Young people: drugs, treatment and support

Andrew BrownDirector of Policy, Influence

and Engagement, DrugScope

Context

• Most young people will not use substances, and where they do the majority will do so rarely and are unlikely to come to significant harm.

• The last decade has seen significant falls in the number of young people using substances.

• However a small proportion of under 18s continue to require specialist services and research for DfE suggests that the annual cost of crime and health of young people’s substance use is £104 million a year.1

• The same research estimated a benefit of £4.66-£8.38 for every £1 spent on young people’s drug and alcohol treatment.

• Young peoples substance services are commissioned as part of local authorities public health responsibilities.

1 Specialist drug and alcohol services for young people: a cost benefit analysis, DfE (2010)

Policy Context• The 2010 drug strategy saw the Department for Education

leading on reducing demand for illicit drugs.• However, following a review of its purpose the DfE has

relinquished most of its role in drug policy, as a consequence the only remaining responsibility it has is in setting the school curriculum – which is supported by the ADEPIS project http://mentor-adepis.org/.

• The Home Office and Department of Health now have shared responsibility for the reducing demand sections of the strategy, with Public Health England taking a lead in liaising with local commissioners and in running the FRANK website and helpline.

• There is a commitment from government to develop the public health outcomes framework to include outcome indicators based on prevalence data for 15 year olds – to be collected through the What about Youth? survey.

Lessons from Young people’s drug and alcohol treatment at the crossroads

(DrugScope 2010)• Working with young people in treatment is not only about

problem drug or alcohol use, but multiple needs.• A lot of the work done by specialist drug and alcohol

services is not ‘treatment’ in the narrow medical sense.• Polydrug use creates a new challenge for services.• Young people’s services should not be judged by the same

targets as adult services.• A key challenge is the gap between young people’s and

adult services and the issues of transition this raises.• Young people with drug problems may be involved in drug

supply and services need to address this relationship.• We need investment in community and social

regeneration as well as one-to-one support.

Key points from Domino Effects: The impact of localism and austerity on services for young people and on

drug problems (UKDPC 2012)

• Young people’s services are particularly vulnerable to cuts.

• Cuts to generic services can have a knock-on effect on substance misuse problems, which may be being overlooked.

• There is increasing variation in provision between areas, if good practice is to be spread and developing problems addressed some co-ordinated monitoring needs to be established.

Proportion of young people who took drugs in the last year

20012002200320042005200620072008200920102011201220130.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

16-24 years 11 - 15 years

Based on the SDD and CSEW surveys approximately 1.5 million young people and young adults took drugs last year

Estimate of direct government spend on tackling drug use in

2011/12

Enfo

rcem

ent

Trea

tmen

t

Early

inte

rven

tions

Non-re

habi

litat

ive

treat

men

t act

ivity

Educ

atio

n an

d in

form

atio

n ca

mpa

igns

0

400

800

1200

1600

£ (

mil

lio

ns)

“The overall EIG budget is £2.2bn for 2011/12 and drug-specific spend has been estim-ated as £220m; 10 per cent of the total.”

Source: Drug Strategy 2010 Evaluation Framework – evaluating costs and benefits, Home Office (2013)

How substance misuse spending by local authorities broke down in 2013-14

0

200

400

600

£ (

mil

lio

ns)

Source: Local authority revenue expenditure and financing England: 2013 to 2014 individual local authority data

Young people in specialist drug and alcohol services

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 -

5,000

10,000

15,000

20,000

25,000

30,000

Which substances are identified as problems for young people in specialist

services

Opiat

es

Amph

etam

ines

Cocai

ne

Crack

Ecst

asy

Canna

bis

Solven

ts

Alco

hol

Other

0%10%20%30%40%50%60%70%80%

Primary Adjunctive

Young People presenting to specialist services with cannabis and alcohol

issues

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Cannabis Alcohol

Young people presenting to specialist services with issues to

do with club drugs

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

0

500

1000

1500

2000

2500

Ketamine Ecstasy Mephedrone

Source of referrals to specialist services

Yout

h / c

rimin

al ju

stice

Self,

fam

ily &

frie

nds

Health

Educ

atio

n

Social

car

e

Subs

tanc

e m

isus

e se

rvices

Other

0

10

20

30

40

%

Guidance: Interventions to reduce substance misuse among vulnerable

young people• Develop a local strategy• Use existing tools to identify children and young people who are

misusing, or at risk of misusing, substances.• Work with parents and carers and other organisations involved

with children and young people to provide support and, where necessary, to refer them to other services.

• Offer motivational interviews to those who are misusing substances.

• Offer group-based behavioural therapy to children aged 10–12 years  who are persistently aggressive or disruptive  – and deemed at high risk of misusing substances. Offer their parents or carers group-based parent skills training.

• Offer a family-based programme of structured support to children aged 11–16 years who are disadvantaged and deemed at high risk of substance misuse.

Issues and challenges

• Evidence base for effective prevention interventions is slim and few trials conducted in the UK.

• Services balancing prevention and early intervention – as well as wider the risky behaviours agenda.

• National policy leadership more difficult without DfE buy-in.

• Hollowing out of commissioning expertise at local level.

Thank you

Andrew BrownDirector of Policy, Influence and EngagementDrugScope

@andrewbrown365andrewb@drugscope.org.ukwww.drugscope.org.uk