Adult drugs and alcohol

The estimated prevalence rate (2011/2012) of opiate or crack cocaine users aged 15-64 years is 7.9 per 1,000, (1,058 adults) which is consistent with the national average. Of these, the estimated prevalence for those injecting opiates/crack cocaine is 1.89 per 1,000 (253 adults) (Public Health England (PHE), Prevalence Estimates by Local Authority).

Of those drug users in treatment, our Substance Misuse Needs Assessment 2013 tells us:

• Most Opiate and/or Crack users are known to treatment services, this is greater ‘treatment penetration’ than elsewhere;
• Stimulant use, especially secondary crack use appears to be hindering recovery for a large proportion of those in treatment than elsewhere;
• The majority of those entering both the drug and alcohol treatment for the first time exit within a year;
• The proportion of the drug treatment population who have been in treatment for over six years (and over ten years) is unusually high;
• There is a growing problem of poly-substance use: some 16-18% of alcohol service users also use drugs and 18% of drug service users also drink;
• The complexity of those presenting for alcohol treatment reflects the national average (Calderdale Adult Drug and Alcohol Partnership, 2013).

Calderdale has significant issues related to alcohol abuse with a rate of alcohol related harm hospital stays for adults of 737 per 100,000. This represents 1,456 stays per year and is significantly worse than the average for England (PHE Public Health Outcome Framework (PHOF) indicator 2.18, 2012/13).

Given the characteristics of Calderdale’s 16 year old and over drinking population, we would expect that:

• 74% would drink at a ‘lower risk’ level;
• 19% would drink at an ‘increasing risk’ level;
• 7% would drink at a ‘higher risk level’.

Of these:

• 23% would binge drink.

Using our latest population estimates this would equate to approximately:

• 103,277 Lower Risk Drinkers;
• 27,749 Increasing Risk Drinkers;
• 9,049 Higher Risk Drinkers

Of these, there would be:

• 32,637 Binge Drinkers.

Local Area Alcohol Profiles (LAPE) (PHE, 2014) show that Calderdale has the worst mortality rate in the region for females aged under-75 with liver disease. The rate is significantly higher than the England average in the following areas:

• Alcohol Specific Hospital admissions for males, females and those under 18;
• Alcohol related Hospital admissions for males and females;
• Admission episodes for alcohol related conditions;
• Binge drinking (percentage of adults who consume at least twice the daily recommended amount of alcohol in a single drinking session);
• Employees in bars (as a percentage of all in employment) Calderdale.

The Calderdale rate of admission to hospital for mental and behavioural disorders due to alcohol is higher than the average for the Yorkshire and Humber region. Based on 2010 data, locally some 230 dementia cases are likely to be alcohol related, with a projection that this number will increase.

Calderdale provide an integrated drug and alcohol recovery focused service for adults over the age of 21 that delivers treatment bespoke to the needs of individuals whatever the substance they are using.

It includes:

• A single point of access, a single assessment, planning for recovery and recovery navigation;
• Psychosocial and clinical Interventions;
• Community and In-patient detoxification (including preparation work);
• Wellbeing and Integration services (including Learning and Activity & Housing support);
• An abstinence programme with links to the Calderdale Recovery Community and Mutual Aid.

The service brings together under one management structure all the elements of care needed to support service users along their individual recovery oriented pathway. It will retain strong links with partners through new designated posts:

• Criminal Justice Liaison;
• Families and Carer’s worker;
• A worker with a focus on engaging Black, Asian, and minority ethnic (BAME) communities.

Public Health are developing a good working relationship with the licensing department and to date are:

• Reviewing applications for licences relating to the sale of alcohol;
• Attend the enforcement licensing sub group;
• Involved in the review of the statement of licensing.

We continue to work with our clinical commissioning partners to establish appropriate commissioning responses to the needs of those with alcohol-related conditions attending Accident and Emergency (A&E).

We commission an Alcohol Intervention and Brief Advice Service from accredited community pharmacies across the area to raise awareness of the risks of alcohol, help people to better understand alcohol units, and providing brief advice to those who’s drinking falls into the increasing and higher risk category.

We have community assets supporting the outcomes of treatment, they include:

• Mutual Aid ((Self-Help And Recovery Training (SMART) / Narcotics Anonymous (NA) / Alcoholics Anonymous (AA) / Al-Anon);
• Faith Community Initiatives;
• Calderdale in Recovery (a community interest group)
  • Calderdale in Recovery
  • Find us on Facebook: @calderdaleinrecovery
  • Follow us on Twitter: @calderdalers

The Recovery Orientated Drug and Alcohol System opened on 2 February 2015. We have performed (PHE PHOF indicator 2.15, 2013) at a similar rate to the rest of England but the direction of travel is currently downhill and whilst this may continue during the transition period it is envisaged to improve as the new model becomes established.

Calderdale compares favourably with the West Yorkshire average when residents are asked whether they believe there is a major problem with drunk and rowdy behaviour in their local area (Calderdale Community Safety Partnership, 2014). As at September 2014, 14.3% of residents surveyed indicated that they believed there was a problem with drunk and rowdy behaviour, an improvement on last year’s result (15.7%) and is below the average for other regional authorities (17.9%). 26.5% of residents surveyed in Calderdale believe there is a major drug problem in their local area, an increase on last year’s outturn (25.5%) but significantly lower than the Force average of 29.3%.

The service users surveyed in the Substance Misuse Needs Assessment 2013 cited group work found the following very helpful. The recovery service, the availability of mutual aid groups, access to detoxification and substitute prescribing. Areas they identified for improvement were the location of the current treatment service, the flexibility of opening times and the need for rapid access to doctors particularly following relapse.

Specific Groups that expressed the need for a more tailored treatment response included: the Black and Minority Ethnic (BME) community, drug users aged 40 and over, those who had relapsed, and those living in particular areas of the borough, particularly Todmorden.

The new treatment service will offer treatment to those with an Alcohol Use Disorders Identification Test Consumption (AUDIT C) score of 16 or above that identifies higher risk drinking. The service is not commissioned to do Alcohol Brief Interventions (ABI) or Tier 2 advice and information which leaves a gap in prevention opportunities.

We have committed to train a maximum of 40 people, in 'Training the Trainers' ABI and establish a Calderdale ABI trainer’s network in early 2016.

We currently have no mechanism or resource to capture data - ie under 18 alcohol admissions, local alcohol consumption or drinking behaviour surveys, ambulance pick-ups, alcohol related assaults attending A&E that provides evidence of the impact of alcohol outlet density and availability on crime, harm to children and health. Work is underway with the Business Intelligence unit to improve this situation.

We do not have a cross borough strategy to address the impact of alcohol on individuals, families and communities. This will be developed early in 2016.

We will need to monitor the impact of novel and emerging drugs, and prescribed and over the counter medication.

Welfare reform will potentially affect our treatment population in a problematic way, widening the gap in inequalities for adults using drugs and alcohol, impacting on recovery outcomes. Liaison with partners in housing, employment and the benefits system is essential.

The increasing group of older drinkers and drug users in treatment services will need to adapt to meet their needs.

The over-six years in treatment group, with more complex patterns of substance use and needs, will require targeted support to work towards abstinence, they present a significant challenge to the system.

Resources to further develop the substance misuse prevention agenda, particularly alcohol will be required to develop this agenda.

The National Treatment Agency (NTA) Building Recovery in Communities report (Department of Health (DH), 2012) advocates the development of Recovery Oriented Integrated Systems (ROIS) bringing drug and alcohol treatment together as a means of helping more people achieve sustained abstinence from their drug and alcohol problems.

The report recommends a single point of assessment and referral using single generic assessment documentation that results in an individualised recovery focused care plan that will enable seamless transitions for individuals across the recovery oriented system, provided either by a single provider or a range of providers.

A key factor in the development of a successful recovery oriented approach is a closer partnership between treatment and other services such as education / training / employment, housing, mental health, mutual aid and family support. In addition, best practice suggests the need to develop a local visible ‘recovery community’ that provides motivation and hope for change for those with substance misuse problems.

Strang (2012) in the NTA report Medications in Recovery (NHS, 2012), makes the point that it is not acceptable to leave people on substitute prescriptions without actively reviewing the benefits of their treatment, supporting their recovery and assessing their readiness to change. Equally, neither is it acceptable to put a time limit on an individual’s treatment that takes no account of their personal history, complexity, needs and circumstances and the benefits of their current treatment regime.

Research has shown that there are a variety of factors that assist individuals to achieve full process. Some people recover naturally or ‘mature’ out of their addiction; others recover through treatment and / or the assistance of self-help and mutual aid groups. These groups are often characterised by having higher level of personal and social capital. With this evidence in mind we have developed a ROIS with user-led, recovery oriented, tailored treatment that is regularly reviewed. This will be delivered by a trained workforce, through multiagency working, peer support with users having access to a menu of treatment options and information.  We also continue to support the development of Calderdale in recovery as visible local recovery community.

References

• Calderdale Adult Drug and Alcohol Partnership (2013): 2013 Needs Assessment (available from Calderdale Council Public Health Department).
• Calderdale Community Safety Partnership (2014): Strategic Assessment 2014/15.
• Department of Health (2012): Building recovery in communities: the transition to the new public health system - action plan for the NTA 2012-13 (Accessed, 29th January 2015).
• NHS (2012): Medications in Recovery: Re-orienting drug dependence treatment (Accessed, 29th January, 2015).
• PHE (2015): Public Health Outcomes framework (Accessed, 29th January 2015).
• PHE (2015): Local Alcohol Profiles for England (Accessed, 3rd November 2016).

More information

• Calderdale Adult Drug and Alcohol Partnership (2013): 2013 Needs Assessment (available from Calderdale Council Public Health Department).