Substance misuse

Overview and key messages

The Welsh Government’s 10 year strategy (Welsh Government, 2008) provides the framework for partner organisations in West Wales to tackle the harms associated with drug and alcohol misuse across four key themes;
  • Preventing harm
  • Support for those that misuse drugs and alcohol in order to improve their health and aid and maintain recovery
  • Supporting and protecting families
  • Tackling availability and protecting individuals and communities via enforcement activity

Those at risk of harm from alcohol misuse come from across the spectrum of society. They include chronic heavy drinkers, adults at home drinking hazardous or harmful levels and children and young adults who suffer from the consequences of parental alcohol misuse. The health impact of misuse of alcohol is considerable; more people die from alcohol related causes than from breast cancer, cervical cancer and MRSA infection combined. Foetal alcohol syndrome is also a risk to the babies of mothers who use alcohol. Most recent data on hospital admissions for Hywel Dda University Health Board show that over 5,000 bed days were taken up by patients with alcohol related conditions at a cost to the Health Board of over £5.2million per year in in-patient treatment alone.

Misuse of drugs, both legal and illegal, and other mind-altering substances such as solvents, can damage health in a variety of ways. These include fatal overdoses, addiction, mental health problems, infections caused by injecting and the toxic effects of the many substances that dealers mix with the active substance. Although the greatest harms are associated with the use of illicit drugs, the misuse of prescription only medicines and over the counter medicines continues to be a problem.

 

 

Demographics and trends

Within the West Wales region the percentage of adults drinking above the recommended guidelines has reduced by 5% since 2010/11 and from 40% to 37% in 2014/15 (Welsh Government, 2016).

 

 

 

 

 

Demographics and trends

The percentage of adults binge drinking has reduced by 4% over the same time period from 24% to 20%. Hywel Dda UHB is below the Welsh average for both indicators.

 

 

Demographics and trends

Whilst there has been some decreases for Ceredigion and Pembrokeshire in alcohol related hospital admissions, in Carmarthenshire there has been an overall increase of 6.7% between 2014/15 and 2015/16. Similarly, for alcohol attributable hospital admissions both Pembrokeshire and Carmarthenshire have seen rises of 1.3% and 1.7% respectively since 2014/15. (Public Health Wales, 2016)

In 2015/16 there were 1137 referrals for alcohol treatment with 82% successfully completing treatment. In the same year there were 713 referrals for drug treatment with 79% completing treatment. The figures for those successfully completing treatment are above the Welsh baseline.

Of those accessing drug treatment 65% were male and the largest number of referrals were in the 30-39 years age group (27%), followed by 24% in the 40-49 year age group and 13% in the 50-59 year age group.

There are considerable variations between local authorities in the proportion of Children in Need cases where parental substance misuse is a factor. The figures for the West Wales region are below the Welsh average and Ceredigion and Pembrokeshire have the lowest proportions in Wales. These areas have dedicated Hidden Harm services and Integrated Family Support Services (IFSS) which may account for the lower figures.

West Wales area data for school exclusions due to substance misuse are not available, but Welsh data (Public Health Wales, 2016) indicates that permanent exclusions as a result of drug or alcohol related incidents across Wales was 20.2% in 2015/16. Exclusion from school is a key vulnerability for young people and can result in lack of meaningful daily learning and activities.

There has been an increase in drug related deaths during 2016 compared to 2015/16 and a similar increase is being experienced elsewhere in Wales and in England.

Current and future care and support needs

The Dyfed Area Planning Board for Substance Misuse are developing their commissioning strategy in order to address the following population outcomes:

  • To stop people from starting to take drugs, and to reduce harm from alcohol through ensuring the whole population is informed of the risk and side effects of drug and alcohol misuse
  • To minimize the impact of drug and alcohol use on the health and well-being and safety of children, young people and families
  • To support people with substance misuse issues to achieve a good quality, meaningful life and to make a positive contribution to the community
  • To reduce health related harm as a result of drug and alcohol misuse and make communities safer through tackling issues created by drug and alcohol misuse within communities

Current care and support provision

In April 2015 a new Dyfed wide drug and alcohol service (DDAS) was commissioned by the Dyfed Area Planning Board for Substance Misuse in partnership with the Police and Crime Commissioner, National Probation Service, Hywel Dda University Health Board and two of the three local authorities. The service provides a single point of contact for access to all adult drug and alcohol treatment services, including for criminal justice clients, and is delivered by a consortium of third sector partners.

The region adopts a partnership approach and in each LA area weekly meetings are held between DDAS, HDUHB and LA Substance Misuse teams to manage risk, where appropriate share information and oversee the transfer of care between teams. Teams are co-located in dedicated bases throughout the region and have established systems and protocols to reduce the barriers to effective partnership working.

Referrals into Tier 4 treatment – Inpatient Detoxification or Residential Rehabilitation – are also managed by the Tier 3 community teams. Social Care teams also access other types of specialist accommodation such as that commissioned through the Supporting People Programme for example ‘dry house’ or supported accommodation provision, as well as Floating Support for individuals with substance misuse needs within their own homes in the community.

The UHB and LAs commission a range of third sector organisations to support people with substance misuse needs including information and advice, counselling services as well as treatment and support services. There are many voluntary and community organisations and social enterprises working with people with substance misuse needs including Drugaid, Chooselife and Cais.

A specialist children and young people’s service is provided by Drugaid Choices West, a third sector organisation who link closely with a range of other partners including the Police School Liaison Officers, Specialist Child and Adolescent Mental Health Services (Sp CAMHS), Children’s Services, Youth Services, HDUHB Youth Health Team and Youth Offending Services. The Dyfed Area Planning Board also commission a dual-diagnosis service for young people who have co-occurring mental health and substance misuse needs and this is provided by Hywel Dda UHB Specialist CAMHS.

Gaps and Areas for Improvement

The Dyfed Area Planning Board for Substance Misuse is in the process of developing its third Commissioning Strategy for Drug and Alcohol Misuse. This will involve the development of a full needs assessment, market and service mapping, gap analysis and the development of future commissioning intentions. The development of fit for purpose services right across the range is an on-going journey but a number of areas in which further improvements can be made have been set out below against the core principles of the SSWB Act. The further development of services will be in the context of strategic priorities within the national ‘Working Together to Reduce Harm –Substance Misuse Delivery Plan 2016-18’ (Welsh Government, 2016).
 
  • Ensuring that children, young people and families are able to access services through their language of choice and that the offer through the medium of Welsh is available
  • Establishing a more co-ordinated and coherent approach to drug and alcohol misuse education and awareness raising for young people across schools and for those who are not in education, employment and training (NEET)
  • Establishing clear and coherent treatment options for young people and their families with drug and alcohol problems to provide a more holistic approach to prevention and early intervention ensuring that there is a clear link to the Adverse Childhood Experiences (ACE) agenda
  • Developing clear pathways between services for service users with co-occurring substance misuse and mental health
  • Targeting prevention, early intervention and treatment interventions to reduce harm to older people (50 plus) with alcohol problems
  • Development of housing options and reintegration opportunities within the community for recovering service users
  • Establishing, developing, implementing and managing a robust process for the review of both fatal and non-fatal overdoses including the rollout of the distribution of Naloxone across hospital sites
  • Developing consistent, integrated commissioning and procurement processes based on co-production principles, which involve service users, carers, young carers, parents or significant others, user-led community-based groups and fora in the design and delivery of services