Impact of drugs and alcohol on individuals and the community

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1 Impact of drugs and alcohol on individuals and the community

2 Introduction and overview Lynn Wilson Consultant in Public Health

3 Overview and purpose Alcohol: The Problem Alcohol and Drug Service Review Life share a service user perspective Alcohol emerging strategic issues Alcohol - emerging issues across the life-course What are the strategic issues we should be focussing on? What should we be doing differently?

4 Alcohol: The Problem Kirsty Wilkinson Alcohol Harm Reduction Coordinator

5 Alcohol what s the problem? Top 5 risk factor for disease, disability and death (WHO, 2014) Harmful use of alcohol is the leading risk factor for death in males aged years Causal factor in over 200 disease and injury conditions (WHO, 2014) Not only volume but pattern of drinking affects risk The more you drink and the more often you drink the more your risk of harm increases Fuels inequalities people who live in deprived areas have poorer outcomes

6 Alcohol what s the problem? Toxic effect on organs and tissues: Liver disease Cancers liver, oral, breast, oesophageal, gastric, colon Heart disease and hypertension Stroke Intoxication, leading to impairment of physical coordination, consciousness, cognition, perception, affect or behaviour Dependence

7 Alcohol profile County Durham

8 Alcohol consumption Consumption within the home is 38% higher than it was 20 years ago (Alcohol Statistics 2013) Alcohol is 61% more affordable now than it was in back in 1980 (Alcohol Statistics 2013) 32% of people in County Durham are estimated to binge drink (LAPE 2012)

9 Perceptions Survey Men and older adults (55 years+) are more likely to drink 6+ times a week Men and younger people (18-34 years) are more likely to be increasing or high risk drinkers Increasing/high risk drinkers tend to perceive their drinking as moderate People who are increasing/high risk drinkers are more likely to be concerned about how much alcohol they drink

10 Indicator County Durham North East England Rank Direction of travel Alcohol specific mortality rates male 16.8 per 100, per 100, Alcohol specific mortality rates female 9.3 per 100, per 100, Alcohol specific hospital admissions male Per 100, Per 100, Alcohol specific hospital admissions female Per 100, Per 100, Alcohol specific hospital admissions under-18s 81.5 Per 100, Per 100, Admission episodes for alcohol related conditions (broad) 2478 per 100, per 100, Alcohol related hospital admission (narrow) 794 per 100, per 100, New indicator

11 Alcohol and Drug Service Review Mark Harrison

12 Introduction 1 Drug and Alcohol Review 2 Impact of Drugs and Alcohol on Families and Communities 3 Current Issues 4 Recovery Orientated Pathway 5 Next steps

13 AIM To commission an integrated service model which is evidence based, efficient, cost effective and delivers on key outcomes. The new service will be in place by 1 st January 2015 Objectives To improve outcomes for service users and their families To ensure community recovery from dependency To make efficiencies from the current system to ensure there is best value for money.

14 Why are we doing this? To make the client journey through treatment services more successful identifying key pathways with other services and strengthening these to ensure better outcomes for service users. To remove duplication The need to ensure an appropriate focus on prevention and early intervention The current significant investment into separate drug and alcohol treatment services is inefficient The removal of ring fenced budgets and the need to revisit the most appropriate ways of utilising this proportion of the Public Health grant.

15 National Guidance National Drug Strategy 2010 National Alcohol Strategy 2012 NICE Guidance (see current system to match against services) Public Health Outcomes Framework Local Guidance Safe Durham Partnership Plan Police and Crime Commissioner plan County Durham Alcohol Harm Reduction Strategy County Durham Drug Strategy County Durham and Darlington Dual Diagnosis Strategy Safe Durham Partnership Reducing Offending Strategy

16 4 Links to Health and Wellbeing Strategy Strategic objective 1 Children and Young People Make Healthy Choices and Have the Best Start in Life Strategic objective 2: Reduce health inequalities and early deaths Strategic objective 4: Improve mental health and wellbeing of the population Strategic objective 5: Protect vulnerable people from harm

17 Impact on Families and Communities

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24 Current Issues The following issues have been identified from the annual health needs assessment and consultation with stakeholders including service users and carers.

25 Current Issues 1 Referral and Access Low referrals to drug and alcohol services from external services such as children s services, mental health, Employment and housing. Low referrals from hospital settings to drugs service. Low referrals from criminal justice to alcohol service. Low referrals between Drugs Service and alcohol service Geographical spread of County Durham - mix of rural and urban areas 556 estimated opiate users not known to treatment No accurate estimate of dependant drinking population Repeat assessments for clients with drug and alcohol services Repeat assessments external agencies High DNA rates for initial assessment Treatment High representations to community alcohol service. High DNA rates for psychosocial interventions for drugs service. 27% opiates in treatment 6 years + Small number of successful completions from community drugs service 57% opiates are still injecting at 6 month review after starting treatment and low levels of BBV vaccination and testing. Large number of providers working across drug and alcohol services. Some providers are working within both services Low numbers of Non Opiates accessing and successfully completing treatment compared to other areas.

26 Current Issues 2 Recovery and Exit Low levels of facilitated access to mutual aid groups for both service users and families Low numbers of referrals to Liberty, Btc, Stronger families (national troubled families programme) Low numbers of service users in employment, education, training Low levels of referrals to external agencies, limited involvement as part of recovery plans (recovery plan audit 2013/14) Prescribing High levels of branded medication i.e. subutex is being prescribed in the east of the county We have identified a significant number of people who are on 30ml of methadone or less. Estates CDS and CAS currently have 7 treatment centres, 2 recovery centres and a recovery hub. The services also use a range of community venues.

27 Recovery Pathway

28 Recovery Outcome Domains Recovery is a process which involves achieving or maintaining outcomes in a number of domains, not just overcoming dependence on drugs. People generally are not able to sustain drug outcomes without having gained or maintained recovery capital in other domains such as having positive relationships, having a sense of wellbeing, meaningful occupation of their time, adequate housing, etc. The recovery process necessitates achieving or maintaining outcomes across a number of domains. These domains appear to be interrelated and changes in recovery capital in one domain may impact on other recovery domains. Those with greater capital in a number of domains appear to be more successful in achieving voluntary control over their substance dependence. Granfield and Cloud (2008) define recovery capital as the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from AOD [alcohol and other drug] problems.

29 What is the Evidence?

30 Human Capital (health and wellbeing) Recovery Outcomes There is research evidence, from multiple studies, that those who have had drug dependence generally have a shorter life expectancy than the general population. There is also evidence that dependence on drugs is associated with a range of diseases, infections and ill health. Heroin dependence is particularly associated with high risks of morbidity and mortality. Mortality and morbidity risks may be due to dependence itself as well as the lifestyle risks associated with drug dependence such as poor nutrition, poor levels of hygiene, living in deprivation or poverty and increased exposure to violence. There is a lack of evidence on mortality and morbidity for some substances, including morbidity risks of cocaine and other stimulants, prescription opioids and new and emerging drugs. There is research evidence that there is a genetic element to dependence, with some people likely predisposed to develop dependence on drugs.

31 Social Capital Outcomes There is evidence that those who come from troubled or dysfunctional families are more likely to develop drug dependence than others. There is evidence that families or partners may hinder recovery outcomes (if they are dysfunctional or have dependence issues themselves) or aid recovery outcomes (if they are supportive). There is emerging evidence that supportive local communities can enable recovery outcomes. There is evidence that involvement with mutual aid can significantly improve recovery outcomes, particularly drug and alcohol outcomes, with most research from studies of 12-step fellowships within the USA. Some factors including more active or frequent involvement with mutual aid and becoming a sponsor are associated with greater improvement in drug and alcohol outcomes. There is evidence that active encouragement to engage with mutual aid enables better drug outcomes, although coerced involvement is not beneficial.

32 Physical & Economic Capital Outcomes The relationship between substance dependence and crime is complex. There is research evidence that some types of dependence are associated with higher levels of crime than in the general population (for example acquisitive crime among those who are heroin dependent). There is research evidence that drug treatment significantly reduces substance-driven offending. There is evidence that having a criminal conviction can significantly limit life opportunities and hinder a range of recovery outcomes. There is evidence of greater prevalence of drug dependence among those with housing problems and that stable housing is beneficial to drug recovery outcomes. There is emerging evidence that drug dependence is more common among those living in social deprivation, and that debt is common among those with drug dependence. There is evidence that the rates of employment among people in treatment for drug dependence are lower than average, especially in Britain and that this outcome is more impervious to change than other outcome measures. Those unemployed upon seeking treatment tend to remain unemployed at follow-up and vice versa.

33 Recovery Continuum Model Active Addiction Early In Treatment Stable In Treatment Abstinent Rec. Supp.

34 Component Elements Recovery Team Recovery Academy Prevention Recovery System Recovery Hub

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36 Alcohol: Life Share

37 Availability, Affordability and Advertising C/I Ian Butler Balance North East

38 Alcohol Affordability, Availability Increasing numbers of licensed premises and hours of operating Alcohol is 61% more affordable than in 1980 Is the current strategic approach to licensing fit for purpose in regard to the minimisation of all harms associated with alcohol?

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40 On Sales / Off Sales

41 Health Harms - Liver Disease

42 Alcohol: Emerging issues across the life course Kirsty Wilkinson Alcohol Harm Reduction Coordinator

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44 Alcohol - Prenatal Less likely to use contraception Sexual health/unwanted pregnancy No amount of alcohol is safe to drink in pregnancy 0 for 9 Foetal Alcohol Spectrum Disorder individuals 70% of people with FASD are looked after

45 Alcohol - Prenatal Egg and alcohol video gvideo.html E-dw

46 Parents drinking: Alcohol Pre-school Normalisation of alcohol use Learnt behaviour kids copy that s how they learn Child Protection 32% of all initial child protection conferences in 2013/14 were due to parental alcohol misuse Children of people with alcohol problems are more likely to have problems with alcohol themselves in the future.

47 Alcohol School Less young people in County Durham are regularly drinking alcohol than ever Those who do drink are drinking more Social norms influence time of first drink and frequency of drinking What young people drink is influenced by advertising television, radio, cinema Social media

48 Alcohol Training/Higher Under 25 report getting very drunk more than any other age group Students - generally aware of lower risk drinking guidelines Drinking habits won t last Education Drinking patterns in student years continue to post- University Males victim of violence High rates of STIs

49 Alcohol Employment Being employed is a strong determinant of alcohol use for men and women (Colell et al) White collar drink more frequently Home drinking is unrestricted Somebody else s problem Functioning Workplace health impact of alcohol on attendance and productivity

50 Alcohol Retirement Aging population Living longer but with more illness Greatest age group for alcohol related hospital admissions Not dependent but people who have drunk too much too often Trigger factors: isolation, bereavement, loneliness Health benefits? Moderate drinking is a sign of good health not a cause of it!

51 Workshop

52 Workshop questions? What are the big issues that you think an alcohol strategy in County Durham should be tackling? What would be your top 3 priorities? What do you think should be done to reduce alcohol related health harms think about prevention, early intervention, enforcement, control, treatment, support and recovery. What can your organisation/you do to reduce alcohol related harm?

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