Topic Report: Drugs and alcohol

Please note, this is not an exhaustive list of risk factors, and some may be both a risk factor for substance misuse as well as a consequence of substance misuse.

Adverse childhood experiences (ACEs) are “highly stressful, and potentially traumatic, events or situations that occur during childhood and/or adolescence. They can be a single event, or prolonged threats to, and breaches of, the young person’s safety, security, trust or bodily integrity.” (Young Minds, 2018) (source: Addressing Adversity).

Experience of one or more childhood adversities has been linked to poorer physical and mental health outcomes in adolescence and adulthood. Individuals who experience multiple adversities in childhood are more likely to abuse drugs and alcohol. A study conducted in 2014 in England found that adults who had experienced four or more adversities in their childhood were twice as likely to binge drink and eleven times more likely to go on to use crack cocaine or heroin (source: BMC Medicine).

Growing up in a household with adults experiencing alcohol and drug use problems is an adverse childhood experience in itself. Individuals who experience ACEs are at an increased risk of exposing their own children to ACEs, which can create an intergenerational cycle of substance misuse (source: World Health Organization). Children with one parent who misuses alcohol are 2.5 times more likely to also misuse alcohol than those whose parents do not misuse alcohol (source: Public Health England).

The proportion of adults entering drug treatment who live with children was slightly higher in Buckinghamshire than nationally (19.6% versus 17.3%) in 2020/21. In Buckinghamshire, the proportion of children in need assessments identifying alcohol (24%) or drug (25%) misuse by a parent or other adult living with the child has been rising over the past two years, compared to remaining stable nationally and amongst benchmark areas (Figure 17). Benchmark areas for these data were identified by OHID using the Chartered Institute of Public Finance & Accountancy (CIPDA) 2018 model. However, the rate of children identified as in a household where a parent has alcohol or drug problems is similar to nationally (36 versus 40 per 1,000 0-17 year olds in 2019/20) (source: Parents with problem alcohol and drug use).

Stakeholder consultation with local professionals highlighted county lines as a growing concern. Whilst often associated with the exploitation of young people, stakeholders reported that vulnerable adults are also being involved locally.

Hazardous drinking (defined as a score of 8 or more using AUDIT) has been identified in a greater proportion of armed forces personnel than the general population. For men the rate is 1.8 times higher (67% versus 38%) and in women the rate is 3.1 times higher (49% versus 16%). In 2016/17, an initiative to screen for alcohol misuse during routine dental appointments saw three quarters (74%) of all regular UK armed forces personnel completing the shorter AUDIT-C screening questionnaire (source: Patterns of drinking in the UK Armed Forces). 61% of those screened scored 5+ indicating they may be at increasing risk of alcohol related harm, and 2% scored 10+ indicating they may be at higher risk and were advised to see their GP (source: Alcohol Usage in the UK Armed Forces).

There are 2,840 UK Regular Forces personnel in Buckinghamshire (April 2021), of which the vast majority (98%) are serving in the Royal Air Force (source: Ministry of Defence). Buckinghamshire has the second highest number of serving RAF personnel in the South East, with only neighbouring Oxfordshire having more. There are an additional 15,128 armed forces veterans residing in Buckinghamshire based on the 2021 Census – 3.4% of the adult population, close to the national average of 3.8%. Fewer than one in ten (1,282) of these veterans are currently identified on Buckinghamshire primary care records (March 2023).

Alcohol consumption can be a consequence of domestic abuse and violence, as well as a cause. Women who experience domestic violence are up to 15 times more likely to misuse alcohol than women who are not victims of domestic violence (source: Preventing Intimate Partner and Sexual Violence against Women).

Drug use amongst prisoners in custody is reported to be high. Almost one in five (19%) of the 3,489 prisoners who had ever used heroin reported first using it in prison (source: Prison Reform Trust). Offenders who receive residential drug treatment are 45% less likely to reoffend after release than comparable offenders receiving prison sentences. It has been estimated that around 75% of those who come into contact with the UK's criminal justice system (those in police custody, probation settings and the prison system) have a problem with alcohol, and over 25% are dependent on alcohol (source: Institute of Alcohol Studies). Currently there are different drugs and alcohol interventions available across the six Thames Valley custody suites.

There are 182 convicted Buckinghamshire residents in prison, excluding the remand population (October 2022). In 2019/20 there were nearly 5,000 ex-offenders in Buckinghamshire.

Nationally, nearly two thirds (63%) of adults entering specialist drug treatment were identified as having a mental health treatment need in 2020/21, following a continued rise over the past five years. While the proportion with mental health needs is also rising in Buckinghamshire, it is lower at just over half (52%) of adults entering specialist drug treatment (Figure 18).

Mental health treatment needs are more commonly identified in women at 73% entering specialist drug treatment versus 58% in men nationally. This gender gap is wider in Buckinghamshire – locally women are 42% more likely than men in Buckinghamshire to have a mental health treatment need identified on entering drug treatment, compared to women being 26% more likely than men nationally (2020/21).

Stakeholder consultation with local professionals described issues relating to mental health as adversely affecting many service users. Significant life events (such as relationship breakdown, healthcare concern, housing issue, bereavement or change in employment status) were reported to be the main driver for referrals into specialist services by several professional stakeholders. In many cases this referral coincided with the first professional identification of wider health and social issues for the individual. Similarly, those with lived experience identified the link between bereavement and addiction. Service users spoke of a lack of grief or bereavement counselling, which some felt was the cause of their addiction. Those with lived experience interviewed felt that their mental health needs were not being met and that this was an important aspect of their addiction. Service users often reported that access to additional services, such as counselling, was reserved only for those who were ‘clean’. Professional stakeholders highlighted a need to increase substance misuse awareness, training and promotion of clinical pathways for mental health professionals. All those consulted felt there was a need for some form of joint provision for mental health and substance misuse services.

Nationally, 8% of adults entering drug treatment reported an urgent housing problem and a further 14% reported having a non-urgent housing problem in 2020/21. Fewer alcohol-only treatment clients raised housing issues with 2% entering treatment reporting an urgent problem and 7% reporting a non-urgent problem nationally in 2020/21. The proportion of clients entering drug and alcohol treatment in Buckinghamshire reporting housing issues is similar to national levels.

Stakeholder consultation with local professionals described issues relating to housing as adversely affecting many service users. Stakeholders working in the housing sector commented that landlords are often unwilling to accommodate those with substance misuse and/or mental health issues either during or post treatment. In addition, those trying to recover from substance dependence are often accommodated in the same location as others with similar issues which can disrupt recovery.