Drugs, alcohol and tobacco use cause harm to an individual’s health and wellbeing.
Smoking causes one in five deaths in people aged over 35. It is the primary cause of preventable illness and premature death. Two thirds of smokers begin before they are 18 (Robinson & Bugler, 2008; General Lifestyle Survey 2008; Office for National Statistics (ONS), 2010).
Problematic drink and drug use among under-18s rarely occurs in isolation and is frequently a symptom of wider problems. It often goes hand in hand with other risk factors, such as offending or truancy (Public Health England (PHE), 2014/15).
The local picture
Results from the 2015 local eHNA (Electronic Health Needs Assessment) schools survey reveal that:
- a third of pupils in Years 7 and 10 have tried alcohol. This figure is slightly lower than in 2014;
- pupils trying e-cigarettes has remained the same whereas the percentage of pupils trying tobacco smoking for the first time has reduced to 10%;
- very few pupils use alcohol or smoke regularly; however of those smoking daily, tobacco is smoked more than e-cigarettes;
- a quarter of pupils live with people who regularly smoked cigarettes;
- the number of pupils trying drugs has fallen slightly since 2014 and now over 90% of pupils have never tried drugs. Of the ones who have tried drugs Cannabis is the most common.
Overall the eHNA indicates that since 2010 regular use of drugs or tobacco is on a downward trend., and in 2015 we have reached an all-time low in young people drinking alcohol regularly.
Prevention and Treatment Needs
In 2014/15, 184 under-18 year olds and 38 18-21 year olds were in treatment services in Calderdale. No young people were waiting more than three weeks from referral to intervention which indicates that young people are not lost as a result of lengthy waiting times and support is given quickly (Calderdale Joint Strategic Needs Assessment (JSNA) Support Pack 2016/17). Figure 1 and 2 detail the numbers of young people involved with specialist services and the referral sources of each.
Figure 1: Specialist treatment service involvement in Calderdale, 2014-15
Figure 2: Specialist treatment service involvement - referral sources in Calderdale, 2014-15
It should be noted that a high proportion of young people accessing services for drug and alcohol use have other vulnerabilities, (Calderdale JSNA Support Pack, 2016/17) - see figure 3.
Figure 3: Number and percentage of young people in specialist treatment services by risk/vulnerability in Calderdale, 2014-45
The majority of young people (up to age 21) entering treatment, seek help with cannabis (85%), followed by alcohol (72%) as primary drug use. Stimulant use accounts for 21% and heroin/crack cocaine 5%. However, the majority of young people use more than one substance regularly and some combine their drug use. The percentage of young people accessing treatment services in Calderdale is far higher than the England percentage, 72% to 52%.
For the period 2008/09 to 10/11, the rate of (such as unintentional alcohol overdose) for young people in Calderdale (55.7 per 100,000 population aged 0 to 17 years) remains significantly higher than the national average and broadly similar to that of the 2007-10 period. Nevertheless, this hospital admission rate for under-18s for alcohol-specific conditions for Calderdale has been reducing from a peak during the period 2006/7 to 2008/9, see Figure 4.
Figure 4: Alcohol specific hospital admission rates for 0-17 year olds in Calderdale
Hospital admissions for substance misuse in 15 to 24 year olds in Calderdale are also consistently significantly higher than the national rate and also one of the highest in the region. The most recent figure for the period 2011/12 to 2013/14 shows an admission rate of 114.6 per 100,000 15 to 24 year olds (Public Health Outcome Framework (PHOF)). While this is a decrease from the previous data release it is too early to say whether this is a trend, see figure 5.
Figure 5: Substance misuse hospital admission rates for 15 -24 year olds in Calderdale
Nationally, the proportion of young people regularly smoking has decreased in recent years. This trend is mirrored in Calderdale (electronic Health Needs Assessment (eHNA), 2015).
Calderdale has a specialist young people’s treatment service for drugs and alcohol. In 2009 the service was reconfigured to include prevention activities as a core part of delivery. This has seen increases in young people accessing services, closer working relationships with schools, and increases in young people stating they have knowledge regarding drugs and alcohol. In 2015 the service was reconfigured again to include tobacco as part of the offer and to extend age appropriate primary prevention activities into primary schools.
This service delivers prevention in schools and community settings and delivers treatment in venues in each locality and the town centre, catering for transitional ages up to 21 years. The role of the specialist service is to prevent drug, alcohol and tobacco use and help users to reduce or abstain. The service delivers universal prevention activities in schools, and treatment for those using drugs, alcohol and tobacco. The aim is to reduce harm caused by these substances and prevent them from becoming a greater problem. The service operates as part of a wider network of universal, targeted and specialist services that support young people with a range of issues and help them to build their resilience. In 2014/15 the service delivered to 1,620 young people prevention activities relating to alcohol and 1,391 young people relating to drugs.
The majority of young people leaving treatment do so in a care-planned way. 80% of young people have ‘planned exits’, a proxy indictor suggesting that young people leave treatment with a successful outcome. This figure is slightly higher than the national average but is a decrease in our local services from 89% in 2012/13 (Calderdale JSNA Support Pack 2016/17).
There have not been any large local consultations with young people in the last two years about drug and alcohol use.
For those young people accessing treatment, their feedback is gathered continually throughout the year via a feedback box in reception areas of the service and questionnaires, however Branching Out - Lifeline (the Specialist Drug, Alcohol and Tobacco Prevention and Treatment Service for Children and Young People in Calderdale) generate most of their feedback via their Facebook page and conduct a yearly ‘feedback week’ where young people anonymously complete a questionnaire. This exercise has found that 66% of young people returned after their first visit because they were ‘keen to get help’, and 56% because of staff friendliness and 86% felt the service had really helped them (Lifeline Local Data).
Findings from the local eHNA school survey indicate that children and young people want more information about drugs, alcohol and tobacco. There is also an argument that all young people require age appropriate prevention interventions on the matter of drugs, alcohol and tobacco as we live in a society where they are used and at some point it is likely that young people will be offered and will need to make an informed choice about their own use.
Robust tobacco prevention and cessation activities were not available in Calderdale until April 2015, so we have yet to see the results of that approach, though there is evidence from pre-2015 to suggest that most young people who entered treatment for cannabis use also used tobacco and that some wanted to quit both substances. It is accepted that the local evidence base around tobacco prevention and cessation is poor.
Locally, the majority of referrals to treatment services are from education settings (45%, compared to 26% nationally), reflecting the high visibility of the prevention agenda in schools, which gives schools and young people the confidence to seek support. Referrals from mental health services and Accident and Emergency (A&E) are much lower than national rates. The number of referrals from mental health services is of particular concern given the relationship between substance use and mental health. Calderdale also has lower referral rates from CJS than nationally (17% Calderdale, 29% national), though this may reflect a drop in the number of young people in the CJS (Calderdale JSNA Support Pack 2014/15). Locally, no young people are in adult treatment services. Within treatment, multi-agency work takes place and the majority of young people leave in a care-planned way with either reduced use or abstinence.
Though data suggests that work to date has had a positive impact, for example in reducing hospital admissions due to alcohol use, admissions for substance misuse remain high. Further, there is evidence that some services are not referring in the numbers expected to drug and alcohol services, for example mental health services. For some young people, often those with other vulnerabilities, drug, alcohol and tobacco use is still a key concern.
Projected future need
Drugs, alcohol and tobacco use will never been completely removed from society and there will always be a need for prevention and treatment activities. Indeed the use of the internet and rise of new psychoactive drugs means that information about substances becomes ever more important. Further, there is a need for work with parents and carers in terms of their own behaviours and attitudes, particularly in relation to alcohol, which may have an impact on the choices that young people make.
An emerging trend in Calderdale is the use of heroin and pervitin in under 21s. While the numbers are small and it is mainly restricted to certain population groups, this is something that has not been apparent in Calderdale treatment services prior to 2013. There is also an increasing trend for young people seeking treatment for heroin and crack cocaine use. While these drugs have been a problem in Calderdale for a number of years, the increase and younger age profile of those seeking treatment is a worrying trend.
Key considerations linked to the known evidence base (what works?)
Within the prevention and treatment element of young people’s drug, alcohol and tobacco use, the National Institute Clinical Excellence (NICE) have published a suite of good practice recommendations:
- Reducing substance misuse among vulnerable children and young people ;
- Substance misuse interventions for vulnerable under 25s ;
- Drug misuse overview ;
- Drug misuse in over 16s: psychosocial interventions ;
- Minimum pricing for alcohol 'will protect young people' ;
- Alcohol: school-based interventions ;
- Alcohol-use disorders overview ;
- Alcohol-use disorders: prevention ;
- Alcohol: preventing harmful use in the community ;
- Looked-after children and young people ;
- Smoking: preventing uptake in children and young people ;
- Smoking: tobacco harm-reduction approaches overview ;
- Smoking prevention and cessation overview .
Public Health England has produced a JSNA Good Practice Guide for service delivery:
References and further information
- Calderdale Council: electronic Health Needs Assessment (eHNA) survey: key findings
- Health and Social Care Information Centre (HSCIC) ;
- Robinson S & Bugler C. Smoking and drinking among adults, 2008. General Lifestyle Survey 2008. ONS,2010;
- PHE: Specialist Substance Misuse Treatment for Young People in England 2014/15 ;
- Young people’s substance misuse data: JSNA support pack: Key data for planning effective young people's substance misuse interventions in 2016-17;
- Tobacco Control: JSNA support pack: Key data sources for planning effective tobacco control in 2016-17.
More information on children and young people can be found in Further resources .
If you require further information on drugs, alcohol and tobacco for yourself or someone you know under the age of 21, or you are a school in Calderdale please contact:
- Username Branching Out (Lifeline)
Branching Out (Lifeline)
11 Wards End
- Facebook Find us on Facebook: http://www.facebook.com/http://www.facebook.com/lifeline.out?fref=ts
- Twitter Follow us on Twitter: @Branching_Out
Donna Green, Children and Young Peoples Programme Manager, Public Health, Calderdale Council;
edited by Naomi Marquis, Public Health Intelligence Officer, Public Health, Calderdale Council.