1. Path to this page:Home
  2. >> Social Care and Health
  3. >> Health
  4. >> Joint Strategic Needs Assessment
  5. >> Health of Mothers, Children and Young People
  6. >> Substance Misuse in Children and Young People

Substance Misuse in Children and Young People

Introduction

The number of young people accessing specialist drug and alcohol treatment in 2011-12 was 126 (see footnote 1). Nationally and in London there is a wide variation in the proportion of young people in treatment (NTA, 2008).

The national and local evidence suggests that the majority of young people who misuse substances are likely to be using alcohol or cannabis although this may be changing due to the growth of the ‘legal highs’ market. New psychoactive substances and patterns of use, though usually first appearing among restricted social groups or in a few locations, can have important implications for public health and for drug policy.

There has been a steady decline in the proportion of pupils who drink alcohol nationally (NHS Information Centre, 2011), but the amount of alcohol consumed by young people is rising (DSCF, 2008; Alcohol Concern, 2010). For example, the proportion of secondary school pupils who report to have never drunk alcohol increased from 39 per cent in 2003 to 55 per cent in 2010. Less than half (45%) of pupils aged between 11 and 15 said that they had drunk alcohol at least once (NHS Information Centre, 2011).

Drug and alcohol misuse pose a significant risk to a young person’s physical and psychological health and development. In particular the adolescent brain is known to be particularly susceptible to alcohol. By delaying the start in drinking young people are less likely to engage in health risk behaviours (Grunbaum et al, 2004) and to later become dependent on alcohol (Grant et al, 2001). The Government’s Chief Medical Officer recommends that no one 15 or under should drink alcohol (DH, 2009).

Responses to children and young people’s drug and alcohol misuse can broadly be divided into three categories:

  • Universal prevention – accessible to all children and young people and delivered, for example, through schools or by GPs
  • Targeted prevention – for young people who are considered to be vulnerable or who have been identified as having needs that require some low intensity intervention and monitoring (such as social inclusion programmes)
  • Specialist treatment – accessible to young people with identified substance misuse needs that cannot be met by universal or targeted provision (such as mental health services, specialist schools, in-patient services, substance misuse treatment services).

This JSNA chapter provides information about drug and alcohol misuse in children and young people. It also touches on the impact of parents or carers drug and alcohol misuse. The age group referred to here is children and young people aged under 18 with the exception of crack and opiate prevalence data which covers ages 15-24.

For related topics go to drug misuse (adults), alcohol, teenage pregnancy, children and young people mental health, and children in care sections of the JSNA.

|Back to top

Key issues and gaps

  • The illegality of drug use and underage drinking means that the problems are partly hidden. This is compounded by the lack of systematic screening and identification of substance misuse locally in universal and targeted services.
  • The number of referrals to specialist drug or alcohol treatment from services in contact with vulnerable young people is low. This makes the case for improving the systems for substance misuse screening and pathways within universal and targeted services, and highlights the importance of effective partnership working between key agencies.
  • There is a need to join up sexual health work streams with young people and substance misuse agenda - particularly in the light of Haringey’s high teenage pregnancy rates which at 64.7 per 1000 in 2010 was the highest in England.
  • Reaching those parents who are not in contact with, or have dropped out of treatment, is a priority.
  • Universal and targeted services need to keep up to date with developments in drug trends, policy and interventions.
|Back to top

Who is at risk and why

The majority of young people who seek help for substance misuse have other emotional or social problems, such as self-harming, offending and family issues. They are also less likely to be in education, employment or training (NTA, 2011). Studies have shown that young people from more than one vulnerable group are more at risk of drug or alcohol misuse (DfES:2005; The NHS Information Centre, 2011). The groups at risk are:

  • Young offenders
  • Looked after children
  • Care leavers
  • Children affected by parental substance misuse
  • Homeless young people
  • Young people at risk from sexual exploitation
  • Excludees and persistent truants

It is also known that children of parents or carers who misuse drugs or alcohol are more likely to develop misuse and/or mental health problems themselves (ACMD, 2003; DfES, 2005). It is estimated that up to 2.6 million children are living with parents who are drinking hazardously. 705,000 are living with dependent drinkers and 30% of under 16s are living with at least one binge drinking parent (Manning et al, 2009). This has important implications for effective co-ordination, interagency working and information sharing.

|Back to top

The level of need in the population

The level of need is difficult to establish as there are no accurate prevalence estimates nationally or locally. What constitutes a need can be broadly related to the intensity of the intervention required, i.e. the three categories outlined in the introduction:

  • Children and young people who benefit from universal prevention
  • Vulnerable groups who should receive targeted intervention
  • Individuals who require specialist substance misuse treatment.

The case for universal prevention:

According to a local survey (Haringey Council and NHS Haringey, 2009) of primary school pupils aged 10-11(sample size n=656), 8 per cent of boys and 3 per cent of girls reported having drunk an alcoholic drink in the week before the survey. Most pupils (91%) did not drink alcohol. As for drugs, 17 per cent said that they were ‘fairly sure’ or ‘certain’ they knew someone who uses drugs in the area where they live and a very small minority (2%) had been offered cannabis or other drugs.

Of the secondary school children aged 12-15 who completed the survey (n=1213), by far the most commonly taken drug was cannabis, with 7 per cent stating that they had taken cannabis at some point in their lives. 6 per cent had taken an illegal drug within the last month. 15 per cent of pupils had drunk alcohol in the week before the survey and 7 per cent had been drunk. 7 per cent of year 10 boys and 2 per cent of year 10 girls had drunk over the advised weekly limit for adult females of 14 units (Haringey Council and NHS Haringey, 2009).

The results of this survey give cause for concern given that no amount of alcohol is considered safe for under 15’s and the fact that 7% of boys and 2% of girls had drunk over the recommended limit for adults in the week of the week before the survey.

In the Haringey Annual Residents Survey (see footnote 2), 21% of young people aged 11 to 17 identified drug use and/or drug pushers as a source of concern, compared to 23% in London as a whole.

The last TellUS 4 survey completed in the same year found that even higher levels of reported drug and alcohol use with 8% (n=1275) of secondary and primary school pupils reporting having been drunk, half of whom had been drunk on more than one occasion. Given the extent of alcohol related hospital admissions in adults in the borough some targeted work with schools should be considered in the coming year, although alcohol specific hospital admissions for under 18s in Haringey were lower than London and national averages during 2008/9-2010/11 with 32.67 per 100 000 population (confidence interval: 24.09-43.31). The difference from London is not however statistically significant. See figure 1.

Figure 1


Source: North West Public Health Observatory (2012)

The need for targeted interventions:

The extent of drug and alcohol misuse amongst vulnerable groups locally is not fully known. Improved screening and recording in universal and targeted services would help estimate the level, and understand the nature of local need.

The main referral sources to specialist treatment in 2011-12 were criminal justice services (46%), schools (28%) and other substance misuse treatment services (10%). The lack of referrals from social care and mental health services locally suggest that substance misuse is not systematically screened and, subsequently, addressed. It may be that some of the issues are resolved within those services without the need for specialist treatment. Self referrals are also lower than nationally which points to issues around accessibility and publicity of services. The proportionally higher rate of referrals from the youth offending service, on the other hand, is to do with the fact that Youth Offending Team are commissioned to offer specialist treatment within their own service.

The lack of consistent screening, recording and the overall low number of onward referrals to the specialist substance misuse services means that local specialist treatment data is likely to be an underestimate of the extent substance misuse amongst vulnerable young people locally.

Parental substance misuse

Nearly a fifth (18%, n=116) of adult clients who entered drug treatment in 2011-12 were living with children. A little over a third (35%, n=136) of new clients in alcohol treatment in the same period were living with children (see footnote 3). This is only an indication of the hidden harm that local children and young people may be experiencing because of parental substance misuse. Arguably parents who are accessing treatment are already taking steps to improve their lives and the lives of their children. Reaching those parents who are not in contact with, or have dropped out of treatment, is a priority.

The need for specialist substance misuse treatment:

The number of children and young people in specialist drug and alcohol treatment was 126 during the last financial year (April 2011 – March 2012). (see footnote 4). Cannabis was the first drug of choice for four out of five (81%, n=80) service users. Whereas alcohol was the main substance for nearly one in five (18%, n=23). There were no presentations to treatment for crack, opiate or cocaine use by under 18’s. However, the prevalence of young opiate and crack users aged 15-24 in Haringey is estimated to be 12.35 per 1000 population (in 2009-10, confidence interval 10.55 - 15.69) (see footnote 5). The rate is higher than in London and nationally (8.52 and 6.87 respectively). Overall, national evidence suggests that fewer young people are getting involved in crack and heroin use (NTA, 2011).

A vast majority of young people in treatment in Haringey during 2011-12 were male (73%, n=92). The largest age group represented was 17 (32%, n=40). A vast majority were non White British (85%, n=107). Other Black (25%, n=31), White British (15%, n=19) and Other White (14%, n=18) were the most prominent ethnic groups. See figures 2-3.

Figure 2


Source: National Drug Treatment Monitoring System (NDTMS quarterly report)
* data suppressed for data protection

Figure 3


Source: National Drug Treatment Monitoring System (NDTMS quarterly report)
* data suppressed for data protection

|Back to top

Current services in relation to need

Universal

  • Healthy Child Programme: pregnancy and the first five years of life (external link) details a programme of care from various providers for pregnant women and for families with young children. Whittington Health is currently a Department of Health ‘early implementer’ site looking at the continuing development of the health workforce needed to support implementation of the HCP.
  • Schools are encouraged to maintain healthy schools status by reviewing how they promote their approach to health, including substance misuse. They can also work towards enhanced healthy school status. Schools working towards enhanced status can choose from five local priorities, including a reduction in substance misuse, and do targeted work focusing on their most vulnerable pupils.
  • Media and resources aimed at tackling teenage pregnancy include alcohol and drug awareness and support services. Please refer to JSNA teenage pregnancy section for further information.
  • The Youth Service’s website Youth Space provides information about drugs and alcohol as well as support services available in Haringey.
  • Voluntary sector organisations HAGA and Insight Haringey provide outreach services in schools and further education establishments. Insight Haringey also trains staff in children and young people’s services. The training covers: types of drugs; what they look like; signs of misuse; the law; how and which services to refer to in the borough.

Targeted services

Insight Haringey is the integrated specialist substance misuse treatment service providing targeted support to schools, the Pupil Referral Unit, looked after children and Child and Adolescent Mental Health Services (CAMHS). Satellite services are provided in several secondary schools and referral can be made directly to the service by phone or by filling in a simple referral form.

  • The Senior Substance Misuse Practitioner placed at the Children and Young People’s Service works directly with children and families affected by substance misuse supporting colleagues within the safeguarding and social work team by providing advice on for individual cases. Monthly surgeries are held at one of the adult drug treatment services (DASH) who work closely with HAGA, a local alcohol treatment service for adults, to discuss shared families, practice and inter agency working.
  • Cosmic (part of HAGA) is a voluntary sector organisation that works with children and families affected by substance misuse. Cosmic supports children and young people who have a range of needs due to parental substance misuse. The service works with parents and has good links with social workers based in Children and Families Service.

Specialist services

Universal and targeted services across children and young people’s services are required to be able to identify, assess and support substance misuse needs as appropriate. Those in need for specialist drug and alcohol treatment are referred to Insight Haringey which is an open access service located in the north east of the borough. Specialist substance misuse treatment includes, for example, counselling, motivational interviewing and family work.

In addition, there are two substance misuse workers placed in Haringey’s Youth Offending Service. They assess young people coming through the courts or those who are known to the prevention/triage team. Young people are assessed using a SASSI – substance abuse subtle screening inventory – and depending on this assessment, individual or group work is carried out. Drug and alcohol awareness and education sessions are devised according to need. The youth offending team also works in one of Haringey’s secondary schools completing assessments and providing drug and alcohol education for pupils and staff.

|Back to top

Service users and carers opinion

Extensive consultation was completed in 2010 prior to a tender of the new specialist substance misuse service Insight Haringey. Young people were consulted from Youth Offending Service, Pupil Support Centre, and the former specialist substance misuse service, In-volve. The consultation, which also involved professionals from local services, directly informed the development of the new service.

Speakeasy, an event which also took place in 2010, brought together a group of young people to discuss drug and alcohol issues. 97 young people from Haringey’s secondary schools took part. The key recommendations to come out of the event were:

  • Work with schools is vital as many young people said they would seek help from a teacher, a counsellor (likely to be school counsellor) or someone in their school “who they could trust”.
  • There should be better joint-working between Youth Service and young people’s substance misuse services, encouraging engagement of young people in diversionary activities, delivering identification and brief advice (IBA) interventions, and facilitating referrals into services.
  • On-going consultation is important to improve service provision and preventative work.
  • Marketing and promotion of services is crucial as most young were not aware of the services available to them.
|Back to top

Projected service use

There has been steady decline in the proportion of pupils who drink alcohol nationally (NHS Information Centre 2011) but the amount of alcohol consumed by young people is rising (DSCF, 2008; Alcohol Concern, 2010). The number of young people seeking treatment for heroin or crack use is also in decline but new drugs are coming into the market. Given the ever changing trends in drug and alcohol use amongst young people it is difficult to predict long term service needs. Also, better prevalence data is needed to produce accurate local projections.

|Back to top

Expert opinion and evidence base

The National Treatment Agency for Substance Misuse (NTA) which is to move to Public Health England in April 2013, is in charge of developing national policy and the evidence base for substance misuse. They also monitor services through the National Drug Treatment Monitoring System (NDTMS). All local agencies who deliver specialist substance misuse interventions report to the NDTMS.

A range of guidance has been published in the area:

|Back to top

Unmet needs and service gaps

The latest large scale needs assessment (2010) identified the following key issues:

  • The low levels of drug and alcohol misuse screening and recording especially in services aimed at vulnerable groups, and the relatively low number of referrals to the specialist treatment service Insight. This risks early detection and appropriate responses to substance misuse issues.
  • Commissioners and agencies need to keep up to date with the changing trends in drug use and modify services accordingly. The emergence of legal highs have implications for drug education, emergency response services, health care providers and specialist substance misuse services.
  • The substance misuse support should involve effectively co-ordinated joint working by all the relevant agencies and be tailored to the individual’s needs and address the motives for drug and alcohol misuse.
  • A narrow focus on substance misuse may be ineffectual since young people are likely to experience multiple problems.
  • The extent of parental use needs to be monitored by adult services and followed by co-ordinated support for both the children and parents.
  • More accurate data is needed for homeless young people in the borough: lack of stable accommodation increases the risk substance misuse amongst vulnerable children and young people. The potential cuts to housing benefits as part of the welfare reform may exacerbate the problems. This is all the more pertinent since the Southwark ruling (the ruling that places the responsibility of supporting and finding suitable accommodation of young people to children and young people’s services).
  • Identification and brief advice (IBA) is an evaluated and national recognised and evaluated intervention for alcohol but more widely used for adults. National Institute for Health and Clinical Excellence (NICE) recommends IBA to be used with under-18s but modified to reflect the lower tolerance levels and harmful effects of alcohol for young people (NICE, 2011). Currently IBA is only used in Haringey for adults.
|Back to top

Recommendations for commissioning

  • Local commissioning of substance misuse services has been closely prescribed and monitored by the National Treatment Agency. The localism agenda and the National Treatment Agency’s move to Public Health England in April 2013 provide an opportunity to review the current model and practice. This makes it all the more important that local need is better understood so that services can be developed to effectively respond to local need.
  • Map the range of substance misuse services, including the substance misuse elements within the Healthy Child programme, and referral pathways and agree expectations around early identification, assessments, interventions and referrals with commissioners of health and children and young people services.
  • Improve the systems for identification and referral of young people with substance misuse issues, including screening and assessment tools, training and ongoing support for professionals. Agree with commissioners the level and the type of information that needs to be recorded in order to provide more robust information around need.
  • Satellite surgeries to continue in schools for young people, staff and parents. Work within schools is vital as many young people say they would seek help from a member of staff in the school.
  • Monitor progress of the schools healthy programme.
  • Increase joint work between youth service and young people substance misuse services to: encourage engagement in diversionary activities; deliver brief interventions in youth service; and facilitate referrals into specialist services.
  • Adult treatment services and children and families need to work together to identify, assess, refer and support adults with the aim of protecting children.
|Back to top

Recommendations for further needs assessments

Once more reliable and valid data becomes available via improved screening and recording, a large scale assessment of local need would be beneficial for commissioners to have a better understanding of the level and the type of substance misuse needs amongst children and young people.

|Back to top

Key Contact

Marion Morris
Drug and Alcohol Strategy Manager
Public Health Directorate
marion.morris@haringey.gov.uk
telephone: 0208 489 6909

|Back to top

References

|Back to top

Footnotes

1. Source: National Drug Treatment Monitoring System (www.ndtms.net)

2. Annual Residents Survey -Young Peoples Views - 2009-2010

3. This includes individuals 18+ starting a new treatment journey who have children (16 years or under) living with them at least part of the time. Source: National Drug Treatment Monitoring System (external link)

4. Source: National Drug Treatment Monitoring System (external link) (figures accurate as at 30 October 2012)

5. Source: Glasgow University prevalence estimates for crack and opiate users 2009-10

|Back to top

Page Last Updated: 2 April 2013

If you want to give comments on the service itself please visit our Contact page.