Drugs, alcohol and tobacco use cause harm to an individual’s health and wellbeing.
Problematic drink and drug use among under-18s, rarely occurs in isolation. It is often a symptom of wider problems. Prevention approaches for young people are usually not drug, alcohol or tobacco specific. They are focused more on reducing risks and building resilience. The more risk factors young people have, the more likely they are to misuse substances. Risk factors include:
- experiencing abuse and neglect (including emotional abuse);
- truanting from school;
- early sexual activity;
- antisocial behaviour;
- and being exposed to parental substance misuse.
(Association for young people's health (AYPH): A public health approach to promoting young people's resilience , 2016).
Smoking accounts for over one third of respiratory deaths. Over 1 in 4 of deaths are from cancer, and approximately 1 in 7 of deaths are related to cardiovascular disease. Smoking is the primary cause of preventable illness and premature death. Two-thirds of smokers begin before they are aged 18 (Action on Smoking and Health (ASH): Smoking statistics , 2016). Young people are more likely to smoke if they have a parent, carer or sibling who smokes. Lower socio-economic status, higher levels of truancy and substance misuse are all associated with higher rates of youth smoking.
The main predictor for the severity of young people’s substance misuse problems, is the age that they start using substances. Evidence shows that physical and mental wellbeing, and good social relationships and support are all protective factors. Important predictors of wellbeing are positive family relationships and a sense of belonging at school and in local communities. Other factors include good relationships with adults outside the home and positive activities and hobbies. (United nations office on drugs and crime (UNODC): International standards on drug use prevention , 2016). Most recent advice from the Chief Medical Officer (2009), is that an alcohol-free childhood is the healthiest and best option. Also, if children do drink alcohol, it should not be until they are at least aged 15. (Department of Health (DoH): Guidance on the consumption of alcohol by children and young people , 2009).
The local picture
Results from the 2016 local eHNA (Electronic Health Needs Assessment) schools survey reveal that:
- approximately one third of pupils in Years 7 and 10 have tried alcohol. This figure is slightly higher than in 2015;
- the proportion of pupils trying e-cigarettes has remained the same. The percentage of pupils trying tobacco smoking for the first time has remained the same for Year 7, but has reduced slightly in Year 10;
- few pupils use alcohol or smoke regularly; however of those smoking daily, tobacco is smoked more than e-cigarettes;
- just over one fifth of pupils live with people who regularly smoke cigarettes;
- the percentage of pupils trying drugs has fallen slightly since 2015 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 shows that since 2010, regular use of drugs or tobacco is on a downward trend. In 2015, there was an all-time low in young people drinking alcohol regularly.
Prevention and Treatment Needs
In 2015/16, 146 under-18 year olds and 34 18-24 year olds were in treatment services in Calderdale. Only one young person waited more than three weeks from referral to intervention. This shows 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 2017/18). 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, 2015/16
Figure 2: Specialist treatment service involvement - referral sources in Calderdale, 2015/16
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, 2015/16
* There are no safe drinking levels for under-15s. Young people aged 16-17 should drink less often, no more than one day a week. (Department of Health: Guidance on the consumption of alcohol by children and young people , 2009). This measure captures young people drinking on an almost daily basis (27-28 days a month). Those drinking above 8 units/day (males) or 6 units/day (females), on 13 or more days a month.
** Substances for young people include alcohol.
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.
In June 2017, Lifeline, the organisation that delivered this service, went into administration. The service is currently managed by DISC (Developing initiatives for support in the community), who deliver Calderdale's adult drug and alcohol treatment services. This provides an opportunity to review provision and work more effectively with the families of those in substance misuse treatment.
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 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. It supports 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. 78% of young people have ‘planned exits’, a proxy indicator suggesting that young people leave treatment with a successful outcome. This figure is slightly lower than the national average of 79%, and is a decrease in our local services from 89% in 2012/13 and 80% in 2016/17 (Calderdale JSNA Support Pack 2017/18).
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. This is as well as questionnaires and feedback via their Facebook page. There is also an annual Feedback week, where young people anonymously complete a questionnaire.
This exercise has found that 66% of young people returned after their first visit. This was because they were ‘keen to get help’ and 56% because of staff friendliness. 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. We live in a society where they are used! 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. We have yet to see the results of that approach. There is evidence from pre-2015 that suggests most young people who entered treatment for cannabis use, also used tobacco. Also, that some wanted to quit both substances. It is accepted that the local evidence base around tobacco prevention and cessation is poor. To-date, there are very low levels of successful 'quitters'.
Locally, most referrals to treatment services are from education settings (41%, compared to 28% nationally). This shows the high visibility of the prevention agenda in schools. It gives schools and young people the confidence to seek support. Referrals from mental health services and Accident and Emergency (A and E) are much lower than national rates (3% in Calderdale, 7% nationally). 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 the Criminal justice system (CJS) than nationally (13% in Calderdale, 26% nationally). This may reflect a drop in the number of young people in the CJS (Calderdale JSNA Support Pack 2017/18). 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.
Figure 4: Referral sources in Calderdale, 2015/16
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. There will always be a need for prevention and treatment activities. Use of the Internet and the rise of new psychoactive drugs mean that information about substances become ever more important. There is a need for work with parents and carers in terms of their own behaviours and attitudes. This is mainly in relation to alcohol, which may have an impact on the choices that young people make.
In recent years, Calderdale saw an emerging trend of heroin and methamphetamines use in under 21 year olds. However the numbers are low and it appears restricted to certain population groups. We are concerned that we are not seeing young people seeking treatment for New psychoactive substances (NPS) use. Anecdotal evidence tells us that these drugs are being used in Calderdale and an up to date local needs assessment of young people's drug use is an identified gap.
Key considerations linked to the known evidence base (what works?)
The National Institute Clinical Excellence (NICE) have published a suite of good practice recommendations. This is within the prevention and treatment element of young people’s drug, alcohol and tobacco use:
- Reducing substance misuse among vulnerable children and young people ;
- 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:
- Young people’s drug, alcohol and tobacco use: joint strategic needs assessment (JSNA) support pack .
References and further information
- Action on smoking and health (ASH)(2016): Smoking statistics ;
- Association for young people's health (AYPH)(2016): A public health approach to promoting young people's resilience ;
- Calderdale Council: electronic Health Needs Assessment (eHNA) survey: key findings
- Department of Health (2009): Guidance on the consumption of alcohol by children and young people ;
- British medical journal (2012): Clustering of substance use and sexual risk behaviour in adolescence: analysis of two cohort studies ;
- Public Health England (2015): Specialist substance misuse treatment for young people in England 2013/14 ;
- Public Health England (2017): Young people - substance misuse data: JSNA support pack: key data 2017/18 ;
- Public Health England (2017): Tobacco Control: JSNA support pack Key data sources for planning effective tobacco control in 2017/18 ;
- United Nations office on drugs and crime (UNODC)(2015): International standards on drug use prevention .
For more on children and young people, see: Further resources .
For more on drugs, alcohol and tobacco for you, someone you know (under 21), or you are a Calderdale school, contact:
Niamh Cullen, Drug Programme Manager, Public Health, Calderdale Council.
Edited by Emily Powell, Public Health Intelligence Officer Intern, Public Health, Calderdale Council (August 2017).