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Interesting things about alcohol and other drugsFebruary 2017ANDREW BROWN@ANDREWBROWN365
There were 27,428 appointments made with drug and alcohol treatment for people who used adult secondary mental health and learning disabilities services between April and November 2015
Attended Did not attend Appointment cancelled/postponed by provider
Invalid/missing data0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0% n = 27,428
Source: Mental Health Bulletin: 2015-16 Annual Report (NHS Digital, 2016)
Estimated excess deaths per year below age 70 in England for people with diagnosed mental health disorder, by diagnosed disorder
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000 UnnaturalNatural
Source: On the State of the Public’s Health, Baby Boomers: Fit for the Future (Department of Health, 2016)
The number of offences charged and reaching a first hearing at a Magistrates’ court in England under section 3 of the Vagrancy Act 1824
2006-07
2007-08
2008-09
2009-10
2010-2011
2011-12
2012-13
2013-14
2014-15
2015-16
-
500
1,000
1,500
2,000
2,500
3,000
3,500
Source: Rough Sleepers and Anti-Social Behaviour (England) (House of Commons Library, 2016)
“Begging is an offence under section 3 of the Vagrancy Act 1824 (as amended). It is a recordable offence. The maximum sentence is a fine at level 3 on the standard scale (currently £1000). Other provisions also criminalise begging behaviour: wilfully blocking free passage along a highway is an offence contrary to section 137 of the Highways Act 1980 (as amended), punishable by a level 3 fine. Using threatening or abusive words or behaviour is an offence under section 5 of the Public Order Act 1986, which also carries a level 3 fine.”
Average custodial sentence (months) in England for drug offences
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 201626
27
28
29
30
31
32
33
34
35
3635.1
32.6 32.5 32.331.5
30.629.9 29.6
31.6
33.5 33.6
Aver
age
cust
odia
l sen
tenc
e (m
onth
s)
Source: Criminal justice system statistics quarterly (MoJ 2016)
“The requirements for courts to follow the wide overall offence guidelines, rather than the narrower category ranges within them, mean that the Council can report high rates of compliance. In 2014, for drug possession offences, 84 per cent of sentences imposed fell within the guideline offence range for Class A drugs, over 99% for class B and 89% for Class C.”
Source: The Sentencing Council for England and Wales: brake or accelerator on the use of prison? (Transform Justice 2016)
New sentencing guidelines
The five countries with the highest estimated prevalence of drinking in pregnancy
Russia UK Denmark Belarus Ireland0%
10%
20%
30%
40%
50%
60%
70%
80% “We estimated the prevalence of alcohol use during pregnancy among the general population via random-effects meta-analyses for 29 countries and via fractional response modelling for 158 countries (ie, countries with one or no empirical studies). The five countries with the highest estimated prevalence of alcohol use during pregnancy were Russia, UK, Denmark , Belarus, and Ireland.”
Source: Popova, Svetlana et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health
Estimated prevalence of fetal alcohol syndrome (per 10,000) among the general population in selected countries
Russian Federation United Kingdom Denmark Belarus Italy Ireland Croatia 0
50
100
150
200
250
Source: Popova, Svetlana et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health
Proportion of respondents to the Crime Survey for England and Wales identifying drug use and drunkenness as very/fairly big problem in their communities
2005 - 06 2006 - 07 2007 - 08 2008 - 09 2009 - 10 2010 - 11 2011 - 12 2012 - 13 2013 - 14 2014 - 15 2015 - 160
5
10
15
20
25
30
People using or dealing drugs
People being drunk or rowdy in public places
Source: Crime in England & Wales, year ending March 2016 - Annual trend and demographic tables (ONS, 2017)
Number of drug offences recorded by police, for selected periods from year ending March 2006 to year ending September 2016
Apr '05 to Mar '06
Apr '10 to Mar '11
Oct ' 14 to Sep '15
Oct '15 to Sep '16
0
50,000
100,000
150,000
200,000
250,000
Trafficking of drugs Possession of drugs
Number offences for possession of cannabis recorded by the police in England and Wales by quarter
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q22012-13 2013-14 2014-15 2015-16 2016-17
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Source: Police recorded crime and outcomes open data tables (Home Office, 2017)
Comparing the first half of 2012-13 with the first half of 2016-17 there were 31 thousand fewer cannabis possession offences recorded by the police in England and Wales, a fall of 42%.The following areas saw over 50% fall in the number of offences recorded between 2012-13 and 2015-16: Avon and Somerset (-62%), British Transport Police (-56%), Cambridgeshire (-54%), Greater Manchester (-57%), Leicestershire (-67%), Merseyside (-50%).
Diagnosis of alcohol abuse or dependence by age of onset of alcohol use amongst adolescents who had consumed alcohol in the past 3 months visiting Emergency Departments in England (n=609)
Age of onset before age 15 Age of onset age 15+0
50
100
150
200
250
300 No diagnosis Diagnosis Among adolescents who had consumed alcohol in the past 3 months, 15% screened positive for alcohol abuse or dependence (using MINIKID).
“The prevalence of a diagnosis of alcohol abuse or dependence was considerably higher among participants who started drinking before the age of 15 years, with almost 1 in 3 meeting the criteria for alcohol abuse or dependence.”
Source: Donoghue, Kim et al. Alcohol Consumption, Early-Onset Drinking, and Health-Related Consequences in Adolescents Presenting at Emergency Departments in England, Journal of Adolescent Health
Top 10 telephone enquiries and TOXBASE accesses relating to drugs of misuse
Branded pro
ducts
Cocaine
Legal
high (unkn
own)
MDMAHero
in
Cannabis
SCRAs
Diazepam
Methadone
Amphetamines
Mephedro
ne0
50
100
150
200
250
300
Number of telephone calls Branded products, such as ‘Black Mamba’, ‘Vertex’ or ‘Sweet Leaf’ were the most common reason for health professionals to contact NPIS by telephone in regards to drugs of misuse. Analytical data published by other sources, such as WEDINOS , suggest that the great majority of these contain synthetic cannabinoid receptor agonists (SCRAs).
Enquiries relating to branded products fell compared with the previous year, but there has been a marked increase in those enquiry numbers where the health professional suspected exposure to a SCRA. In only eight of the 108 telephone enquiries (7.4%) the caller reported the specific chemical involved, meaning in most cases the caller had recognised that a SCRA of some type was involved.
Source: National Poisons Information Service Report 2015/2016 (NPIS)
Number of TB cases with social risk factors
2010 2011 2012 2013 2014 20150
50
100
150
200
250
300 Drug misuse Alcohol misuse Homelessnes Prison
Source: Public Health England (2017) Tackling TB in Under-Served Populations: A Resource for TB Control Boards and their partners. Public Health England: London.
There has been an increase in the number and proportion of TB cases reporting drug misuse between 2010 and 2015, from 2.9% (188/6,551) in 2010 to 4.3% (221/5,189) in 2015. There has also been an increase in the number and proportion of TB cases reporting alcohol misuse between 2014 and 2015, from 3.4% (197/5,770) to 3.9% (205/5,191).
ETS data shows that between 2010 and 2015 the proportion of TB cases with a current or history of homelessness increased from 3.0% to 4.4%
Between 2010 and 2015, ETS data shows that the proportion of TB cases with current or a history of imprisonment has fluctuated between 2.8% and 3.9%.
Positive drug tests amongst members of the UK armed forces in 2014 and 2015, by drug type and by rank
2014 20150
100
200
300
400
500
600
700
Cocaine Ecstasy Cannabis BenzoSteroids Amphetamine Other
2014 20150
100
200
300
400
500
600
700
Pte aged 16-24 Pte aged 25 or over LBdr LCplBdr, Cpl, CofH Sgt
Source: Freedom of Information Request
In accordance with the Data Protection Act and obligations in relation to the protection of confidentiality when handling personal data, the figures provided have been rounded to the nearest 10, and where below 5 have been suppressed.
Latest observed mortality from alcohol-related causes as a proportion of all mortality, amongst adults aged 35-79 years
Men (aged 35-79 yrs) Women (aged 35–79 yrs)0.0%
1.0%
2.0%
3.0%
4.0%
5.0%4.5%
2.5%2.3%
1.8%
3.3%
1.9%
ScotlandEngand and WalesEurope (median)
Source: Mackenbach, Johan P., et al. "Inequalities in alcohol-related mortality in 17 European countries: a retrospective analysis of mortality registers." PLoS Med 12.12 (2015): e1001909.
Number of people in contact with NHS funded adult secondary mental health and learning disability services by provider type, 2003/04 - estimated 2015/16
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 -
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000 Independent providersNHS providers
Source: Mental Health Bulletin: 2015-16 Annual Report (NHS Digital, 2016)
Hospital outpatient attendances for mental and behavioural disorders due to the use of alcohol and/or drugs
- 2,000 4,000 6,000 8,000
10,000 12,000 14,000 16,000
Source: Hospital Outpatient Activity, 2015-16 (NHS Digital, 2016)
Please note: primary diagnosis is not a mandated field in the outpatients dataset, therefore coverage within this field is poor.
Use of section 136 in England, 2011/12-2015/16, health and police based places of safety
2011/12 2012/13 2013/14 2014/15 2015/16 -
5,000
10,000
15,000
20,000
25,000 where PoS was health-based i.e. a hospital
where PoS was police cell or cus-tody suite
The use of section 136 of The Act (under which people were brought to hospital as a ‘place of safety’) increased by 18 per cent since last year, to 22,965.
The increase in uses of Section 136 to take people to a hospital as a place of safety should also be viewed in the context of a fall by a similar number in the use of section 136 where the place of safety is a police cell. Data released by the police in 2016, and previous years, shows the number of uses of section 136 where the place of safety was a police cell in England reducing from just under 9,000 in 2011/12 to 1,764 in 2015/16, a fall in number of 6,903 (80%) across that four year period.
Source: Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment (NHS Digital, 2016)
Numbers of people referred to Drink Drive Rehabilitation (DDR) Schemes and the number of completions, across England and Scotland
0
2,000
4,000
6,000
8,000
10,000
12,000 ReferralsCourse completion
Source: Drink-drive rehabilitation scheme data (Driver and Vehicle Standards Agency, 2016)
Last month traditional drug use by vulnerable users of Novel Psychoactive Substances in Scotland
Cannabis
Benzodiazepines
Heroin
Power Coca
ineCrack
Ecstasy
Poppers
Amphetamine
Ketamine
LSD / m
ushrooms
Crystal M
eth
2C drugs
Nitrous O
xide
Solve
nts0%
10%
20%
30%
40%
50%
60% • The majority of those using NPS in the last six months reported having taken synthetic cannabinoids (41%, n=104) and benzo-type NPS (41%, n=102), while approximately one fifth reported taking stimulant-type NPS (21%, n=53) and mephedrone (19%, n=48).
• Poly-substance use was very high. Only one person reported being a sole NPS user, with 99% (n=251) of NPS users also reporting traditional drug use.
• 86% (n=364) of all respondents to the NPS survey reported ever using traditional illicit drugs. Use of illicit substances within the last 6 months included: cannabis (40%, n=148), benzodiazepines (29%, n=105), heroin (23%, n=83) and powder cocaine (13%, n=46).
Source: Understanding the patterns of use, motives, and harms of New Psychoactive Substances in Scotland (Scottish Government, 2016)
n = 252
Proportion of vulnerable groups in Scotland with a history of NPS use by substance type
Mental health service users Vulnerable young people Homeless people Men that have sex with men0%
10%
20%
30%
40%
50%
60%
70%Synthetic cannabinoids Benzodiazepine-type NPS Stimulant-type NPS Mephedrone GBH/GBL
n = 99 n = 69 n = 92 n = 70
Source: Understanding the patterns of use, motives, and harms of New Psychoactive Substances in Scotland (Scottish Government, 2016)
Sources of New Psychoactive Substances amongst users in vulnerable groups in Scotland
Mental health service users Vulnerable young people Homeless people Men that have sex with men People who inject drugs0%
10%
20%
30%
40%
50%
60%Dealers Shops Friends or family Online
Source: Understanding the patterns of use, motives, and harms of New Psychoactive Substances in Scotland (Scottish Government, 2016)
n = 99 n = 69 n = 92 n = 70 n = 141
Number of looked after children aged 16 to 17 years identified with substance misuse needs and the proportion refusing intervention
2014 2015 20160
200
400
600
800
1,000
1,200
1,400
0%
10%
20%
30%
40%
50%
60%Male Female Refused intervention
Num
ber i
denti
fied
with
subs
tanc
e us
e ne
ed
Prop
ortio
n re
fusin
g in
terv
entio
n
Any young person who is at increased risk of substance misuse, including those who are leaving care, should be provided with targeted prevention support which focuses on reducing risks and strengthening resilience. Through commissioning of public health services, local councils should ensure they have clear referral pathways into specialist substance misuse services for those young people who are assessed as requiring structured drug and alcohol interventions.
Source: Healthy futures; Supporting and promoting the health needs of looked after children (LGA, 2016)
Source: Children looked after in England including adoption: 2015 to 2016 (DfE, 2016)
Proportion of higher risk drinkers in England – men who drink over 50 units a week, and women who drink over 35 unitsMEN
16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+0
1
2
3
4
5
6
7
8More than 50 units
WOMEN
16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+0
1
2
3
4
5
6
7
8 More than 50 unitsMore than 35, up to 50 units
Source: Health Survey for England (NHS Digital 2016)
Distribution of alcohol consumption risk group for those aged 40 to 60 between 1991 to 1993 and 2011 to 2013
non-drinkers lower risk increasing risk higher risk0%
10%
20%
30%
40%
50%
60%
70%
80%
90% Female1991 to 19932011 to 2013
non-drinkers lower risk increasing risk higher risk0%
10%
20%
30%
40%
50%
60%
70%
80%
90% Male1991 to 19932011 to 2013
Source: Changes in the behaviour and health of 40 to 60 year olds between 1991 to 1993 and 2011 to 2013 (PHE 2016)
Drugs used and frequency of use by clients entering drug treatment in Northern Ireland in year ending March 2016
CannabisBenzos
Other HypnoticsCocaineEcstasy
Methedrone/ MephedroneNew Psychoactive Substances
SpeedOther Stimulants
TramadolHeroin
Codeine & ParacetamolCodeine
Other OpiatesSolvents
Other drugs
0 200 400 600 800 1,000 1,200 1,400 1,600 In 2015/16, a total of 2,229 clients presented to services for problem drug misuse for the first time or first time in six months.
Cannabis was the most commonly reported drug (used by two-thirds of clients) followed by Benzodiazepines (37%) and Cocaine (35%).
NB - Problem alcohol use was reported by a third of clients (31%). Only 3% of those in Prison reported problem alcohol use, but this ranged between 37% and 44% in the Health and Social Care Trust areas. Overall, 14% of clients reported alcohol as their main problem.
Source: Statistics from the NI Drug Misuse Database: 1 April 2015 – 31 March 2016 (The Northern Ireland Statistics and Research Agency, 2016)
Daily84%
Weekly11%
Monthly1% Occa-
sionally4%
Number of attendances at A&E in England recorded as having social problems (including chronic alcoholism and homelessness)
2013-14 2014-15 2015-160
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
39,507 40,86743,993
Please note:
During the period covered not all NHS trusts have provided data submissions to A&E HES and data quality can be poor for some fields.
Source: Accident and Emergency Attendances in England - 2014-15 and Hospital Accident and Emergency Activity, 2015-16 NHS Digital
Number of attendances at A&E in England diagnosed with psychiatric conditions
2013-14 2014-15 2015-160
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
143,090 146,574
165,999Please note:
During the period covered not all NHS trusts have provided data submissions to A&E HES and data quality can be poor for some fields.
Source: Accident and Emergency Attendances in England - 2014-15 and Hospital Accident and Emergency Activity, 2015-16 NHS Digital
A&E attendances by day and hour of arrival (Assaults), 2015-16
04:0009:0014:0019:0000:0005:0010:0015:0020:0001:0006:0011:0016:0021:0002:0007:0012:0017:0022:0003:0008:0013:0018:0023:0004:0009:0014:0019:0000:0005:0010:0015:0020:00Monday Tuesday Wednesday Thursday Friday Saturday Sunday
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
Day and hour of arrival
Percentage
Source: Hospital Accident and Emergency Activity, 2015-16 NHS Digital
Young people in receipt of specialist drug and alcohol services in England in 2015-16DATA FROM THE ANNUAL REPORT FROM PHE
Age profile of young people in treatment in England over the last decade
2010-11 2011-12 2012-13 2013-14 2014-15 2015-160
1,000
2,000
3,000
4,000
5,000
6,000
7,000 Under 12 12-13 13-14 14-15 15-16 16-17 17-18 “The number of young people attending specialist substance misuse services during 2015-16 was 17,077, a decrease of 1,272 (7%) from 18,349 in 2014-15, and a reduction of 6,976 (29%) since the peak of 24,053 in 2008-09. Falling alcohol and drug use among young people in general may in part explain this decline, although it is also possible that any reduction in the provision of youth support services may affect the number of referrals.”
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
The number of young people entering treatment with a primary problem with cannabis or alcohol in comparison with all other drugs
2010-11 2011-12 2012-13 2013-14 2014-15 2015-160
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Cannabis Alcohol All other drugs
“Since 2005-06, young people have been increasingly likely to seek help for problems with cannabis compared to other substances. During 2015-16, 12,863 presented to specialist services with cannabis as their primary substance (75% of all those receiving help during the year). Although there was a 7% fall in the number of young people in treatment in 2015-16, the proportion of young people citing primary cannabis use increased slightly (from 73% in 2014-15 to 75% in 2015-16).”
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
Sources of referral into drug and alcohol treatment for young people in England
Education
Criminal ju
stice
Socia
l care
Self,
family and fr
iends
Health
Substa
nce m
isuse se
rvice
Young people's housin
gOther
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
2012-13 2013-14 2014-15 2015-16 “The most common route into specialist treatment services [in 2015-16] was via education services (28%). The youth justice system was the second most common referral source (26%), with youth offending teams being the single largest source (23%), although this has been declining in recent years. This is the first year of reporting that referrals from education services have exceeded referrals from youth/criminal justice sources.”
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
Age and gender breakdown of young people starting treatment in England in 2015-16 who reported sexual exploitation
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
Under 14 14-15 15-16 16-17 17-180
20
40
60
80
100
120
140
160
180 Female Male “Overall, 6% of young people reported sexual exploitation. However, the proportion is much higher among females (14%) than males (just over 1%). Although these figures suggest a large difference between sexual exploitation experienced by boys and girls, research from Barnardo’s has highlighted difficulties in identifying sexual exploitation of boys and young men because they often do not disclose abuse. The median age of young people reporting sexual exploitation was 15, compared to 16 for all new presentations, reflecting the high proportion who was female.”
Where are young people living, if they are not living with their parents or other relatives?
YP living in
care
YP supporte
d housing
Independent – se
ttled accommodation
Independent – unsettled/housin
g problem
YP living in
secu
re care
Independent – no fixe
d abode -
200
400
600
800
1,000
1,200
1,400
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
Selected individual vulnerabilities identified among all young people starting treatment in England in 2015-16
Affected by o
thers' su
bstance
misu
se
Affected by d
omestic a
buse
Mental health
problem
Self-h
arm
Sexu
al exp
loitation
Pregnant and/or p
arent
Injecting
- 200 400 600 800
1,000 1,200 1,400 1,600 1,800 Female Male “Young people do not develop substance misuse
problems in isolation. The 2015-16 data shows that a significant proportion of young people who entered specialist treatment services also had other multiple problems or vulnerabilities that were linked to their substance misuse. “For some young people these wider issues may be the cause of their substance misuse problems, and for others, a consequence. So it is vitally important that young people’s treatment services are working closely with a wide range of other children and young people’s health and social care services, to ensure that vulnerable young people have all their needs supported.”
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)
