish average for both males and females; and East Ayrshire has a higher than average percentage of the population claiming job seekers allowance and a higher than average percentage of lone parents claiming income support. National research conducted by the ISD2 revealed that Scotland had an estimated 59,600 individuals misusing opiates and/or benzodiazepines in the year 2009/10. This corresponds to 1.71% of the population aged between 15 and 64. The prevalence in East Ayrshire is estimated at 2200 problematic drug users or 3.11% of the population aged between 15 and 64. East Ayrshire has the third highest prevalence rate of the 32 local authority areas in Scotland. Drugs related deaths in East Ayrshire have risen from six in 1999 to twelve in 2009 mirroring the rise in drug related deaths nationally. While alcohol related deaths (underlying cause) in Scotland have dropped by 15% between 2005 and 2009 the data shows that this is not a consistent trend. East Ayrshire data shows a similar pattern with alcohol related deaths in females dropping from 14 in 2006 to 12 in 2007 before rising again to 14 in The 9 alcohol related deaths in females in East Ayrshire in 2009 represent the lowest death rate since Alcohol related deaths in males in East Ayrshire show a similar trend with 20 alcohol related deaths in 2006, 27 alcohol related deaths in 2007, 16 in 2008 and 22 in Using the European Age Standardised Rate per 100,000 population data, alcohol related death rates in males in East Ayrshire were nearly three times higher than alcohol related death rates in females in 2009 (32.8 deaths per 100,000 population in males, 12.1 deaths per 100,000 population in females). 3 Drinking and drug use in children and young people presents a challenge across all populations. 13% (61) of 500 young people recently surveyed in East Ayrshire admitting to having used drugs. More significant however was that 60% (278) of young people do not know where to go if they need help concerning drugs. While drug use in East Ayrshire remains an issue, the survey of young people revealed that many more are using alcohol on a regular basis with 27% (86) drinking at least once a week. Of the young people who drink alcohol, a significant number do so with friends, (48% or 224). As with drugs, 39% (179) young people have no idea where to go if they need help concerning alcohol. 4 The Hidden Harm report highlights the plight of children, whose voices, too often, go unheard. It is estimated that there may be as many as 69,000 children in Scotland affected by parental drug use. This equates to 6% of under 16s. In East Ayrshire, this means that as many as 1800 children may be living in households where problematic drug use is an issue. 3 Information Services Division NHS (2011) Alcohol Statistics Scotland East Ayrshire Council and NHS Ayrshire and Arran (2009) - smoking, drinking and drug use among young people in East Ayrshire 16 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

17 In East Ayrshire the issue of children being affected by parental drug use is further compounded by an increasing number of female drug users becoming pregnant. East Ayrshire reported 101 maternities involving drug misuse in the period 2006/7-2008/9, a rate of 25.7 maternities per 100,000 population. This is almost three times the Scottish average of 9.8 maternities per 100,000 population leaving East Ayrshire with the second highest level of drug misuse maternities in Scotland. 5 In the financial year 2009/10 there were 39,408 drug-related offences (mainly Misuse of Drugs Act 1971) recorded by Scottish police forces, which is a rate of 759 per 100,000 population. 74% per cent of drugrelated offences were for possession with a further 23% for possession with intent to supply. During this time, Strathclyde Police recorded 849 drug-related offences in East Ayrshire with 592 (70%) being for possession and 224 (30%) being for possession with intent to supply. These 849 drug-related offences represent a rate of 706 offences per 100,000 population. This statistic places East Ayrshire below the national average in terms of drug related offences. The link between alcohol, drugs, crime, disorder and danger is more complex than just specific drug-related offences. For example, we know that of the 178 people accused of homicide in Scotland in 2007/08, only 13% (19) were not reported to have been under the influence of alcohol or drugs. We also know that 49% of the prison population reported being drunk at the time of their offence. Within East Ayrshire, crimes of domestic abuse continue to rise incidents of domestic abuse were recorded by police during Research 6 has indicated that at least 62% of domestic abuse cases are related to alcohol. This could mean that at least 789 domestic abuse incidents in East Ayrshire were alcohol related. Data from the East Ayrshire Adult Protection Committee suggests that there are other vulnerable sections of the community being harmed or at risk of harm from the problematic use of alcohol by either themselves or others. The Adult Protection Committee reports that of the 134 adult support and protection referrals received in 2010, alcohol use was a factor in 40% of cases with more females (57%) than males (43%) affected. 5 Information Services Division (2010) Drug Misuse Statistics Scotland Gilchrist, E., Johnson, R., Takriti, R. Weston, S., Beech, A. & Kebbell, M. (2003) DV offenders: characteristics and offending related needs, Findings 217, London: Home Office. East Ayrshire alcohol and drug partnership Alcohol and drug strategy

18 Delivering the strategy 18 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

19 Our strategy to reduce alcohol and drug-related harm will ensure progress and achievement is delivered in a robust and measureable way. We will ensure that partners, stakeholders, service users, their families, carers and the wider community are clear about what difference the strategy will make. Delivering this strategy must not be seen in isolation as it will impact on all aspects of East Ayrshire s Community Plan, reflecting the all-encompassing nature of drug and alcohol related problems. Our partnership is working to develop and implement an outcome-based reporting framework. In order to ensure the best possible level of service for citizens of East Ayrshire this will identify service delivery outcomes which link strategically to both national and local planning structures. Delivering community regeneration Work stream 2.3: Community focussed prevention - positive attitude and positive choices. Celebrating success We must celebrate recovery successes and work with individuals so they become our community partners. If we accept that recovery is not just about treatment then we also need to accept that the key resources in promoting recovery are the natural peer leaders in families and communities. This means that what counts as treatment becomes more blurred. Each individual success is a potential recovery icon in their local community and our support for them is key to helping recovery to spread. Developing recovery champions Our partnership is establishing a network of community therapeutic and strategic recovery champions who are visible across the whole system within all organisations and in each locality of East Ayrshire. These individuals are key to the successful integration of service users within community based support structures (eg mutual aid groups), existing health and social care providers and independent sector organisations. Work stream 2.4: Prevention and early intervention - supporting families and communities. Many people are currently affected by their own or others alcohol or drug use within our local communities. We recognise the benefits of early intervention for individuals, their families/carers and communities. We continue to deliver Alcohol Brief Interventions, an evidence based way of reducing consumption to those drinking at hazardous levels. We recognise the importance of providing support to children, families and carers affected by others alcohol and/ or drug use in order to reduce the negative impact of this behaviour as early as possible. Current activity: Early years practitioners in East Ayrshire have adopted the Solihull Approach in order to better support parents in a creative and consistent way. Development of this shared approach and language has been effective in a multitude of settings from individual practice through to group settings. Sustaining recovery journeys The recovery journey is owned by the service users, their families and their communities. The crucial factors in promoting sustained recovery are stability in housing, relationships and activities (the latter being primarily, but not exclusively, through employment). We recognise the need to move from an expert model of treatment to a partnership model in which the user owns their recovery journey and is the judge of progress. To make this fundamental shift, it is imperative that the recovery outcomes are not developed or owned by the service. In order to sustain the recovery journey, the outcomes achieved along the journey are established and owned by the service user. Communities A change in the current culture is required if the impact of alcohol and drug harm in East Ayrshire is to be reduced in future years. We need to work with communities, challenge their attitudes in relation to their own alcohol consumption and increase knowledge across all age groups to enable individuals to make informed choices about their personal alcohol and drug use. Currently many people within East Ayrshire are drinking alcohol at a hazardous levels without being fully aware of the risks associated with this behaviour. We must identify these individuals through either statutory or community services and provide them with appropriate information and support to make a behavioural change. East Ayrshire alcohol and drug partnership Alcohol and drug strategy

20 Current activity: East Ayrshire s Community Health Improvement Partnership (CHIP) team provide a range of opportunities through the CHIP van, the activity on prescription initiative and Alcohol Awareness Week. These aim to help individuals to address their drinking habits and at the same time make small improvements to their overall lifestyle. Improving community safety Work stream 2.6: Protection - reducing consumption and law enforcement. The World Health Organisation's European Charter on Alcohol proposes that each Member State should: Promote health by controlling the availability, for example for young people, and influencing the price of alcoholic beverages, for instance by taxation 7. Since the UK is a signatory to this charter, East Ayrshire Alcohol and Drug Partnership will continue to develop and support initiatives that seek to reduce young people s access to alcohol in partnership with Strathclyde Police. The WHO charter is not just about young people. Research 8 illustrates that price is a key determinant in alcohol consumption, and with alcohol now being cheaper than water, we support the Scottish Government s proposals to re-introduce minimum pricing legislation. Our partnership will continue to work with East Ayrshire Council s liquor licensing forum to examine ways of promoting the protecting public health objective contained within the Licensing (Scotland) Act Current activity: The Occupational Therapy service within NHS Addiction Services currently provide one to one or group interventions to service users, for people aged 50 years and over living in East Ayrshire, who have conditions due to problematic alcohol use which have a significant impact on their ability to function safely and /or independently and which have resulted in individuals experiencing falls. The programme focuses on motivating and supporting service users to move toward recovery by improving health and social functioning in partnership with other addictions services. The Improving Community Safety theme of the Community Plan outlines a range of actions to tackle alcohol and drug related crime. These include regular reporting to the East Ayrshire Licensing Board with respect to premises which give cause for concern, intelligence led youth alcohol action plans implemented during key times such as school holidays and the development of community intelligence to identify those concerned in the supply of controlled drugs. Current activity: Proactive joint work by Strathclyde Police domestic abuse unit and Women s Aid is ensuring that women affected by alcohol related domestic abuse are being provided with high quality support and protection. NHS Ayrshire & Arran is committed to tacking gender-based violence, including domestic abuse. A new patient information leaflet on domestic abuse was produced in March 2011, highlighting support services, and distributed through the NHS and appropriate partners. NHS Ayrshire & Arran has run a three year programme of training to enable staff in six key areas to implement routine enquiries on domestic abuse. In addition, we continue to work with Strathclyde Police to reduce the supply and demand for drugs controlled via the Misuse of Drugs Act Current activity: The Criminal Justice and Licensing (Scotland) Act 2010 introduced the Community Payback Order (CPO) for offences committed on or after 1st February A Community Payback Order (CPO) with a condition of drug treatment provides courts with an alternative to a custodial sentence or a Drug Treatment and Testing Order, where an individual has not established a chronic history of drug misuse. It puts the needs of the individual at the centre of their care and treatment. A CPO with a condition of Alcohol Treatment is imposed where the Court is satisfied that the dependency on alcohol requires support and may benefit from treatment, and that arrangements can be made for the treatment to take place. 7 World Health Organisation 1995 European Charter on Alcohol 8 University of Sheffield Independent Review Of The Effects Of Alcohol Pricing And Promotion 20 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

21 Current activity: Strathclyde Fire and Rescue is working with a range of Community Planning Partners in particular NHS Addiction Services, to provide Home Fire Safety Visits to vulnerable members of the community who may be at risk of fire in their home as a result of alcohol or drug misuse. Initiatives include working with families to create bespoke fire action plans for their home, fitting smoke alarms where appropriate and fitting specialist detectors for hearing impaired and profoundly deaf people. Improving health and wellbeing Current activity: Barnardo s AXIS East Ayrshire works in partnership with various organisations to deliver early alcohol intervention sessions to primary and secondary pupils throughout East Ayrshire. Interactive tools and resources are used to illustrate the negative impact that alcohol can have. This includes both the short and long term health and social effects that alcohol can have on a young person s life. These interactive sessions set in an informal environment provide young people with information and advice which allow them to ask questions and assist them to make informed choices. Work stream 2.5: Treatment and recovery promoting recovery As partners and service providers in East Ayrshire we know that we need a shift in emphasis toward recovery. This means a move from a primary focus on the drug problem itself towards a model based on improving an individual s quality of life through the development of recovery supportive communities and services. The Road to Recovery states central to the strategy is a new approach to tackling problem drug use based firmly on the concept of recovery. The report goes on to assert that the explicit purpose of all treatment services is recovery, which in turn is characterised as an aspirational person-centred process. The Road to Recovery makes clear that recovery should be the explicit aim of all services and that what we now regard as treatment must integrate with a wide range of local services including the development of Recovery Networks. This includes a commitment to build and strengthen advocacy services. Our new strategy demands a fundamental culture change, making the recovery journey a process through which an individual is enabled to move on from their problem drug use towards a drug-free life as an active and contributing member of society. In practice, this means it is crucial for professionals to empower and engage with service users rather than attempt to find cures to their problems. In order to empower and engage, we must recognise that one worker alone will lack the resources and expertise required. Everyone involved in the partnership must work together around the individual. Current activity: SMART Recovery peer led meetings are now prevalent throughout East Ayrshire. A group of these service users recently succeeded in obtaining a grant from The National Lottery Awards for All Programme. By obtaining a plot of land via Kilmarnock College, these service users have now established an allotment growing fruit and vegetables for use by their families, friends, carers and the wider community. Formal treatment is only one component of recovery from problematic alcohol and drug use and one which may not be required by all individuals who have problems. Such treatment should rarely be the first resort for individuals experiencing alcohol and drug problems. The recovery model suggests that the initial task is to look at community resources as the fundamental building blocks in generating recovery. Methadone and harm reduction During the 1980s drug treatment services were delivering a largely drug-free approach with minimal medical support. The arrival of HIV in Scotland changed this. The McClelland report of 1986 advocated urgent reappraisal of services, establishing pilot needle exchanges and methadone substitute prescribing clinics as a matter of urgency - introducing strong support for "harm reduction" approaches which were formally accepted as the basis of treatment strategies in Scotland from East Ayrshire alcohol and drug partnership Alcohol and drug strategy

22 In the 1990s, as methadone prescribing expanded, its benefits in the Criminal Justice arena were recognised and Criminal Justice services incorporating methadone programmes were developed. In the 2000s, concern had returned to blood borne virus infection with clear associations between Hepatitis C and injecting drug use maintaining pressure to increase availability of methadone prescribing to reduce drugrelated harm. 9 In April 2010 due to inaccurate reporting and misrepresentation in the media of the use of methadone, 40 world -wide experts in the treatment of opiate-dependent people published key messages and information on the effectiveness of methadone. Some sections of the media repeatedly report a view of methadone treatment which is fundamentally contrary to the extensive documented worldwide clinical and research experience of many decades. The purpose of substitute medication (and methadone in particular) treatment for opiate dependency is widely misunderstood in some quarters. People with serious addictions are at great risk of death from overdose and infection. Methadone helps reduce deaths, reduce crime, stabilise lifestyles and improve social functioning. Our treatment and the use of substitute medication are supported by a programme of accompanying psychological and social support and must be continuous. Some people will need long-term and even lifelong treatment as part of their overall recovery. Most individuals who benefit from methadone treatment can live otherwise normal lives. Research shows that methadone treatment substantially reduces deaths, crime, HIV infection and drug use while assisting social functioning with improved education, training, parenting and employment. Methadone treatment has been endorsed by three UN agencies. The World Health Organisation (WHO) has also included methadone treatment in its essential medicines list. Seventy countries now provide methadone or buprenorphine treatment to an estimated one million individuals. It remains an important treatment option for some individuals and its use is fully in line with Scottish Government policy on drug treatment and recovery. The role of maintenance in recovery Within a recovery system prescribing is given considerably lower status and prominence it is seen as a necessary process in the management of medical symptoms that are likely to persist over long periods of time. It should not be regarded as the cure but as a preliminary step in recovery. For many the relapsing nature of their condition means they will have a long and complex recovery process involving multiple episodes and multiple components of treatment. Even within the recovery model there is a recognition that there will be a minority of clients for whom sustained abstinent recovery is not possible, and who will require indefinite maintenance prescriptions (of methadone, buprenorphine, or other substitutes). The aim of a recovery model is to minimise the number of people for whom long-term abstinence is not a viable option and, for this group, to generate meaningful pathways to maintained recovery. The delivery of structured interventions for long term maintenance populations will still have the same basic principles of improving global health. It will support sobriety and improve clients participation in community activities and family life, and, where possible, other aspects of citizenship such as training and employment with the aim of moving towards active participation in community life. Fundamentally the recovery agenda is about hope. It is about giving communities ownership of their own problems and recognising that our role is to be facilitators and coordinators of recovery journeys. However, without working actively with communities to build better environments, restore expectations of employment, promote the benefits of education, and the value of living healthy and active lives, these recovery journeys will be unlikely to succeed. 9 SACDM (2007) - Reducing harm and promoting recovery: a report on methadone treatment for substance misuse in Scotland 22 East Ayrshire alcohol and drug partnership Alcohol and drug strategy

23 Recovery in practice In the past, services in East Ayrshire were delivered in line with the acute care model of service provision, constructed upon a three tiered system of treatment provision (phased model of treatment and rehabilitation). This model sought to describe service user journeys in and through services. Recognising that recovery requires more than just specialist addiction service support, we have adopted a Recovery Oriented System of Care model (ROSC) (appendix 2) At the heart of this model is our belief that: recovery is possible and is central to all services we provide; people will own their own recovery and service staff will facilitate that recovery journey; people in recovery will support others along the path to recovery; and communities will support their members through recovery. The ROSC helps people take charge of their own recovery and is well suited to the asset-based community development approach. ROSC relies upon the input of peers and support within communities. The experiences of those in recovery and their family members contributes to the ongoing process of improving services. (A Recovery Orientated System of Care for Ayrshire & Arran, February 2010). Promoting lifelong learning Work stream 2.1: Recognise and build on the skills off all stakeholders within the Alcohol and Drugs Partnership. Development of a workforce capable of delivering the key actions is crucial to delivering this alcohol and drug strategy. This covers the spectrum from prevention through to embedding the recovery philosophy. Our partnership will work to deliver the Scottish Government and CoSLA s Supporting the Development of Scotland s Alcohol and Drug Workforce launched in December This sets out the actions required to deliver the alcohol and drug workforce requirements and outlines the roles of those directly involved in workforce development. We will identify the workforce development needs in line with this strategy and work with our partners to provide appropriate training Work stream 2.2: Education - preventing alcohol and drug use in young people. As well as supporting those experiencing alcohol and drug problems, East Ayrshire Alcohol and Drug Partnership is committed to supporting and developing initiatives which will reduce the impact of alcohol and drug use in future years. Changing Scotland s Relationship with Alcohol and The Road to Recovery both emphasise the importance of drug and alcohol education which provides opportunities to pass on facts, explore attitudes and, crucially, foster the skills necessary to make positive decisions and lifestyle choices. Schools have a role to play in educating young people about drugs and alcohol, however they cannot do it alone. Preventing alcohol and drug use cannot lie solely with schools. There is a role for parents, youth workers and other young people in addressing the nature and range of complex issues that lead young people into drugs and alcohol. Current activity: The prevention and service support team within NHS addiction services and East Ayrshire Council have devised and developed a comprehensive, evidence based, education programme for schools (SPICE). This resource links to the Curriculum for Excellence and has been recognised as good practice by the Scottish Government and Learning Teaching Scotland. East Ayrshire alcohol and drug partnership Alcohol and drug strategy

24 We recognise that education alone will not prevent or reduce the impact of alcohol and drug use. We view the provision of a range of sports and leisure activities as central to the prevention agenda for children and young people, helping them to develop personally. These opportunities increase both participation and diversion and improve the likelihood of positive long-term outcomes. Current Activity: Match Fit and Dance Fit programmes delivered by a partnership of East Ayrshire Council active schools, Kilmarnock Football Club and Y Dance all provide opportunities for vulnerable young people to engage in fun activities while learning about body physiology, healthy eating and the impact of alcohol and drugs. These programmes encourage participants to engage with their parents, relatives and carers, and seek out community opportunities and facilities to continue their football training and dancing once the formal programme ends. Resources Audit Scotland published a report on Drug and alcohol services in Scotland in March This identified for the first time how much the public sector spends on drug and alcohol services in Scotland. It assessed whether evidence of need or what works determined how this money is spent and what impact the money has had. The report found that: Scotland has high levels of drug and alcohol misuse compared to the rest of the UK and Europe; 173 million was spent on drug and alcohol services by the public sector in Scotland spent in 2007/08 ( the wider costs to society are estimated at 5 billion a year); and Spending decisions are not always based on evidence of what works or what is needed. An analysis of health and social care expenditure in Ayrshire for the same period recorded a direct spend of over 6 million per year on alcohol and drug services from these sectors alone. During 2011/12 we are undertaking further analysis to detail spend and impact across all sectors. While resources relating to alcohol and drug interventions have been directed mainly through health authorities, the establishment of Alcohol and Drug Partnerships has encouraged a partnership approach to targeting resources to meet local need as identified and agreed by all members of the partnership. During 2011/12, in East Ayrshire 1.4 million has been committed by the partnership to support continued treatment programmes and commissioned services. In recognition of the shift in focus of service delivery to encompass a recovery model, we have allocated a change fund of 160,000 to support activities which facilitate and evidence this move. This will inform a Commissioning Strategy 2012/ East Ayrshire alcohol and drug partnership Alcohol and drug strategy