Substance misuse

Introduction

Illicit drug use, particularly by young people, continues to be one of the most significant public health challenges in England.  It is a key policy concern for Government because of the negative short and long-term impact on the individual, their children, families, parents and communities in which they live.

The Government’s 2010 drug strategy (accessed 3 May 2016) makes it clear that young people who misuse drugs and/or alcohol are at higher risk of achieving poor outcomes in education, training and employment, involvement in the criminal justice system, poor housing and higher levels of deprivation.

The 2014 Health and Social Care Information Centre (NHS Digital) survey on smoking, drinking and drug use by young people in England reported that the prevalence of drug use among 11-15 year olds declined between 2001-2010 but that the decline slowed since 2010.

Key inequalities and risk factors

NICE guidance sets out factors that influence substance misuse among children and young people which include:

• environment (e.g. availability of drugs)
• family (e.g. sibling and/or parental substance misuse and lack of discipline)
• individual experience (e.g. early sexual encounters and peer group pressure to misuse substances)
• mental health (e.g. low self-esteem, depression)
• education (e.g. parental expectations)
• being a smoker or drinking alcohol

Those at particular risk include young people:

• who are – or who have been – looked after by local authorities, fostered or homeless, or who move frequently
• whose parents or other family members misuse substances
• from marginalised and disadvantaged communities, including some black and minority ethnic groups
• with behavioural conduct disorders and/or mental health problems
• excluded from school and truants
• who are young offenders (including those who are incarcerated)
• involved in commercial sex work
• with other health, education or social problems at home, school and elsewhere
• who are already misusing substances
• who have suffered abuse or neglect
• who are or who were engaged in early sexual activity

There are different patterns in substance misuse and access to support services based on:

• Gender – Just under two-thirds of the young people accessing specialist substance misuse services were male (65% – which is higher than the mid-2014 general population of 9-15 year olds at 51.3%).
• Age – Just over half (52%) of all persons were aged 16 or over. Girls in treatment were younger, with 25% aged under 15 compared to 19% of boys.
• Mental and emotional health – impact on substance use such as self-harming, offending or domestic abuse. Girls are more likely to report mental health problems and self-harming while boys are more likely to be involved in antisocial behaviour and not be in education, employment of training (NEET) and substance misuse often goes hand in hand with other risk factors, such as offending or truancy.
• Ethnicity – all young people in treatment is comparable to the general population as measured by the 2011 Census.
• Sexual exploitation – In 2014/15, the  National Drug Treatment Monitoring System (NDTMS) recorded data on sexual exploitation for the first time since this is an emerging area of concern. Five per cent (5%) of young people presenting to treatment services in 2014-15 reported sexual exploitation. This proportion was higher among females (12%) than males (just over 1%) – although the figure for boys and young men is considered to be underreported because they often do not disclose abuse.

In Bracknell Forest, of new triages to DAAT services, the four most common risk factors in 2014/15 were self-harming, involvement in the criminal justice system, mental health problems and being subject to social services intervention through a child protection plan.

A number of ‘protective factors’ that build young people’s resilience, include educational achievement, positive relationships and good physical and mental wellbeing, can contribute to good outcomes, despite negative life experiences.

Facts, figures and trends

Evidence suggests that drug use and problematic drug use (and other risk behaviours) in young people can be a manifestation of poor emotional wellbeing, psychological distress, and injury and an absence of protective factors (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help them deal more effectively with stressful events.  The Drug Strategy Review 2013 highlights how education and information approaches (integrated into the national curriculum) have proven to be effective in increasing awareness of the dangers associated with drugs by helping young people to make informed, healthy decisions and to keep them safe.

The 2014 HSCIC survey (NHS Digital) shows the prevalence of drug use among 11 to 15 year olds in England declined between 2001 and 2010. Since then the decline has slowed:

In 2014, 15 per cent of pupils in English schools had ever taken drugs (16% in 2013), 10 per cent had taken drugs in the last year (11% in the previous period), and 6 per cent had taken drugs in the last month (same as previous period).

Drug use by age and gender

The likelihood of drug use increased with age. Among all 11 year olds, 6% said that they had tried drugs at least once, 4% said that they had taken drugs in the last year, and 2% said they had taken drugs in the last month. Among 15 year olds, the corresponding proportions were 24%, 19% and 12%.  The likelihood was greater for older boys than older girls:

Taking these percentages and applying them to the mid-2014 population estimate of children aged 11-15 for Bracknell Forest (7,092) and drug taking behaviour is estimated as follows:

Drug use by type

Exploring drug use by type, data from the 2014 HSCIC survey (NHS Digital) on smoking, drinking and drug use by young people in England continues to show cannabis to be the most commonly used drug:

Nationally, 2014/15 data from the Public Health England (accessed 3 May 2016) shows that most common drug that young people need help with is cannabis for which 86% seek support.  Although numbers have dipped slightly in 2014-15, the numbers in treatment for cannabis has been on an upward trend since 2005-06.

Between 2001 and 2010, the proportion of pupils who reported taking drugs in the last month declined from 12% to 7%. In 2014, 6% had taken drugs in the last month, a similar proportion to 2010. The frequency at which children and young people take drugs at least once a month increases with age, with boys more active than girls.  Substance misuse by gender is outlined below:

“Legal highs” / new psychoactive substances (NPS)

‘Club drug and NPS use’ incorporates a number of different substances typically used by young people in bars and nightclubs, at concerts and parties, before and after a night out, and in place of other drugs.

NPS or so called “legal highs” present a danger because they are easily accessible, they are constantly being adapted to avoid legislative control, they may not necessarily hold the same perceived threat to health and well-being as illegal drugs, some young people are unaware that just because they are advertised as legal, doesn’t mean they are safe or legal.

The HSCIC 2014 survey (NHS Digital) reported that the prevalence of legal high usage in 11-15 year olds is low, with 2.5% having ever taken legal highs (including 5.0% of 15 year olds).  The survey found that around half of 11-15 year olds were aware of legal highs, including 74% of 15 year olds.

Public Health England data for 2014/15 states that 5% of young people aged 9-15 have presented at services for support with NPS.  Measurement of use began in 2013/14 and there has been a small increase on the previous year.  The full extent of their use is still not fully known, and the impact of their use is emerging from hospital A&E departments.

Referrals into services

The most common route into specialist services continues to be via the youth justice system (29%), with youth offending teams the single largest source (26%), although this has been declining in recent years. Education was the second most common referral source (26%).

Referrals from children and family services accounted for 9%, and self-referrals made up 7% of all recorded referrals. Referrals from A&E account for 1% while referrals from child and adolescent mental health services (CAMHS) account for 3%.

The Public Health England report for 2014/15 states that the number of young people attending specialist substance misuse services during 2014-15 was 18,349, down by 777 (4%) from 19,126 in 2013-14, and a reduction of 5,704 young people since the peak in 2008-09 (a fall of 24%). However, this is stated with a note of caution: whilst the numbers of the younger age groups (under 13) are consistently falling year on year, the proportion (%) of young people in these groups remains fairly stable.

Bracknell Forest Drug & Alcohol Action Team (DAAT)

The Bracknell Forest Drug & Alcohol Action Team works with young people who are referred via the criminal justice system or the wider community.  Working primarily through Youth Offending Services, interventions are also delivered in community venues such as schools and youth centres. The caseload in this service varies from between 15 – 25 young people at anyone time. The large variation is due to the complexity of the young people presenting to the service.

Other interventions include a weekly Family and Friends group which supports approximately 30 people who are mostly parents of young drug and alcohol users to share issues and look for solutions to ongoing situations within their family group.  There is also a young people’s counselling service with capacity to support 15 young people at any time and which provides person-centred therapy for young people who misuse drugs and/or alcohol as well as the children of drug misusing parents.

Local data for 2014/15 from the Bracknell Forest Drug & Alcohol Action Team (DAAT) shows that:

• Mid-year population estimates for 2014 indicate a total population of 118,025 of which 24% are under 18 years old (27,823 individuals)
• 74 young people resident in Bracknell Forest were accessing structured treatment in 2014/15 and 50 were new triages in this period.
• Of the 74, 35 (47%) of young people in treatment resident in Bracknell Forest were aged 15 years or under and 39 (53%) were aged between 16 and 17 years.

Effectiveness of services

In terms of the number of people engaged with the service, the local DAAT team compares well with England figures.

In 2014/15, more young people accessed the service at an earlier age (13-14) than in 2013/14 where more accessed the service aged 15.  This is a positive message as earlier engagement and intervention presents opportunity to reduce negative outcomes earlier and for longer:

All people accessing the service received their first intervention within 3 weeks which exceeded the national figure (98%) and the average treatment length lasted 21 weeks compared to the England average of 23 weeks

The number of planned exits from the service was 62% which is lower than than the England average of 79%.

There is currently no evidence to suggest that there are unmet needs or gaps in service provision.  None of the Bracknell Forest Drug & Alcohol Action Team services operate waiting lists in terms of referrals. However, consideration should be given to commissioning a range of preventative services, particularly in educational establishments.

Free, friendly and confidential online support  and information on anything drugs and alcohol realted is also available from the SMART website.

Want to know more?

A Review of Substance Misuse Involving Children and Young People (Children, Young People and Learning Overview and Scrutiny Panel, 2015) – the local response to government strategy setting out a life course approach to drug prevention that covers early years, family support, universal drug education, and targeted and specialist support for young people.

Drug misuse and dependency (Home Office) – Portal area for all government guidance, policy, advice, and data relating to drug misuse.

Health behaviours in young people: What about YOUth? (Public Health England) – local authority level estimates for several topic areas, based on what 15 year olds themselves said about their attitudes to healthy lifestyles and risky behaviours (self-reported), including diet and physical activity, smoking, alcohol, use of drugs, bullying and wellbeing. For each topic area, the information is shown by gender, ethnicity, deprivation, sexuality, region and local authority.  Extracted from the Health and Wellbeing of 15-year-olds in England – Main findings from What About YOUth? Surveys.

National Drug Strategy 2010 (revised 2012) – set out Governments commitment to reduce demand, restrict the supply of drugs, build recovery and support people to live drug free lives.

New Psychoactive Substances (NPS) (Home Office, 2015) – Resource pack for informal educators and practitioners about NPS usage, side effects, case studies, advice, information, prevention and treatment options.

Prevention of drug and alcohol dependence (Advisory Council on the Misuse of Drugs, 2015) – sets out, within the context of young people, significant evidence relating to the factors influencing and reducing drug and alcohol dependence with an evaluation of a wide range of prevention interventions and how these might be designed and delivered.

Smoking, drinking and drug use among young people in England in 2014 (NHS Digital, 2014) – a suite of surveys covering numerous aspects of smoking, drinking and drug use among young people in England, in particular, prevalence, behaviours, types of alcohol and drugs taken, how often, access to substances, pupil attitudes and predictors of smoking, drinking and drug taking among secondary school age children.  Different surveys also focus on different aspects.

Substance misuse interventions for vulnerable under 25s (NICE, 2007) – guidance for anyone involved in reducing substance misuse among vulnerable and disadvantaged children and young people under the age of 25. With a focuses on community-based activities taking place in, e.g.  schools and youth services, recommendations cover strategy development, identifying children and young people who are existing users or at high risk, whole family and holistic support approaches to support, referring and signposting and interview techniques. Guidance is also supported by a 2014 Evidence update.

Supporting public health; children, young people and families (PHE, updated 2016) – guidance to support local authorities and providers in the commissioning and delivery of services across the highest impact health and wellbeing outcomes for children and young people through the 0-19 healthy child programme.

Young People’s Health Profile (Public Health England) – key statistics for health protection, promotion, improvement and reducing inequalities in younger people

Young people’s alcohol, drug and tobacco use: JSNA support pack (Public Health England) – Key data for planning effective young people’s specialist substance misuse interventions in 2016-17 and Good practice prompts for planning comprehensive interventions in 2016-17 which recommends:

• effective evidence-based interventions commissioned universally and in a targeted way to prevent young people’s use of drugs, alcohol and tobacco
• availability of a full range of specialist drug, alcohol and tobacco interventions to young people in need
• integrated commissioning across prevention and specialist interventions and the wider children’s agenda (including wider determinants, such as housing and accommodation)
• a skilled workforce is in place to provide effective interventions

This page was created on 24 May 2014 and updated on 09 November 2016.  Next review date September 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Substance Misuse in Children and Young People. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/substance-misuse (Accessed: dd Mmmm yyyy)

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