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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 NHS GGC Health Improvement Alcohol and Drug Team website.

For further details on the NHSGGC Prevention Framework contact –

Trevor Lakey, Health Improvement Lead (Alcohol and Drugs) – NHSGGC trevor.lakey@ggc.scot.nhs.uk

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

GGC 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 & 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