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Summary

In Merton, in terms of drinking behaviour the only source of information on attitudes and beliefs towards drinking alcohol we have is from the TellUs 4 survey (2009) in which the majority of children (8 to 16 years) report not having ever had an alcoholic drink. For those that do report drinking, the number getting drunk once, twice or three or more times in the past month was consistently lower than national figures. Drinking estimates for Merton young people extracted from the 2013 Merton Young People’s Sexual Health and Substance Misuse Needs Assessment, based on the National Centre for Social Research’s Smoking, Drinking and Drug Use survey (2011), suggest that 1,977 (19%) of young people between 11 and 15 years are drinking once a month or more, with an additional 2090 (20%) drinking a few times year. For young people 16-17 years consuming alcohol in the last week, the estimation based on the Institute of Alcohol Studies was 2,476 (62%).

Latest reported figures from the local alcohol profiles for England (LAPE) for alcohol-specific hospital admissions in the under 18 age group (2012) suggest a slight decrease in hospital admissions in the past six-year period. Merton, however, ranked ninth highest in London. As absolute numbers were small, one or two admissions would affect the ranking and didn’t include attendance at an A&E department, so therefore need to be treated with caution.

Merton has seen an increase in the numbers of young people under 18 years presenting for specialist treatment interventions in 2011-12. An analysis of needs assessment data for 2011-12 reveals that 138 young people aged under 18 were in treatment, which represents a 23% increase on the previous year. Figures for 2012-13, however, return to levels seen in previous years of just under 100. In [2011-12], 46% came through the youth justice route and 27% were using alcohol and cannabis.

Key commissioning recommendations

A joint young people’s sexual health and substance misuse needs assessment was carried out in Merton in 2013, which highlighted local needs and gaps. The needs assessment indicated improvements could be made in relation to:

  • strengthening preventive and early identification strands of support, including outreach provision
  • providing referral pathways for substance misuse and further integration with sexual health services
  • increasing training to improve early identification and increase referrals to specialist services
  • provision for young people aged 18 to 24 in contact with criminal justice services but using Class A drugs were also highlighted as a local gap
  • providing effective transitions into adult substance misuse services for 18-24 year olds who require extended support and treatment
  • providing an A&E intervention pathway for young people who present there with substance misuse issues
  • upon completion of the review of the existing young peoples’ Substance Misuse Service, agreeing recommendations and retendering in 2014.

 

Key facts on young people’s substance misuse

The Government's drug strategy (2010) recognises that young people’s drug use is a distinct problem. Most young people do not use drugs and the majority of those that do are not dependent. However, drug or alcohol use can have a major impact on young people’s education, health, family and longer-term chances in life. While drug and alcohol education should be offered to all, specialist interventions should prevent young people’s drug and alcohol use from escalating, reduce the harm young people can cause to themselves or others, and prevent them from becoming drug or alcohol-dependent adults. Furthermore, the cross-governmental policy Positive for Youth (2011) makes clear the links between substance use and risky behaviour, and stresses the importance of prevention, early intervention and support to those who need it.

Vulnerable groups including sex workers, offenders, young people excluded or truanting from school, homeless people, looked-after children (children under the care of social services) and children whose parents misuse drugs are at greater risk of developing problematic drug use. Alcohol, tobacco and cannabis use is strongly related with youth offending. Heroin use is linked with less affluent groups in the population, while unemployed 16 to 29 year olds have higher rates of drug use for any drug, for heroin and for Class A drugs especially. In younger people, risky drinking behaviour is associated with anti-social behaviour and teenage conceptions.

Drinking and young people

In Merton, in terms of drinking behaviour, the only source of information on attitudes and beliefs towards drinking alcohol we have is from the TellUs 4 survey (2009) in which the majority of children (8 to 16 years) reported not having ever had an alcoholic drink. For those that did report drinking, the number getting drunk once, twice or three or more times in the past month was consistently lower than national figures. Drinking estimates for Merton young people extracted from the 2013 Merton Young People’s Sexual Health and Substance Misuse Needs Assessment, based on the National Centre for Social Research’s Smoking, Drinking and Drug Use survey (2011), suggest that 1,977 (19%) of young people between 11 and15 years are drinking once a month or more, with an additional 2,090 (20%) drinking a few times year. For young people 16-17 years consuming alcohol in the last week, the estimation based on the Institute of Alcohol Studies was 2,476 (62%).

Latest reported figures from the LAPE for alcohol-specific hospital admissions in the under 18 age group (2012) suggest a slight decrease in hospital admissions in the past six-year period. Merton, however, ranked ninth highest in London. As absolute numbers were small, one or two admissions would affect the ranking and didn’t include attendance at an A&E department, so therefore need to be treated with caution.

Drugs and young people

The Government's drug strategy states that specialist interventions should prevent young people’s drug and alcohol use from escalating, reduce the harm young people can cause to themselves or others, and prevent them from becoming drug or alcohol-dependent adults.

Specialist interventions should be delivered according to a young person's age, degree of vulnerability, and the severity of the problem. Good practice is to meet their substance misuse needs as part of a broader package of care that includes support with housing, education and family relationships and contributes to improving health and wellbeing, educational attendance and achievement, and reduced risk-taking behaviour, such as offending, smoking and unprotected sex.

In the Merton Young Residents Survey 2012, young people expressed concerns about drug use and pushers, which had increased by 4% in 2012 from 2011, rising to 18%, although below the London average.

Merton saw an increase in the numbers of young people under 18 years presenting for specialist treatment interventions in 2011-12. An analysis of needs assessment data for 2011-12 reveals that 138 young people aged under 18 were in treatment, which represents a 23% increase on the previous year. Figures for 2012-13, however, return to levels seen in previous years of just under 100. In this year 46% came through the youth justice route and 27% were using alcohol and cannabis.

The risk-harm profile identifies 10 key items to gauge the vulnerability of young people entering specialist substance misuse services, including contracting an STI, having a child, being in contact with the Youth Justice Service, receiving benefits before the age of 18 and being not in education, employment or training (NEET). The higher the score, the more complex the need. In 2012-13, 78% of young people coming for treatment in Merton presented with two to four vulnerability factors, an increase on the previous year; 52% were using two or more substances and 75% began using substances under the age of 15 (NTA 2013). A more in-depth analysis of the 2011-12 figures reveal that Merton young people in treatment had a high-risk profile for polydrug use, offending and early onset.

Effective treatment for young people can be achieved in a relatively short time, as their use is not as entrenched, but others will need support for longer periods of time. The proportion of those leaving in a planned way as a percentage of all exits was 82% in 2012-13 in Merton compared with the national figure of 79% (NTA 2013). Of the planned exits, 97% did not represent to services within six months. This is an increase on previous years.  

Key facts on services

See also Merton: Alcohol, drugs and substance misuse

A Department for Education cost-benefit analysis found that every £1 invested in specialist treatment interventions delivered up to £8 in long-term savings and almost £2 within two years.

LBM currently commissions a specialist Substance Misuse Service to provide three key work strands: increasing substance awareness; identification of needs and referrals; and providing treatment. This is achieved through:

  • providing support to universal or targeted services via advice and consultancy
  • developing capacity to identify substance-related needs of young people through joint working with, advice to and training of service staff working with vulnerable young people
  • providing a service for young people aged 18 to 24
  • delivering education workshops in schools, colleges and via education, training and employment services
  • providing a range of specialist, care-planned substance misuse treatment interventions
  • supporting services for parents through interventions that enable them to support the young person in the family, or as a young parent. Interventions are also offered to kin carers, and foster carers.

A specialist Substance Misuse Service also operates through the Child and Adolescent Mental Health Service (CAMHS) and is commissioned to work with young people with a dual diagnosis of substance misuse and mental health. Early identification and prevention elements for substance misuse are also integrated into mainstream youth service delivery.

What works and best practice

To tackle some of the root causes and to find solutions to prevent harm from drug and alcohol misuse require tight partnership working. The provision of specialist substance misuse services for young people is also outlined within the memorandum of understanding (MoU) between the Department for Education and Public Health England (formally the National Treatment Agency). The MoU highlights that local delivery of young people’s substance misuse interventions should be integrated into broader children’s services provision, with planning and commissioning becoming an integral part of strategic children’s and young people’s planning. This presents an opportunity to ensure specialist interventions are integrated with wider children’s services to effectively address the root causes of their problems and build the resilience they need to resist substance misuse in the future.

Evidence about what works to prevent harmful drinking has been produced by National Institute for Health and Care Excellence (NICE) in 2010. For young people the evidence recommends supporting children and young people aged 10-15 years and commissioning screening and extended brief interventions for young people aged 16-17 years.

NICE further recommends school-based interventions on alcohol, including:

  • screening for young people aged 16-17 years
  • brief intervention for hazardous or harmful drinking
  • age-sensitive school-based education and advice on potential damage through alcohol use
  • introducing a ‘whole school’ approach to alcohol
  • ensuring locally defined care pathways for alcohol treatment.

For vulnerable young people who are problematic substance misusers, offering motivational interviewing has been shown to be effective in reducing or stopping substance misuse.

Vulnerable young people assessed to be at high risk, specialist interventions should offer:

  • family-based programmes of structured support, and more intensive support for those who need it
  • group-based behavioural therapy
  • parents or carers group-based training in parenting skills
  • counselling-based techniques to encourage behavioural and emotional change
  • pharmacological interventions, including prescribing for detoxification.

In terms of primary prevention, interactive education programmes should be part of a comprehensive prevention programme that includes:

  • in schools, interventions with children, parents and teachers
  • multi-component programmes (e.g. school-based drug education; parent or carer involvement; media campaigns; community partnerships; local health initiatives)
  • life skills training (LST).

Commissioners must also focus on primary preventive measures for all children to ensure that the focus isn't solely on secondary prevention (i.e. those already at risk). Merton’s joint Teenage Pregnancy and Substance Misuse Partnership Board oversees the delivery of annual locally agreed action plans that focus on both primary preventive measures and secondary prevention. This includes:

  • The delivery of a young people’s specialist Substance Misuse Service (up to age 24) providing a range of specialist interventions and targeted prevention programmes.
  • Support for the delivery of effective drug and alcohol education.
  • Commissioning of an interactive Theatre in Education project addressing sexual health and consequences of alcohol consumption in Merton secondary schools and youth settings.
  • Further development of the successful South West London Getting It On sexual health website to include information on drugs and alcohol.
  • Workforce training and development on early identification of young people at risk.

Further sources

DCSF and NTA (2008). Memorandum of Understanding between the Department for Children, Schools and the Families (DCSF) and National Treatment Agency for Substance Misuse Treatment (NTA) on Young People’s Specialist Substance Misuse Treatment. FINAL.

HM Government (2011).  Positive for Youth: A new approach to cross-government policy for young people aged 13 to 19.

HM Government (2010). Drug Strategy 2010.  Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life.

National Institute for Health and Care Excellence (2007).  Interventions to reduce substance misuse among vulnerable young people.

National Institute for Health and Care Excellence (2007).  School-based interventions on alcohol. Public Health guidance PH7.

 

National Institute for Health and Care Excellence (2010).  Alcohol-use disorders – preventing harmful drinking. Public Health guidance PH24.

Public Health England (2013). Alcohol and drugs: JSNA support pack; Key data to support planning for effective young people’s specialist substance misuse interventions, Merton.

Ward Management Ltd (2012). Young People’s Sexual Health and Substance Misuse Services – Independent Evaluation.

Ward Management Ltd (2013). Young People’s Sexual Health and Substance Misuse Needs Assessment.