Substance misuse

Welsh Government has recently launched its new Substance Misuse (drug and alcohol) Delivery Plan for 2019 - 2022. The new plan builds on the progress made during the lifetime of the 2008-2018 strategy and is a key reference for the Population Assessment.

• Data shows the rate of alcohol misuse in 2018 was 389 individuals per 100,000 population in Ceredigion, 276 individuals per 100,000 population in Carmarthenshire, and 243 individuals per 100,000 population in Pembrokeshire. The rate for the whole of Wales was 245 per 100,000 population.

• Data shows that the rates per 100,000 for drug misuse are 256 in Ceredigion, 215 in Carmarthenshire and Pembrokeshire. The rate for the whole of Wales is 224.

• There is evidence to show that men are more likely to drink alcohol than women.

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.

The current care and support needs focuses on addressing 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 wellbeing 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 because of drug and alcohol misuse and make communities safer through tackling issues created by drug and alcohol misuse within communities.

Whole Population Prevention:

There is no locally co-ordinated campaign that addresses whole population prevention. Key messages need to be developed to respond to trends of use emerging for different age groups and showing evidence of harm.

Screening and Brief Interventions in primary care:

The evidence base clearly states that this should be in place across primary care settings for all patients or as a minimum those at risk. There is currently no co-ordinated programme of screening in place within primary care.

Treatment and Recovery Access, treatment models, age appropriateness of treatment:

There is evidence that older (40/50 plus) substance users are reluctant to seek support from traditional services, because of the model of service provision and concerns over stigma at accessing a drug and alcohol service. We need to think differently about what services are offered (not just for this age group), across the health system and in different settings, to avoid this stigma.

Psychology and psychological support:

For older adults with alcohol dependence issues.

Dual Diagnosis psychology/psychological support:

Gap in provision for those who don’t have Serious Mental Illness but suffering from significant other mental health issues as well as issues with drugs, alcohol, and other lifestyle behaviours.

Prescribing Capacity:

Rapid access to prescribing is a protective factor against drug related deaths. Same day prescribing models are in place in other parts of the country, longer waits are in place locally with Carmarthenshire having the third highest drug related deaths in Wales. Local model reliant on GP capacity for prescribing.

Service User Involvement:

Good local service involvement but little involvement of service users within planning process.

Harm Reduction Learning and Implementation:

Review of alcohol deaths as well as drug deaths needed, and we need to establish non-fatal reviews.

Housing:

Fundamental to an individual’s ability to recover. Limited options available locally and housing reallocation policies often detrimental to recovery.

Future service development plans, care and support provisions and needs should focus on the following interventions:

• Turn the curve and reduce the inequalities gap in smoking prevalence through prioritising specific groups who are at high-risk of tobacco related harm. High-risk groups include inpatients, people with mental ill-health, people with conditions made worse by smoking, people with smoking related illness and pregnant women who smoke
• Support pregnant smokers to quit
• Continue to target smoking cessation interventions in those areas with the highest smoking prevalence
• Use social marketing to maximise reach
• Use asset-based approaches to work with local communities to assess barriers and facilitators to prevent uptake and reduce prevalence
• Treat smoking at the point of diagnosis for a wide range of diseases to improve outcomes. The evidence suggests that smoking quit attempts in healthcare settings are effective as smokers are overrepresented in the population of people who use NHS services
• Support the development of digital or electronic aids to cessation
• Support the development of opt-out models across secondary care settings and maternity
• Work with partners to ensure full implementation of public health and wellbeing legislation
• Work with partners (Local Authority, Education, Housing, Emergency Services) to reduce exposure to environmental tobacco smoke through supporting smoke free legislation, maximising the delivery of brief advice as support smoking cessation
• Work in partnership to improve the strategic alignment of policy and services across the health and wellbeing continuum for tobacco control
• Ensure evidence-based smoking cessation services are available for everyone who smokes, including brief advice, behavioural support
• Implement the recommendations of the NHS Future Forum which emphasises the value of having brief opportunistic ‘healthy lifestyle chats’ including raising the issue of stopping smoking. Providing Very Brief Advice to every smoker is recommended by the Department of Health is effective in general care settings and can be adapted to mental health settings
• Support staff in primary and secondary care settings who already have the necessary therapeutic skills to engage patients in conversations about behaviour change. We know that offering support to stop smoking, rather than merely asking a smoker if they are interested in stopping or telling them they should stop, leads to more people making a quit attempt. Raising the issues of smoking can be done opportunistically with patients, such as during protected engagement time; at the end of a home visit or during clinical visits. It can also be helpful to link these brief interventions to a current health problem such as a cough, breathlessness or something that is of personal relevance to the patient
• Support the implementation of harm reduction approaches for those smokers who may not be able to stop in one step (NICE Guidance, 2013).

The effect of COVID-19 pandemic may have had a significant impact on substance misuse group however, this effect remains unknown.