NHSGGC Alcohol and Drug Prevention Framework

Introduction

The New NHSGGC Alcohol and Drug Prevention Framework

Following a rapid review of the alcohol and drug prevention International evidence base between 2012 and 2018, an updated version of the NHS Greater Glasgow and Clyde Prevention and Education Model which will now be known as the NHS Greater Glasgow and Clyde (NHSGGC) Alcohol and Drug Prevention Framework has been developed.

The new NHSGGC Alcohol and Drug Prevention Framework has 3 main components :

1. Context

The new NHSGGC Alcohol and Drug Evidence Briefings, Implementation Plan and Monitoring Tool take a whole population focus with a life-course perspective being integral to the work. They encourage innovative partnership working and encompass the most recent changes to alcohol, drugs and related topic policy and evidence based practice and changes to the landscape since 2012. A key focus of the Prevention Framework is on the promotion of equalities whilst addressing health inequalities and the impact of life stages, deprivation and vulnerability in the most at risk groups such as vulnerable young people, looked after children, older people and the homeless population.

The definition for prevention in the Prevention Framework is as follows :

Prevention is defined as encouraging and developing ways to support and empower individuals, families and communities in gaining knowledge, attitudes and skills in which to avoid or reduce alcohol and drug issues and alcohol and drug related harm.

2. The ten key themes that underpin implementation of alcohol and drug prevention initiatives / services

3. The NHSGGC Alcohol and Drug Prevention Evidence Briefings

The original NHSGGC Alcohol and Drug Prevention and Education Model (2008), collated Prevention and Education evidence base (2012) and new NHSGGC Alcohol and Drug Prevention Framework (2019) can be viewed at the NHSGGC Health Improvement Alcohol and Drug Team website .

For further details on the NHSGGC Prevention Framework please email Trevor Lakey, Health Improvement Lead (Alcohol and Drugs) for NHSGGC via ggc.mhead@ggc.scot.nhs.uk*.

*Please note that this is a generic admin inbox and not monitored immediately. If you, or someone you know are in distress and need an immediate response call the emergency services on 999 or NHS24 on 111.

Introduction

Context

What is alcohol and drug prevention?

There are various definitions of prevention that typically include some or all of the following elements:

Discouraging any use of alcohol and drugs
Delaying the use of alcohol and drugs
Avoiding the development of harmful alcohol or drug use or dependence amongst those who are using substances
Preventing individuals from additional alcohol or drug use
Reducing the harm associated with alcohol or drug use
Tackling risk factors and increasing individuals’ resilience to prevent problem alcohol or drug use

In the NHS Greater Glasgow and Clyde Alcohol and Drug Prevention Framework, the definition for prevention is as follows:

Prevention is defined as encouraging and developing ways to support and empower individuals, families and communities in gaining knowledge, attitudes and skills in which to avoid or reduce alcohol and drug issues and alcohol and drug related harm.

Environmental prevention addresses reducing the availability and accessibility of alcohol and drugs in the community.

Effective prevention and education in NHS Greater Glasgow & Clyde involves a wide range of stakeholders including (but not limited to) those working in:

Alcohol and drug recovery services
Recovery communities
Community and voluntary organisations
Homelessness and housing services
Community Safety
Government departments and Local Authorities
Primary care
Mental health services
NHS Scotland
Employers
Fire and Rescue Services
Licensing Boards
Police Scotland
Scottish Prisons Services
Youth groups
Education Services
Health and Social Care Partnerships (HSCPs)
Licence owners

Evidence Briefing 1 – Context

The Ten Key Themes that underpin Alcohol and Drug Prevention

This briefing provides detail on the ten key themes which underpin the successful delivery of alcohol and drug preventative approaches outlined in subsequent evidence briefings in the NHSGGC Alcohol and Drug Prevention Framework. These themes can be considered when developing, implementing and monitoring all alcohol and drug prevention initiatives and services.

GGC Alcohol and Drug Prevention Framework – The Ten Key Themes that underpin Alcohol and Drug Prevention

Pre birth, Infancy and Early Years

Need to know

Parental alcohol and drug use can have a negative effect on children. If this is the case, it is considered to be an Adverse Childhood Experience (ACE) alongside other harmful experiences such as physical abuse, emotional abuse and neglect. An accumulation of ACEs can increase the risk of a child being affected by problem alcohol and drug use in later life
Children who grow up in homes with problem alcohol or drug use are more likely to develop alcohol and drug issues themselves and face significantly higher risks of medical, psychosocial and behavioural issues
Children who are exposed to alcohol prenatally can have specific and lifelong neurodevelopmental problems collectively referred to as Fetal Alcohol Spectrum Disorder (FASD)

Key Findings

Improving parenting skills and bonding between children and their parents is an effective preventative approach
A focus on developing protective skills, values and attitudes in early years education is effective
For children whose mother has issues with alcohol or drug use, effective prevention begins before the child is born to lower their risk of problem alcohol or drug use later in life and positively influence their development
The individuals delivering an approach – teachers, psychologists, mentors, peers – need on-going, high quality training and support. This includes training to ensure their practice is trauma-informed
One approach might not fit all. The age, developmental stage, circumstances and needs of each child and family within a targeted group need to be considered when designing and delivering a prevention programme

Good Practice

Strengthening Families parenting programme
Children Harmed by Alcohol Toolkit C.H.A.T.
Oh Lila resource pack for pre-school

Potential Stakeholders

Early years education (including childcare services)
Prenatal and postnatal care (including health visitors)
Families and children
Third sector
Police Scotland
Social workers

GGC Alcohol and Drug Prevention Framework – Pre-birth and early years

Children and Young People

Need to know

Adolescence represents a period of vulnerability to alcohol and drug use issues and related harm
The earlier a young person begins alcohol or drug use, the more likely they are to develop alcohol and drug issues later in life
Those with greater exposure to Adverse Childhood Experiences (ACEs) may have a higher risk of developing certain problems later in life including issues around alcohol or drug use
Care-experienced children and children whose parents have issues with alcohol and drug use are particularly vulnerable groups

Key Findings

Successful preventative interventions engage children and young people in their design and development Sessions for children and young people need to be interactive. Lectures that primarily provide information are ineffective
A focus on developing protective skills, values and attitudes is effective
Fear arousal does not prevent alcohol and drug use in children and young people
The individuals delivering an approach – teachers, psychologists, mentors, peers – need on-going, high quality training and support and where possible have clear alcohol and drug policies in place to deal with any alcohol and drug incidents
One intervention approach might not fit all. The age, developmental stage, circumstances and needs of each child or young person within a targeted group need to be considered when designing and delivering a prevention programme

Good Practice

Strengthening Families programme
Children Harmed by Alcohol Toolkit (C.H.A.T.)
Rory resource pack
LifeSkills programme

Potential Stakeholders

Families and children
Education services
Colleges and universities
Social workers, youth workers
Police Scotland
Young people
Employers
Allied health professionals
Primary care, acute care and youth health services
Housing services
Third sector services

GGC Alcohol and Drug Prevention Framework – Children and young people

Adults

Need to know

For the purposes of this briefing, adults have been defined as anyone aged 25-50 years old
24% of adults in Scotland exceeded the low-risk weekly drinking guidelines in 2017
In 2014/15, 6% of people in Scotland had used one or more illicit drugs in the last year
Problem alcohol and drug use amongst adults are more prevalent in Greater Glasgow and Clyde than on average for Scotland
The rate of problem drug use amongst adults was highest in the 25 to 34 years age group in Scotland
On average, men consume alcohol on more days of the week than women in Scotland, and consume more units of alcohol

Key Findings

There is strong evidence for the effectiveness of Alcohol Brief Interventions (ABIs) in primary care settings in reducing the weekly consumption of alcohol in adults
There is strong evidence for the effectiveness of well-planned psychosocial and developmental prevention interventions involving multiple services in reducing alcohol and drug related harms
There is some evidence for the effectiveness of cognitive behavioural therapy, behavioural couples’ therapy and pharmacotherapy in reducing alcohol and drug related harms, as well as clear alcohol and drug policies in the workplace
There is an evidence gap relating to whether diversionary activities can be effective in preventing alcohol and drug use in adults

Good Practice

NHS Health Scotland resources on delivery of ABIs
Oldham Borough Council pilots
Brighton and Hove City Council ‘named workers’
Newcastle City Council roll-out of Naloxone
Barnsley Metropolitan Borough Council Naloxone pilot
The SOLVE training package

Potential Stakeholders

Adult alcohol and drug services
Allied health professionals
Employers
Scottish Prisons Service
Recovery groups
Local authority staff
Social care staff
Mental health professionals
Community learning and development staff
Police Scotland

NHSGGC Alcohol and Drug Prevention Framework – Adults

Older Adults

Need to know

In this evidence briefing, older adults have been defined as anyone aged 50 and over. At present, the proportion of older people with substance misuse continues to rise more rapidly than can be explained by the rise in the proportion of older people in the UK.
While overall alcohol and drug consumption is falling, in older generations there is evidence that it is increasing, yet there is currently no alcohol strategy in Scotland that specifically considers the needs of older adults
Older adults with problem alcohol use are the least likely to receive treatment, but the most likely to have positive outcomes
Isolation and loneliness are more prevalent amongst older adults. The evidence supports “a strong social role” for drinking alcohol in older adults, thus interventions need to avoid “paradoxical harm”
Age-related factors increase the risk of problem alcohol and drug use, including retirement, bereavement, dementia and chronic ill-health.

Key Findings

Older adults should be included as a distinct group within alcohol strategies, and their lived experience should be used to help design effective services
Older adults’ alcohol and drug use is commonly misdiagnosed or missed entirely. Training primary care staff to spot problem alcohol and drug use, specifically in over 50s, will improve access to treatment, particularly when an older age identification test and cognitive impairment test are used
Venue choice is critical to making services accessible and acceptable for older adults, with a focus on access for those with limited mobility
Intervention involving employers is important in being able to manage the transition to retirement
Age-related alcohol guidelines need to be developed to combat a very low level of awareness of what these are amongst older adults
Reduced hepatic function and the issue of poly pharmacy in older adults mean that pharmacological interventions may be less appropriate for this group

Good Practice

Mast-G and MoCA assessment tests
Older adults’ Cognitive Behavioural Theory manual (SAMHSA)
Healthy working lives initiative

Potential Stakeholders

Alcohol and drug services
Geriatric services
Community services
Allied health professionals
Employers
Pain management services
Policy teams

GGC Alcohol and Drug Prevention Framework – Older Adults

At Risk / Vulnerabilities

Need to know

Socioeconomically deprived groups often report lower levels of average alcohol use but experience greater or similar levels of alcohol-related harm.
Alcohol and drug-related deaths are much higher in the most deprived areas, compared to the least
Alcohol and drug use issues are more common amongst homeless people than the general population
All LGBT+ populations experience some form of health inequality, including an increased risk of alcohol and drug use issues
Alcohol and drug use issues are more common for those with pre-existing mental health issues or behavioural disorders, but equally alcohol and drug use can increase the risk of developing certain mental health issues
The prevalence of alcohol and drug use issues is much greater in the prison population than in the general population
At-risk groups are not mutually exclusive, and often an individual will face multiple risks, and thus multiple barriers to services

Key Findings

Integrated services and care pathways are important for all at-risk groups to tackle multiple and complex needs effectively. This includes multi-agency working, continuity of care and considerable wraparound support eg housing, finance and employment services
At-risk groups face barriers to accessing services. For LGBT+ groups, health staff training and awareness can be effective in mitigating this, as well as capturing data on sexual orientation and gender identity to inform service design and delivery
Specific services, workers and spaces can be effective for supporting protected characteristic groups.
Those with coexisting mental health and alcohol or drug use issues (dual diagnosis) can benefit from tailored interventions which are non-confrontational, simultaneously address mental health and alcohol or drug use, and are delivered by trained staff
For homeless populations, assertive, long-term outreach services and Housing First approaches have demonstrated effectiveness in increasing engagement and reducing alcohol and drug related harms
Rapid, easy and timely access to services is particularly important for homeless populations, and those involved with Criminal Justice services

Good Practice

Pride in Practice
Leeds Dual Diagnosis Project
Housing First Glasgow
Turning Point Scotland218 Centre
The High Impact and Complex Drinkers project
Tomorrow’s Women

Potential Stakeholders

Homelessness services and housing providers
LGBT+ services
All health professionals
Scottish Prison Service
Third sector
Alcohol and drug services
Mental health services
Police Scotland
Service users/peer involvement
Social work

GGC Alcohol and Drug Prevention Framework – At risk groups

Society Wide Approaches

Need to know

The availability, affordability and acceptability of alcohol are the primary drivers of consumption and harm
Advertising is heavily invested in by the alcohol industry and exposure to advertising increases alcohol related harm
Over the last 30 years, alcohol in the UK has become more affordable. Greater affordability in the off-trade has led to different patterns in alcohol consumption, with more people drinking at home, as opposed to in pubs and other leisure settings
Opioids have been implicated or potentially contributed to 86% of drug related deaths in Scotland

Key Findings

Reducing alcohol availability through reduced hours/days of sale and clear licensing practices has been shown to be effective in minimising alcohol related harms. Low drink-driving limits and appropriate minimum age levels are also effective, in combination with strict enforcement
There is evidence that reducing affordability through a combination of minimum unit pricing and taxation is effective in minimising alcohol related harms
As exposure to alcohol advertising has been linked to greater alcohol related harms, regulation is needed to minimise this
Supervised drug consumption facilities can reach marginalised groups, facilitate safer drug use and enable access to health and social services
Drug checking at events/festivals and safer use social media campaigns can help minimise harms associated with use of drugs such as ecstasy and MDMA
Access to Naloxone can help to prevent opioid related deaths, particularly for those released from prison

Good Practice

Scotland’s National Naloxone programme
RSPH labelling examples
What’s in the pill? campaign
Minimum Unit Pricing in Canada
Consumption rooms in Denmark

Potential Stakeholders

Alcohol and drug services

Police Scotland

Scottish Prison Service

Education Services

Licence holders

Advertising regulators

Licensing Boards

Allied health professionals

Social Work

GGC Alcohol and Drug Prevention Framework – Society wide

Appendices