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Drugs, alcohol and tobacco use in children and young people

Drugs, alcohol and tobacco use cause harm to an individual's health and well-being.

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.
  • Offending.
  • Early sexual activity.
  • Antisocial behaviour.
  • Being exposed to parental substance misuse.

(Association for young people's health (AYPH): A public health approach to promoting young people's resilience March 2016.)

Smoking accounts for over one third of respiratory deaths. Over 1 in 4 of deaths are from cancer and around 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 well-being and good social relationships and support are all protective factors.

Important predictors of well-being are positive family relationships and a sense of belonging at school and in local communities.

The local picture

Results from the 2016 local eHNA (Electronic Health Needs Assessment) schools survey show that:

  • Around 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 stayed the same. The percentage of pupils trying tobacco smoking for the first time in:
    • year 7 has stayed the same;
    • in year 10 has reduced slightly.
  • Few pupils use alcohol or smoke regularly. Although, of those smoking daily, tobacco is smoked more than e-cigarettes.
  • Over one fifth of pupils live with people who regularly smoke cigarettes;
  • The percentage of pupils trying drugs has fallen slightly since 2015. Now over 90% of pupils have never tried drugs. Of those that have, Cannabis is the most common.

Overall the eHNA shows:

  • 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 due to long waiting times and support is given quickly. (Calderdale JSNA Support Pack 2017/18).

Figure 1: Specialist treatment service involvement in Calderdale, 2015/16:

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Specialist treatment service involvement in Calderdale, 2015/16

Figure 2: Specialist treatment service involvement - referral sources in Calderdale, 2015/16:

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Specialist treatment service involvement in Calderdale, 2015/16

It should be noted that a high proportion of those accessing services for drug and alcohol use, have other vulnerabilities. (Calderdale JSNA Support Pack, 2016/17):

Figure 3: Number and percentage of young people in specialist treatment services by risk/vulnerability in Calderdale, 2015/16:

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Number and percentage of young people in specialist treatment services by risk/vulnerability in Calderdale, 2015/16

Notes:

* 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 or 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.

Current provision

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. Also, 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). They 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 treatment in venues in each locality and the town centre. It caters for transitional ages up to 21 years. Its role is to:

  • Prevent drug, alcohol and tobacco use and help users to reduce or abstain.
  • Aim to reduce harm caused by these substances and prevent them from becoming a greater problem.
  • Operate as part of a wider network of universal, targeted and specialist services.
  • 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. 78% of young people have 'planned exits'. A proxy indicator that suggests young people leave treatment with a successful outcome. This figure is slightly lower than the national average of 79%. It is also a decrease in our local services from 89% in 2012/13 and 80% in 2016/17 (Calderdale JSNA Support Pack 2017/18).

User views

There has not been any large local drug and alcohol use consultation with young people in the last two years.

For those accessing treatment, feedback is gathered through the year via:

  • feedback boxes in the service's reception areas;
  • questionnaires;
  • feedback via their Facebook page;
  • an annual feedback week, where young people anonymously complete a questionnaire.

This 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).

Unmet needs

Local eHNA school survey findings suggest that children and young people want more information on drugs, alcohol and tobacco. There is also an argument that all young people need age appropriate prevention interventions on these. We live in a society where they are used! At some point, it is likely that young people will be offered them. So, they 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. Mental health services and Accident and Emergency (A and E) referrals are much lower than national rates (3% in Calderdale, 7% nationally). The number 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. Also, most young people leave in a care-planned way with reduced use or abstinence.

Figure 4: Referral sources in Calderdale, 2015/16:

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Data suggests that work to date has had a positive impact. For example, in reducing hospital admissions due to alcohol use. Though admissions for substance misuse remain high. There is also 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 21s. 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. Also, an up-to-date local needs assessment of young people's drug use is an identified gap.

References and further information

References

Further Information

For more on children and young people, see: Further resources.

Also, for you or someone you know (under 21s), see: Drugs, alcohol and tobacco service.

If you are a Calderdale school, please contact:

Author

  • Drug Programme Manager, Public Health, Calderdale Council.
  • Edited by Public Health Intelligence Officer Intern, Public Health, Calderdale Council (August 2017).

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