Adult Drug and Alcohol Treatment Needs Assessment 2011

Adult Drug and Alcohol Treatment Needs Assessment 2011

Contents

1. Introduction

In order to ensure that the commissioning decisions made within the county continue to be based on sound evidence of local need, this document will build on the national needs assessment guidance published by the National Treatment Agency, looking at the local situation of substance misuse treatment and service users in East Sussex. It will also seek to answer questions that were raised in the previous needs assessment, as well as specific questions around primary alcohol misusers in order to develop knowledge about local need and identify populations that are under represented in treatment.

1.1 Drug Treatment in England

The National Drug Strategy, published in December 2010, sought to change the direction of the drug treatment system by reducing demand, restricting supply, and focusing on recovery.

Data recently published by the NTA suggests that this shift in focus is working at a National level as ‘27,969 adults left the drug treatment system free from dependency in 2010/11 – an increase of 28% compared to 2009/10 (23,680), and 150% compared to 2005/06 (11,208)[1]’. However, fewer drug users are entering the drug treatment system, with only 74,028 starting treatment in 2010/11; a reduction of 6.6% on the previous year. National Drug Treatment Monitoring System figures for 2010/11 also show a continuing trend for fewer Heroin and/or Crack dependent users coming into treatment, specifically those under 40, with Heroin and/or Crack dependent users aged 18 to 24 having more than halved since 2005/06.

However, the Home Office report Drug Misuse Declared: Findings from the 2010/11 British Crime Survey[2] states that between 1996 and 2010/11, there has been an increase in the use of Cocaine and Methadone amongst 16 to 59 year olds, while there has been no statistical significant change in the use of Opiates including Heroin and Crack. It goes on to say that ‘use of any illicit drug in the last year (2010/11) among adults (8.8%) is at a similar level to that as the 2009/10 BCS (8.6%). Levels of any drug use are at around the lowest they have been since the measurement of drug prevalence began in the 1996 BCS[3].’

The national picture shows a continuing trend for fewer drug users coming into treatment for heroin and / or crack dependency. ‘This ongoing reduction, which first became apparent in 2008/09, is especially evident among the under 40s. In particular, the numbers of heroin and crack users aged under 30 coming into treatment has dropped significantly in recent years – those aged 18 to 25 have more than halved since 2005/06 and the 25 to 29s have come close to matching this[4].’ However, findings from the British Crime Survey[5] (BCS)state that over the past year, there has been no statistically significant change in the use of Crack Cocaine and Heroin amongst 16 to 59 year olds.

However, the BCS report goes on to say that Cannabis remains the drug most likely to be used by those aged 16 to 24, while powder cocaine is the next most commonly used drug amongst young people, with Mephedrone prevalence amongst 16 to 24 year olds being at a similar level.

Figure 1: Proportion of adults reporting use of the most prevalent drugs in the last year: by age, 2010/11: BCS[6]

1.1.2 New Psychoactive Substances

A briefing paper published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) outlines the importance of national early warning systems in detecting and identifying new psychoactive substances. ‘Recent developments allowing organic chemicals to be synthesised cheaply, combined with the information exchange and marketing possibilities afforded by the internet, have led to new psychoactive substances becoming widely available at an unprecedented pace[7].’ These new substances may not only pose risks to public health and individuals, but also impact on social issues affecting the wider community. The document goes on to say that current procedures of passing legislation in order to control a substance are continuously being challenged by the rate at which new psychoactive substances appear and can be distributed.

1. Ensure staff in specialist services have access to information about novel psychoactive substances as it becomes available

1.2 Alcohol Treatment in England

Published in November ’10, the Department of Health White Paper entitled Healthy Lives, Healthy People[8]not only sets out the strategy for Public Health in England, but also highlights the impact of alcohol on society. Previous research has shown that the risks of alcohol misuse costs the NHS an estimated £2.7 billion a year, while alcohol misuse also contributes to an estimated 1.2 million incidents of violent crime a year and 6% of all road casualties.

Commissioned by the Department of Health and produced by the North West Public Health Observatory (NWPHO), a report entitled Topographyof Drinking Behaviours in England[9]has subsequently been produced looking at abstainers, lower risk, increasing risk and higher risk drinkers in Local Authorities in England. As well as ‘helping Directors [of Public Health] in local authorities understand the levels of alcohol use and misuse in their areas, and support the development and monitoring of the effectiveness of local and national alcohol strategies to tackle the harm caused by alcohol, as these Directors move into local authorities, they will take responsibility for commissioning alcohol misuse prevention and treatment services in collaboration with local commissioning consortia.’[10]

With this in mind, it is important to ask questions locally around primary alcohol misusers in order to develop knowledge about local need and identify populations that are under represented in treatment.

2. Population

2.1 East Sussex Demographics

East Sussex in Figures (ESiF) shows that the 2010 mid year population estimate for the county is 515,522 people, which is an increase of 5,650 (+1.1%) since the 2009 mid year population estimate. The district of Lewes population estimates have seen the fastest growth of 2.4%.

Table 1: ESiF Mid Year 2010 Population Estimate by Age[11]

As the above table shows, just over half (52%) of the population of East Sussex is aged 45 and over. This is broken down by the 45 to 59 year old age group accounting for 21% and the 60+ age group equalling 31% of the total population of East Sussex.

Future population growth over the next 20 years is likely to be even more concentrated among the older age groups as ‘baby boomers’ born after WW2 are now reaching retirement age. When examining age by district, all of the five districts have a higher number of people aged 60+ than any other age group. Rother has the highest number of individuals in this agebracket (38%) and Hastings has the least.

Table 2: ESiF Ethnicity Experimental Statistics: 2001-2009[12]

The above table shows thatwithin East Sussex, the all white ethnicity group accounts for 93.6% of the total population. The remaining 6.4% of the population is made up of Asian or Asian British (2.3%), Mixed (1.4%),Black or Black British (1.6%) and Chinese or Other Ethnic Group (1.1%)

2.2 Levels of Deprivation

The Indices of Multiple Deprivation (IMD) are widely used to analyse patterns of relative deprivation for small areas and to help allocate funding. These small areas are called Lower Super Output Areas (LSOAs) and contain approximately 1,500 people. They provide a snapshot of conditions in an area, looking across a range of factors including Income, Employment), Health and Disability, Education, Skills and Training), Barriers to Housing and Services, Crime and Living Environment.

In East Sussex there are 327 LSOAs, 42 of which are ranked within the 20% most deprived areas in England.Hastings is the most deprived local authority area in the region and has now moved into the 20 most deprived areas in the country. High levels of deprivation exist, particularly in Central St Leonards.

The most deprived LSOA in the county is situated in Baird in Hastings, with this LSOA being ranked as the 4th most deprived in the South East. Results for Eastbourne also suggest that deprivation is widespread across this district. At the other end of the scale, Wealden is among the 75 least deprived districts, although was ranked in the top 20 least deprived districts in 2004. In fact, all of the five districts in East Sussex are now more deprived on the IMD2010 compared to the IMD2007 and more deprived on the IMD2007 in comparison to the IMD2004.

Table 3: LA District rank positions for District in East Sussex in the context of all 326 LA Districts in England[14]

2.3 In treatment population

As the below maps show, there is a strong correlation between the home addresses of the in treatment alcohol and drug population and those in the most deprived areas in East Sussex. For the in treatment drug population, the low numbers in the more rural areas, specifically Wealden, could also be due to their deprivation profile as a correlation has been made between drug misuse and deprived areas within the country. Wealden and Lewes do not generally suffer problems of multiple deprivation and Rother is also noted to be a far from deprived area.

2.4 Complexity Clusters

The NTA has created opiate drug partnership cluster groups in order to make performance comparisons for opiate users with other areas with similar characteristics. They are used as a benchmark in identifying significant variation in performance against the other counties within the individual grouping.

The methodology behind the groupings was based on variables collected by the NDTMS in relation to treatment outcomes. These were then examined alongside external factors likeIndices of Multiple Deprivation (IMD), the Office National Statistics (ONS) rural/ urban descriptors and the size of the opiate treatment populations in each area.East Sussex falls

into cluster group ‘D’. Examples of other counties that sit with East Sussex within this group are Southampton, Bournemouth, Kent and Blackpool.

3. Treatment Map and Bulls Eye 2011

As stated in previous assessments, the treatment services use an integrated case management system, and individuals are in the majority of cases, in treatment with more than one service at any one time. Due to the integrated nature of drug treatment in East Sussex ‘referrals’ between treatment providers are not captured in a way that will serve the treatment map to be an informative process

3.1 Treatment Bulls Eye

As defined by the NTA, the treatment bulls eye is an illustrative way of defining and better understanding groups of Opiate and Crack Users (OCUs) based on their level of engagement with structured treatment. This approach uses two central sources, the NDTMS and Drug Intervention Programme (DIP) data, plus any other available local data to class the estimated OCU population by treatment status. The most dependable data will be found in the centre of the bulls eye, and the less reliable data will be found in the outer rings of the circle.

Figure 2: Treatment bulls eye – estimated OCU population: 2010/11

4. Using the Revised Opiate and Crack Users (OCU) Estimate

Based on the published Hay OCU prevalence estimate of 2224 (with a 95% confidence interval of 2008 – 2606, meaning there is a 95% certainty that the true value exists within the range 2008 to 2606, though it is more likely to lie near the estimate itself), and using the information we know about our treatment population, including the 2010/11 NDTMS data:

1. Those OCUs currently in Tier 3 / Tier 4 treatment872
2. OCUs known to treatment but not in treatment in 2010/11229
3. OCUs in treatment last year (2009/10) but no longer in treatment297
4. DIP OCUs not in treatment – community and prison combined111
5. Total known OCUs1509

We have calculated that there are 1509 OCUs within the inner rings of the bulls eye, known to treatment, giving a treatment penetration estimate of 67.9%. Starting with our prevalence estimate of 2224, we can therefore estimate that there are 715 OCUs in the outer ring who are ‘treatment naïve’. This has increased from 2010 when it was calculated that there were 393 treatment naïve OCUs.

The tables below show the estimated treatment naïve population by gender, age group and injecting status using the published OCU estimates. The tables also include the NDTMS in treatment population figures as shown in chapter 9 by gender, age group (4 clients were older than 64 and so were not counted in this table) and injecting status. Please be aware that although the majority of published OCU estimates have been taken from the most recently published data (2009/10), the gender estimates will be calculated using previously published data.

Table 4: Gender of treatment naïve population (using previously published estimates)

Table 5: Age of treatment naïve population (most recent published data: 2009/10)

Table 6: Injecting status of treatment naïve population (most recent published data: 2009/10)

Hay’s research goes on to provide estimates for those Opiate and Crack users within the county aged between 15 and 64.Opiate users and Crack users are not mutually exclusive. The document suggests that 54.2% (1205) of the total OCU population uses Crack, and our local data shows that 32.4% (408) of our in treatment population have declared use of Crack, demonstrating a stark difference between the figures.

Table 7: Problem substance (most recent published data: 2009/10)

5. OCUs in Effective Treatment

Data published by the NDTMS feeds into this indicator, which contributes to the Home Office PSA 25: to reduce harm caused by alcohol and drugs. The graph below shows that there has been an upwards trajectory, both locally and regionally, over the past 3 years, with the numbers in the South East rising from 7524 in April 2008 to 7868 in March 2011 (+4.6%), compared to an increase of 19.7% locally across the same period; 1129 OCUs in East Sussex at March 2011, up from 943 in April 2008. However, the numbers have now started to move in a slight downwards direction as the numbers of people retained in effective treatment has started to stabilise.