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APPENDIX A 16/05/13
1
APPENDIX A
Drug and Alcohol Services in
Leicester
Joanne Atkinson, Consultant in Public Health
Kate Galoppi, Head of Drug and Alcohol Action Team
19th June 2012
1
Aim of presentation
• To introduce members to the issues of drug and alcohol misuse in Leicester including:
– The extent of the problem
– Existing services
– Gaps in service provision
• Drug and Alcohol needs assessment recently undertaken – presented to SLP 12th June which forms basis for much of the presentation
2
APPENDIX A 16/05/13
2
Aims and objectives of needs
assessment
• Provide a clear and accurate statement of
needs re: substance misuse in Leicester by;
– Collecting and appraising data
– Reviewing evidence base
– Reviewing current system
– Engaging stakeholders
– Disseminate findings
3
National Policy
• 2010 Drugs strategy
– Reduce use
– Increase recovery
– By reducing demand, restricting supply & building recovery into communities
• 2012 Alcohol strategy
– Reduce excess drinking
– By behaviour, crime, binge drinking, alcohol related deaths, young people drinking
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APPENDIX A 16/05/13
3
Local Policy
• Safer Leicester Partnership provides the oversight re: substance misuse and includes a range of partners
• Relevant sub-groups of SLP:- Alcohol Delivery Group- Drug and Alcohol Commissioning Group
• Local strategies and plans include:– Adult drug treatment strategy
– Young peoples substance misuse plan
– Alcohol harm reduction strategy
5
Demographics
A young and growing population
6% 4% 2% 0% 2% 4% 6%
00-04
05-09
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Leicester Population structure, 2010 and 2020
England Females 2010 Leicester Females 2020 Leicester Males 2020
Leicester Females 2010 England Males 2010 Leicester Males 2010
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APPENDIX A 16/05/13
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Demographics II
High levels of deprivation
7
Drug use
• Estimated 2,539 OCU (Opiate/ Crack Users) in Leicester
• 6% report taking drugs in last 12 months, (Leicester Lifestyle Survey) v 8.8% England
• Majority cannabis followed by cocaine/coke
• Higher usage in males, 16-24 year olds and white groups
• Nationally 18% of 11-15yr olds reported taking drugs in the last year
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APPENDIX A 16/05/13
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Alcohol
• In Leicester it has been estimated that: – 63,000 adults (26.2%) drink above recommended levels
– almost 13,000 (5.3%) drinking at harmful levels and
– almost 9,000 (3.6%) dependent on alcohol
• Leicester Lifestyle Survey backs this up – 27% reported drinking above the recommended levels
• However we have a relatively low proportion of people that drink alcohol – just under half of the adult population report that they do not drink
• More males than females report drinking above recommended levels (32% v 23%), highest in 16-24 yr olds (33%) and white populations (36% v 12% in Asian groups)
• Young people (11-15 yr olds) TellUs4 Survey (2009)– 20% reported ever having an alcoholic drink (42% - England)
9
Vulnerable groups
• Clear association between mental illness and drug/ alcohol dependence.
• Estimated that 33% psychiatric patients with serious mental illness have a substance misuse problem (dual diagnosis)
• In Leicester 9% of new drug treatment journeys had dual diagnosis v 14% nationally
• 10% of new alcohol treatment journeys had dual diagnosis v 16% nationally
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APPENDIX A 16/05/13
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Health outcomes: Drugs
0
10
20
30
40
50
60
Ra
te p
er
10
0,0
00
Hospital admission rates for drug poisoning (primary diagnosis),
2010-11
11
Health outcomes: Drugs II
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APPENDIX A 16/05/13
7
Health outcomes: Alcohol
395 405 419 430535 537
652 676 676
952
203 189 148 211 220 210 267 261 250403
0
200
400
600
800
1000
1200
Ag
e-s
tan
da
rd
ise
d r
ate
pe
r 1
00
,00
0
Alcohol-specific hospital admissions for Males and Females, 2009-10 Age
standardised rate per 100,000
Males
Females
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Health outcomes: Alcohol II
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APPENDIX A 16/05/13
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Deaths: Alcohol
35.9
14.9
34.7
15.5
55.7
20.4
13.16.1
12.36.1
19.9
7.90
10
20
30
40
50
60
Eng Males Eng Females EMids Males EMids Females Leicester Males Leicester
Females
Ag
e-s
tan
da
rdis
ed
ra
te p
er
10
0,0
00
Alcohol-specific and alcohol-attributable mortality for Males
and Females, 2007-2009
Alcohol attributable mort rate Alcohol specific mort rate
15
Treatment
Tier 4
Tier 3
Tier 2
Tier 1
Non-substance misuse specific services requiring
interface with drug and alcohol treatment (e.g. primary
care/ A&E/ housing/ police)
Open access drug and alcohol treatment centres (e.g.
Drop-in clinics - Leicester Community Projects Trust LCPT)
Structured care planned
community-based treatment
services (e.g. Community Drug
and Alcohol Teams, LPT)
Inpatient/ Residential services for drug
and alcohol clients (e.g. inpatient detox,
LPT/ residential rehab)
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APPENDIX A 16/05/13
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Current Treatment Services
LCPT (Leicestershire Communities Projects Trust)
• Public front door
• Drugs/Alcohol
• Drop-in and phone advice
• Assessment
• Needle exchange
• Baseline (Crack Cocaine)
• Casework
LPT (Leicestershire Partnership Trust - NHS)
• Referrals from LCPT and other agencies e.g. GPs
• Drugs/Alcohol
• Assessment
• Casework
• Subsitute Prescribing
• Screening & vaccination for blood borne viruses
• Referral to detox
• Primary Care Support to GPs
QoL (Quality of Life Service)
- provided by Leics & Rutland Probation Trust
• Referral from other agencies and some public access
• Drug/Alcohol
• Recovery services
• Group work
• Peer Mentors
• Parents/Carers services
CJDT (Criminal Justice Drugs Team)
- provided by Leics & Rutland Probation Trust
• Integrated treatment pathway for offenders
• Drugs/ Alcohol
• Alcohol Arrest referral
• DIP (Drug Intervention Programme)
• Structured treatment
• Community orders
• Treatment within HMP Leicester
17
Other related services
• Alcohol liaison workers in UHL (tier 2)
• Substance misuse midwife in UHL
• Alcohol Locally Enhanced Service with GPs
(brief interventions)
• Alcohol worker based in the Dawn centre
• Anchor Centre (wet day centre working
predominately with street drinkers)
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APPENDIX A 16/05/13
10
Adult Treatment: Drugs
Referral
• Criminal Justice - 319 (52%)
• Self - 81 (13%)
• GP - 56 (9%)
• Drug Services - 141 (23%)
• Other - 24 (3%)
Treatment
• CJDT - 596 (35%)
• LCPT 120 (7%)
• CDT - 960 (56%)
• Inpatients - 34 (2%)
Discharge
• Planned - 155 (32%)
• Referred on - 194 (40%)
• Unplanned - 138 (28%)
19
Adult Treatment: Alcohol
Referral
• Criminal Justice - 85 (18%)
• Self - 14 (3%)
• Health and Mental Health Services - 255 (54%)
• Other - 118 (25%)
Treatment
• Tier 3 and 4
• Other structured treatment - 580 (79%)
• Inpatient - 78 (11%)
• Structured day programme 65 (9%)
• Other - 14 (1%)
Discharge
• Planned Occasional user - 123 (29%)
• Planned Alc/Drug Free - 111 (26%)
• Referred on - 27 (6%)
• Unplanned - 166 (39%)
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APPENDIX A 16/05/13
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Treatment: Young people
Referral
• YOT - 36 (51%)
• Children / Family Services 24 - (34%)
• Family and Friends 6 - (8%)
• Other - 5 (7%)
Treatment
• Psychological - 89 (86%)
• Harm Reduction- 9 (9%)
• Other - 5 (5%)
Discharge
• Planned - 42 (70%)
• Referred on - 10 (17%)
• Unplanned - 8 (13%)
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Funding Available 2012/13
Department of Health £3.6m
Home Office/ Ministry of
Justice
£1.9m
Leicester City Council £0.35m
NHS £1.8m
TOTAL £7.7m
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APPENDIX A 16/05/13
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Recommendations from
needs assessment
• Greater understanding of needs within specific communities is required e.g. South Asian & Somali
• More analysis required regarding whether service provision matches need (Health Equity Audit)
• Further development of dual diagnosis services
• Improved marketing of treatment services
• Further work needed to explore needs of children whose parents are substance misusers
• Better access to support and information at times of crisis
23
Recommendations – cont’d
• Further exploration of why proportion of referrals from criminal justice is so high
• Improve uptake of vaccination to reduce blood borne viruses
• More exploration re: needs of those using legal highs and steroids
• Improved recording within treatment services
• Increase proportion of dependent drinkers accessing treatment
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APPENDIX A 16/05/13
13
Next Steps
• Refresh plans:
- adult drug treatment strategy/ plan
- young peoples’ substance misuse plan
- Alcohol Harm Reduction Strategy/ plan
• Procurement process – from October 2012,
new services in place from 1st July 2013
25