Drug and Alcohol JSNA

305 Pages·2016·7.14 MB·English

CAMBRIDGESHIRE DRUG AND ALCOHOL
JOINT STRATEGIC NEEDS ASSESSMENT
2016
CAMBRIDGESHIRE DRUG AND ALCOHOL
JOINT STRATEGIC NEEDS ASSESSMENT
CONTENTS
ACKNOWLEDGEMENTS ........................................................................................................................... 2
1. INTRODUCTION ................................................................................................................................... 6
2. EXECUTIVE SUMMARY ........................................................................................................................ 7
CHAPTER 1: Key Themes and Concepts in Scope .................................................................................. 30
CHAPTER 2: The National Picture ......................................................................................................... 33
CHAPTER 3: Prevention ......................................................................................................................... 44
CHAPTER 4: Children and Young People ............................................................................................... 56
CHAPTER 5: Adult Alcohol and Drug Misuse ......................................................................................... 93
CHAPTER 6: Misuse of Drugs and Alcohol in Older People ................................................................. 160
CHAPTER 7: Changing Patterns of Drug Misuse .................................................................................. 175
CHAPTER 8: Emerging Issues ............................................................................................................... 194
CHAPTER 9: Dual Diagnosis ................................................................................................................. 213
CHAPTER 10: Drugs and Alcohol in the Criminal Justice System ........................................................ 245
CHAPTER 11: Housing and Homelessness........................................................................................... 271
APPENDIX 1: Homelessness Schemes in Cambridgeshire and Peterborough as at June 2016 .......... 293
APPENDIX 2: Profile of Homelessness Accommodation in Cambridgeshire and Peterborough as at
June 2016 ............................................................................................................................................ 293
APPENDIX 3: Community Engagement Feedback and Summary of the Community Consultation by
Event/Organisation Method ............................................................................................................... 294
APPENDIX 4: Glossary ......................................................................................................................... 297

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ACKNOWLEDGEMENTS
There have been wide ranging stakeholder contributions to this Joint Strategic Needs Assessment
JSNA. This has been through a number of consultation events initially to discuss the scope and
towards the end of its development to discuss key findings and a survey that has been completed by
service users and staff from relevant organisations. A number of information gathering events were
held with current and ex-service users.
Many thanks to all those who have been involved who are listed below and especially to those
service users who are not named but made an excellent contribution to this document.
First Name Surname Subject area Organisation
Eva Acs Young People’s Co- Cambridgeshire County Council –
ordinator Drug and Alcohol Action Team
Arun Aggarwal Gainsborough Foundation Cambridgeshire GP
Emma Amez Project Worker Healthwatch
Aileen Andrews Trading Standards Service Cambridgeshire County Council
Manager
Rita Bali Pharmacist - LPC Rep LPC Representative
Erin Barrett Public Health Work Cambridgeshire County Council -
Placement Public Health
Sue Beecroft Sub-Regional Housing Cambridge City
Strategy Manager
Jess Bendon Senior Contracts Manager Cambridgeshire County Council -
Public Health
Dickon Bevington Medical Director, Anna Cambridgeshire and
Freud Centre, Consultant Peterborough Foundation Trust
CA Psychiatrist
Shaun Birdsall Health Improvement Cambridgeshire County Council -
Specialist Public Health
Gem Blackburn Recovery Co-ordinator View from the Edge
Russell Bowyer Service User Engagement Sun Network
Facilitator
Adrian Boyle A&E Consultant Cambridge University Hospitals
Foundation Trust
Paul Brand The National Drugs Public Health England
Treatment Monitoring
System
Henry Brown Chief Executive Jimmy’s, Cambridge City
Mark Buitendach Clinical Manager Inclusion
Kathy Bullock Services Manager Headway
Jamie Butcher Housing/homeless provider Riverside
Jon Collen Housing Needs and Huntingdonshire District Council
Resources Manager
Vicki Crompton Drug Action Team Co- Cambridgeshire County Council -
ordinator Drug and Alcohol Action Team
Amanda Crosse Consultant in Dental Public Public Health England
Health
Melanie De Souza GP Cambridge Access Centre
2
Annie Gordon Housing Advice Manager Sanctuary Housing Services
Limited
Sarah Gove Customer Services Contact Fenland District Council
Manager
Sarah Green Research/Development Headway
Co-ordinator
David Greening Housing Advice Service Cambridge City Council
Manager
Sue Hall Senior Public Health Cambridgeshire County Council -
Administrator Public Health
Suzanne Hare Young People Substance Child and Adolescent Substance
Misuse Use Service, CPFT
Lucine Harrison Street Outreach Team Change, Grow, Live
Worker
Jane Heeney Co-ordinator of Voluntary Jimmy's Night Shelter
Services
Sue Hinawski Housing Advice Manager South Cambridgeshire District
Council
Holly Hodge Public Health Manager - Cambridgeshire County Council -
Mental Health & Public Health
Community Safety
Brian Holman Manager Cambridge Cyrenians
Emma Hooton Supported Accommodation Cambridge Cyrenians
Manager
Caroline Houlton Deputy Chief Pharmacist Cambridgeshire and
Peterborough Clinical
Commissioning Group –
Medicines Management
Sarah Hughes Chief Executive Officer MIND in Cambridgeshire
Emma Hyde Service user representative
for the homeless
Eileen Jarred Project Worker YMCA
Tom Jefford Head of Participation and Cambridgeshire County Council
Services for Young People
Sue Johnson School Nurse Cambridgeshire Community
Services NHS Trust
Helen Johnston Senior Public Health Cambridgeshire County Council -
Manager – Older People Public Health
Rita Jones Services Manager for Alzheimer’s Society
Cambridge, Ely and
Huntingdon
Joe Keegan Alcohol Strategic Lead Cambridgeshire County Council –
DAAT
Anne Kershenbau Public Health Cambridgeshire County Council -
m Public Health
Si Kerss Drug and Alcohol Action Cambridgeshire County Council -
Team Drug and Alcohol Action Team
Lorna King Operations Manager Carers Trust Cambridgeshire
Tony Lacey Working Group - Health Cambridgeshire County Council -
Improvement Specialist Public Health
Miriam Lynn SexYOUality SexYOUality
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Ailsa Lyons Health Improvement Cambridgeshire County Council -
Specialist (Tobacco Public Health
Control)
James Martin Services Manager Winter Comfort
Elaine Matthews Community Resilience Cambridgeshire County Council
Development Manager
Adele McCormack Mental Health Cambridgeshire and
Commissioning Manager Peterborough Clinical
Commissioning Group
Denise McFarlane Substance Misuse Worker Youth Offending Team,
Cambridgeshire County Council
Paula Milne Housing Advice Manager Sanctuary Housing
Ivan Molyneaux Adult Safeguarding Team Cambridgeshire County Council -
Adult Safeguarding Team
Jon Moore Advanced Public Health Cambridgeshire County Council -
Analyst Public Health
Lucas Oliver Training Lead Inclusion
Ryan O'Neill Advanced Public Health Peterborough City Council
Analyst
Barry Ord Support Worker Inclusion
Angela Parmenter Housing and Community East Cambridgeshire District
Safety Manager Council
Mary Pennant Research Officer Public Health
Paul Pescud Service Manager Inclusion Drugs and Alcohol
Service
Nicky Phillipson Head of Strategic Cambridgeshire Office of Police
Partnerships and and Crime Commissioner
Commissioning
Lily Quantock Project Worker SexYOUality
Wendy Quarry JSNA Programme Cambridgeshire County Council -
Manager Public Health
Kate Rees Young Carers Centre 33
Leigh Roberts Research Manager Cambridgeshire County Council –
Research Team
Graham Robinson Alcohol Licensing Cambridgeshire Constabulary
Wendy Scott-Earl Head of Nursing Cambridgeshire and
Peterborough Foundation Trust
Glenn Simmons Head of Housing YMCA
Keith Smith Director Ferry Project
Sandie Smith Chief Executive Healthwatch
Sarah Stevenson Health Improvement Cambridgeshire County Council –
Specialist, Nutrition Public Health
Angie Stewart Housing/homeless Provider Cambridge Womens Aid

Susie Talbot Drug and Alcohol Action Cambridgeshire County Council -
Team Co-ordinator Drug and Alcohol Action Team
Tom Tallon Chronically Excluded Cambridgeshire County Council
Adults
Chris Taylor Drug Treatment and Cambridgeshire County Council –
Criminal Justice Lead DAAT
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Val Thomas Consultant in Public Health Cambridgeshire County Council -
Public Health
Louise Tranham Contracts Manager Cambridgeshire County Council
Kevin Vanterpool Constabulary Strategic Cambridgeshire Constabulary
Drugs Lead
Elizabeth Wakefield Public Health Analyst Peterborough City Council
Mick Walker Community Rehabilitation BeNCH Community Rehabilitation
Company
Shelley Ward Drug Co-ordinator Cambridgeshire Constabulary
Andrea Warren Detective Inspector Cambridgeshire Constabulary
Lara Watkins Drug and Alcohol Action Cambridgeshire County Council -
Team Drug and Alcohol Action Team
Teresa Weiler Chief Operating Officer Gainsborough Foundation
Helen Whyman Advanced Public Health Cambridgeshire County Council –
Analyst Public Health
Russell Wilkinson Area Manager Riverside
Jonathan Wood Consultant Psychiatrist Cambridgeshire and
Peterborough Foundation Trust
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1. INTRODUCTION
The scope of this JSNA is broad capturing the needs of children, young people, adults and older
people in relation to the misuse of both legal and illegal substances. It addresses prevention,
treatment and recovery presenting a wide range of data that incudes local service information. This
information is considered alongside the perceptions of local stakeholders regarding their views on
needs and how they are being addressed. Misuse of drugs and alcohol is closely associated with
mental health, the criminal justice system, housing and other socio-economic factors. The interface
between these factors, the complex needs that they create and the challenges in addressing them
are reflected in the document. Also factored in the assessment are the wider social and economic
factors which play an important part in prevention, effective treatment and recovery. The
inequalities associated with substance misuse are described which often reflect the multiple
disadvantages experienced by those misusing substances. There is glossary at the end of the
document.
The overarching aim of the JSNA is to provide an overview of the current drug and alcohol misuse
needs in Cambridgeshire with the following specific objectives.
 Identify the preventative and treatment services and pathways throughout the life course.
 Identify how the pathways, treatment and recovery options in Cambridgeshire are
addressing needs in Cambridgeshire.
 Describe the changing patterns of drug misuse and emerging issues along with their
implications for services.
 Describe how mental health, the criminal justice system and housing interface with
substance misuse and the challenges and opportunities that this presents.
 Present an overview of the evidence and economic evidence for supporting the prevention
and treatment of drug and alcohol misuse
The document is divided into separate chapters. Some of the chapters where there is substantial
robust quantitative data have headlines and data detail sections. Other chapters are more
descriptive and use locally collected data. There will be some duplication of the data because of the
cross cutting themes in the JSNA.
Each individual chapter also provides evidence for interventions and where appropriate case studies
are included to illustrate any issues. Each chapter concludes with “What is this telling us?” which
summarises the key issues and implications.
The executive summary provides an overview of the issues and presents a number of strategic and
action based recommendations for specific areas in the JSNA.

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2. EXECUTIVE SUMMARY
The scope of this JSNA is broad and some key concepts are used to indicate how the prevention and
treatment of substance misuse is understood and addressed.
Figure 1 is the United States Institute of Medicine’s prevention classification system1, validated in
2009 and it is used here to capture the scope and complexity of this JSNA. It has been applied2 to
the substance misuse field to illustrate the continuum of services/interventions between prevention,
treatment, recovery and harm reduction and is a useful tool for describing a conceptually unified
and evidence-based continuum of services. This taxonomy also provides a common language to
describe prevention and assist in the planning, delivery, and evaluation of activities.
Figure 1: The Institute of Medicine model of prevention (1994; 2009)

The JSNA addresses prevention through universal interventions which includes media campaigns
through to environmental interventions such as licensing regulations.
The terms ‘selective’ and ‘indicated’ are terms now increasingly applied to substance misuse and are
explained more fully in the prevention section. They, to some extent, reflect the traditional models

1Institute of Medicine (1994) Reducing the Risks for Mental Disorders: Frontiers for Preventative Intervention Research. In Meazak PJ,
Haggerty RJ, editors. Committee on Prevention of Mental Disorder, Division of Biobehavioural Sciences and Mental Disorders. Washington
DC. National Academy Press
2 Advisory Council on the Misuse of Drugs. Prevention of drug and alcohol dependence. 2015
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of prevention: primary, secondary and tertiary. However selective refers to the targeting of those at
risk and indicated to those who are misusing substances but not yet dependent.
The local prevention and treatment services are described along with any supporting evidence. The
current thinking on abstinence, recovery and harm reduction alongside the long term management
of substance misuse is described.
How the cross cutting themes of mental health, the criminal justice system and housing impact on
the prevention and treatment outcomes is considered
Throughout the JSNA the impact of substance misuse is addressed throughout the life course. This
allows consideration of key transition periods for prevention and treatment.
Drug prevention and treatment are commonly thought of as being most relevant to young people
and most research and activity is concentrated on this age group. However, prevention is relevant
across the lifespan, for example, in reducing prescription drug misuse or alcohol use in older adults.
There are many factors associated with an increased risk of the misuse of drugs and alcohol among
young people and adults. These factors often lead to risk taking behaviours and poor health
outcomes such as mental health problems and offending. The aim of preventative interventions is to
tackle risk factors and build resilience to developing drug and alcohol problems
Intervention, whether preventative or treatment, focuses on reducing risk and building resilience in
individuals and communities, especially those most at risk. Developed primarily for use with children
and young people but applicable to all ages the approach is based on risk and resilience theory.
Resiliency Theory3 provides a conceptual framework for considering a strengths-based approach to
understanding child and adolescent development and informing intervention design. It provides a
conceptual framework for studying and understanding why some young people grow up to be
healthy adults in spite of risks exposure. Resilience focuses attention on positive contextual, social,
and individual variables that interfere or disrupt development from risk to problem behaviors,
mental distress, and poor health outcomes. These positive contextual, social, and individual
variables work in opposition to risk factors, and help young people overcome any negative effects of
risk exposure. The objective is to identify the assets and resources which are positive factors. Assets
include for example self-efficacy and self-esteem. Resources refer to factors outside individuals such
as parental support and programmes that provide opportunities to learn and practice skills. The
children and young people section includes discussion of those individuals who are less likely to have
the assets and resources to develop resilience. The theory and concepts can also be applied to adults
and older people.

3 Zimmerman M, Resiliency Theory: A Strengths-Based Approach to Research and Practice for Adolescent Health Health Education
Behaviour 2013 Aug 40(4) 381-383
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The aim of this JSNA is to provide an overview of legal and illicit drug and alcohol misuse needs in
the Cambridgeshire population. It is a complex area and consequently the scope and scale of the
document is substantial. It includes prevention and treatment throughout the life course.
However, it is possible to identify some key themes throughout the different sections of the
document that demonstrate the interconnectivity of the needs and interventions relating to drug
and alcohol misuse. These are described below along with a number of recommendations for each
section that reflect these key themes.
There are far ranging effects upon the physical and mental health of those who misuse drugs and
alcohol which impact upon their families and communities and across wider aspects of their lives
that are captured in Figures 2 and 3.
Figure 2: Alcohol harms for families and communities

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