Interesting things about alcohol and other drugs - Dec 2016

Interesting things about
alcohol and other drugs
December 2016
ANDREW BROWN
@ANDREWBROWN365

One in five referrals to children’s social care in England in 2015/16
included alcohol and/or drugs a factor when assessed by social workers
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
North East North
West
Yorkshire
and The
Humber
East
Midlands
West
Midlands
East of
England
London South East South
West
Number of referrals to children’s social care where
alcohol and/or drugs were assessed as a factor
Alcohol Drugs
Source: Characteristics of children in need: 2015 to 2016 (DfE)
18.4%
19.3%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Proportion of assessments of
Children in Need where
alcohol and/or drugs were a
factor
n=448,200
Alcohol
Drugs

Expenditure (£ thousands) and number of employees recorded against
substance misuse services by local authorities in England
EXPENDITURE
0
100,000
200,000
300,000
400,000
500,000
600,000
Drugs Alcohol Young
people
2013-14
2014-15
2015-16
EMPLOYEES
0
5,000
10,000
15,000
20,000
25,000
30,000
Drugs Alcohol Yount
people
2013-14
2014-15
2015-16
Source: Local authority revenue expenditure and financing (DCLG)

Proportion of rough sleepers seen in London during July – September
2016 assessed as having drug, alcohol, and / or mental health needs
0%
2%
4%
6%
8%
10%
12%
Alcohol only Drugs only Mental health
only
Alcohol and drugs Alcohol and
mental health
Drugs and mental
health
Alcohol, drugs
and mental health
Source: Chain Quarterly Report | Greater London | Jul-sept 16 (GLA)
n = 2,638

Smoking prevalence in adults with serious mental illness (SMI) in
2014/15 by region
0
5
10
15
20
25
30
35
40
45
50
Source: Local Tobacco Control Profiles (PHE)
In England as a whole, 40.5% of adults
with a serious mental illness are smokers
which is more than twice the rate of the
general population (16.9%). Rates vary
across the country and in some local
authorities smoking rates among people
with serious mental illness are over
50%. These include: Kingston-upon-Hull
(52.3%), Southampton (51.3%) and
Manchester (51.1%). Some of the lowest
rates can be found in Harrow (27.2%),
Redbridge (30.4%) and Barnet (30.8%)
although even here the rates are nearly
twice as high as the average adult
population.
Source: High rates of smoking among people with serious
mental health conditions (ASH)

Local authorities undertaking targeted work to address smoking
prevalence amongst people with mental health conditions
0%
10%
20%
30%
40%
50%
60%
Comprehensive programme of work Some work undertaken No work undertaken
Source: Cutting Down, the reality of budget cuts to local tobacco control (ASH & Cancer Research UK)

Number and proportion of football related alcohol arrests
0%
5%
10%
15%
20%
25%
30%
35%
40%
0
100
200
300
400
500
600
700
800
900
2011 to 2012 2012 to 2013 2013 to 2014 2014 to 2015 2015 to 2016
Number
Proportion
Source: Football-related arrests and banning orders, England and Wales: season 2015 to 2016 (Home Office)

Proportion of those at first assessed episode of self-harm also assessed
as misusing alcohol, by age
0%
10%
20%
30%
40%
50%
60%
18–24 25–34 35–54 55+
Men
Women
Total
Ness, Jennifer, et al. "Alcohol use and misuse, self-harm and subsequent mortality: an epidemiological and longitudinal study from the multicentre study of self-harm in
England." Emergency medicine journal 32.10 (2015): 793-799.

Odds ratio of death amongst those assessed as misusing alcohol in
comparison to the general population, by cause of death and sex
MEN
1
2
3
4
5
6
7
8
All external
causes
Suicides and
undetermined
Accidental Natural causes
WOMEN
1
2
3
4
5
6
7
8
All external
causes
Suicides and
undetermined
Accidental Natural causes
Ness, Jennifer, et al. "Alcohol use and misuse, self-harm and subsequent mortality: an epidemiological and longitudinal study from the multicentre study of self-harm in
England." Emergency medicine journal 32.10 (2015): 793-799.

The number of drug seizures in England and Wales
-00
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Class A
Class B
Class C
In 2015/16, there were 148,553
seizures of drugs in England and
Wales, an 11 per cent decrease since
2014/15, when there were 167,059
seizures.
The number of drug seizures peaked in
2008/09, at 241,473 seizures, and has
since declined by 38 per cent (Figure
2.1).
As in previous years, the majority of
seizures were for Class B drugs, and, in
particular, cannabis. Around three
quarters of all seizures involved
cannabis (either herbal, resin or plant).
Source: Seizures of drugs in England and Wales, year ending 31 March 2016 (Home Office)

Quantity (kg) of heroin and cocaine seized in England and Wales
-00
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2006/07 2007/08 2008/09 2009/10 2010/11 2011/122012/13 2013/14 2014/15 2015/16
Cocaine
Heroin
In 2015/16, 4,228 kilograms of cocaine
were seized by the police and Border
Force, a 25 per cent increase on the
previous year (3,387 kg), and the largest
quantity since 2004. This large increase
was driven by a 31 per cent increase in
the quantity of cocaine seized by Border
Force, from 2,691 kilograms in 2014/15
to 3,530 kilograms in 2015/16.
In 2015/16, 806 kilograms of heroin
were seized, a 28 per cent decrease on
2014/15 when 1,113 kilograms were
seized. Similar to cocaine and crack, 63
per cent of all seizures of heroin
weighed less than one gram each.

Quantities of cannabis seized in England and Wales
-00
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
-00
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Quantityofseizures(plants)
Quantityofseizures(Kg)
Herbal cannabis Cannabis resin Cannabis plants In 2015/16, 30,493 kilograms of herbal cannabis
were seized, just over twice as much as in
2014/15 (an increase of 102%). This large
increase was down to the quantity of seizures by
Border Force increasing from 10,458 kilograms
in 2014/15 to 27,132 kilograms in 2015/16 (up
159%).
Over the same time period, the quantity of
cannabis resin seized decreased from 7,405
kilograms in 2014/15 to 7,035 kilograms in
2015/16 (down by 5%).
In 2015/16, there were 393,702 cannabis plants
seized, an increase of seven per cent since
2014/15 when 366,841 plants were seized. Up
until this year there had been a continuing
downward trend in the number of cannabis
plants seized since the peak in 2009/10 (758,943
plants seized).

Almost half (47%) of seizures of cannabis plants were of quantities of
five plants or fewer.
-00
500
1,000
1,500
2,000
2,500
3,000
3,500
One plant 2-5 plants 6-10 plants 11-100
plants
Over 100
plants
What defines the commercial cultivation of
cannabis? 1
• Twenty- five or more cannabis plants, at any
stage of growth (germination), are being or
have been grown OR…
• There is evidence of a cannabis farm.
The definition of a cannabis farm is:
• The premises, or part therein, has been
adapted to such an extent that normal usage
would be inhibited and usually present within
the premises, or part therein, are items solely
concerned for the production of cannabis.
1 UK National Profile for the Commercial Cultivation of Cannabis, NPCC (2014)

Number of cannabis plants seized by region in England and Wales
-00
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
North East
Region
North West
Region
Yorkshire and
The Humber
Region
East Midlands
Region
West
Midlands
Region
Eastern
Region
London
Region
South East
Region
South West
Region
Wales

Two in three organised crime groups in Scotland are involved in drug
crime
67%
A total of 196 serious organised crime groups (SOCGs) are recorded as
operating in Scotland.
SOCGs diversify into different crime types as a means of maintaining
income. Just under half (48%) of SOCGs are involved in multiple crime types.
67% of SOCGs are involved in drug crime; cocaine is the most popular
commodity, followed by heroin, cannabis, tranquilisers and amphetamine.
Other crime types include violence; various forms of fraud including
cigarette smuggling and tax fraud; money laundering; organised immigration
crime; human trafficking; organised theft; bogus workmen; counterfeit
goods and cybercrime.
66% of SOCGs are involved in seemingly legitimate businesses. The most
common business types are licensed premises, restaurants,
building/construction companies, shops, garage repairs and vehicle
maintenance, taxis and nail bars. Over 720 such businesses have been
identified.
Source: Scotland’s Serious Organised Crime Strategy (Scottish Government)

What proportion of crimes in Manchester and Lancashire are recorded
as alcohol-related by type of offence
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Violence Sexual
offences
Other crimes Criminal
damage
Drug offences Robbery Theft/handling
stolen goods
Forgery Burglary Total
Manchester Lancashire
Source: Local Alcohol Profiles for England (LAPE); methodological review of the crime indicators (PHE)

Proportion of tuberculosis cases associated with social risk factors
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Drug misuse Alcohol misuse Homelessness Prison At least 1 social
risk factor
2 or more social
risk factors
Female Male
Source: Tuberculosis in England 2016 report (PHE)
TB cases with social risk factors
are more likely to have
pulmonary disease and drug
resistance, and have worse TB
outcomes; cases notified in
2014 with at least one social
risk factor were more than
twice as likely to have died or
be lost to follow-up at 12
months compared with cases
with no social risk factors.

Proportion of adults with substance misuse treatment need who
successfully engage in community-based structured treatment following
release from prison, by region
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
East Midlands East of England London North East North West South East South West West Midlands Yorkshire and
the Humber
Source: Public Health Outcomes Framework (PHE)

Association between a recent attempt to quit smoking and attempts to
cut down drinking amongst high-risk drinkers
0
5
10
15
20
25
30
35
40
45
50
No quit attempt in last week Quit attempt in last week
Among those with higher risk
alcohol consumption, smokers who
reported attempting to stop
smoking within the last week
compared with those who reported
no attempt were more likely to
report also currently trying to
restrict their alcohol consumption.
Source: Brown, Jamie, et al. "Are recent attempts to quit
smoking associated with reduced drinking in England? A cross-
sectional population survey." BMC public health 16.1 (2016):
535.

Adult substance
treatment activity in
England 2015-16
ADULT SUBSTANCE MISUSE STATISTICS FROM THE NDTMS: 1 APRIL
2015 TO 31 MARCH 2016

Key messages about adult drug and alcohol treatment in England in
2015-16
There has been a fall in the number of people in treatment – overall down by 2%, with a bigger fall
amongst alcohol only clients (-4.6%)
The number of people who died while in contact with treatment services increased by 14%, but is still
less than 1% of all of those in treatment
Most referrals were recorded as coming from self, families or friends (51%), but nearly 22 thousand
(16%) were from the criminal justice system, of whom over half (53%) were opiate users.
7% of new cases were rough sleeping, further 11% were in housing need (sofa-surfing, temporary
accommodation etc.), with particularly high rates of housing need (50%) were reported by clients
citing both opiates and NPS
Only a minority of new entrants into treatment were in employment either at the start of treatment
(24%) or at the six month review (25%)
About two thirds (69%) of adults in treatment (154,471) at the end of 2015-16 were on at least their
second course of treatment, a third (31%) had been in treatment more than three times
Source: Adult substance treatment activity in England 2015-16 (PHE)

Trends in the number of people in treatment for drugs and/or alcohol in
England
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Opiate Alcohol only Non-opiate and alcohol Non-opiate only
-4.56%
-2.06%
0.20%
3.15%
-5.00%
-4.00%
-3.00%
-2.00%
-1.00%
0.00%
1.00%
2.00%
3.00%
4.00%
Alcohol only Opiate
Non-opiate
and alcohol
Non-opiate
only
Proportion change in number of
adults in treatment between
2014-15 and 2015-16

Number of deaths for adults in treatment in England in 2014-15 and
2015-16
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
Opiate Other drugs Alcohol only
2014-15 2015-16 The number of people who died
while in contact with treatment
services in 2015-16 was 2,689
(0.9% of all individuals in
treatment), this is an increase from
2014-15 when there were 2,360
deaths in treatment (0.8% of all
individuals).
While not all deaths in treatment
will be attributable to an
individual’s substance use, the use
of drugs is a significant cause of
premature mortality in the UK.
Source: Adult substance treatment activity in England
2015-16 (PHE)

Proportion of new referrals to treatment and a breakdown of criminal
justice referrals
0%
10%
20%
30%
40%
50%
60%
Self, family
and friends
Health
services and
social care
Criminal
justice
Substance
misuse
service
Other 0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Opiate Non-opiate
only
Non-opiate
and alcohol
Alcohol only
Arrest referral/DIP
Prison
Probation
ATR

Number of new entrants to treatment with housing needs
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Opiate Non-opiate only Non-opiate and
alcohol
Alcohol only
Housing problem Urgent housing problem (NFA) Particularly high rates of housing need
(50%) were reported by clients citing
both opiates and NPS at the start of
treatment, compared to 29% for opiate
clients overall.
Nineteen per cent of opiate clients
reported an acute housing problem at
the start of treatment, which fell to
13% by the time of the six-month
review. Improvements were also seen
in individuals presenting with other
substances, ranging from a 5% drop for
non-opiate and alcohol to 3% for
alcohol only clients.

Proportion of people in treatment who are in employment at baseline
assessment and at 6 month review
0%
5%
10%
15%
20%
25%
30%
35%
Opiate Non-opiate only Non-opiate and
alcohol
Alcohol only
Baseline 6 month review There was a small increase in the
proportion of opiate clients in paid
work by the time of the six-month
review (16% to 18%), with the
average days of paid work
decreasing slightly (0.1%) during this
time. Non-opiate only clients saw a
slightly greater increase in the
proportion reporting paid work,
(29% to 32%), while non-opiate and
alcohol and alcohol only clients
demonstrated only marginal change
in paid employment.

Number of previous treatment journeys for those retained in treatment
31st March 2016
0%
5%
10%
15%
20%
25%
30%
35%
Continuous journey Second journey Third journey More than three journeys

Children in Custody
2015-16
AN ANALYSIS OF 12-18-YEAR-OLDS’ PERCEPTIONS OF THEIR
EXPERIENCES IN SECURE TRAINING CENTRES AND YOUNG
OFFENDER INSTITUTIONS.

Perceptions of their mental health, substance use needs and availability
of drugs by juvenile offenders in young offender institutions
0%
5%
10%
15%
20%
25%
30%
35%
40%
Do you have any emotional or mental
health problems?
Did you have any problems with
alcohol when you first arrived?
Did you have any problems with
drugs when you first arrived?
Is it easy/very easy to get illegal drugs
here?
2014-15
2015-16
Source: Children in Custody 2015-16 (HMI Prisons)

Sub-group analysis of juvenile male offenders mental health and
substance use needs
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall Aged under 17 BAME boys White boys Muslim boys Considered
themselves
disabled
Said they had
been in LA care
Said they had
emotional or
mental health
problems
Do you have any emotional or mental health problems? Did you have any problems with alcohol when you first arrived?
Did you have any problems with drugs when you first arrived? Is it easy/very easy to get illegal drugs here?
Source: Children in Custody 2015-16 (HMI Prisons)

Health at a glance
DATA FROM AN OECD REPORT ON THE KEY INDICATORS OF HEALTH
AND HEALTH SYSTEMS IN THE EU

Proportions of the population which have used selected illegal drugs
over the last 12 months among people aged 15 to 34 – UK vs EU
average
0%
2%
4%
6%
8%
10%
12%
14%
Cannabis Cocaine Amphetamines Ecstasy
United Kingdom
EU26
SOURCE:
Source: Health at a Glance: Europe 2016: State of Health in the EU Cycle, (OECD/EU 2016)

Alcohol consumption among adults - Litres per capita (15 years and
over)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0

Regular binge-drinking (at least once a month), by gender and by
education level, UK vs EU average
0
5
10
15
20
25
30
35
Women Men Total Lowest
education
level
Medium
education
level
Highest
education
level
United Kingdom EU24
“Alcohol-related harm is a major public
health concern in the European Union,
both in terms of morbidity and
mortality (WHO Europe, 2012; OECD,
2015). Alcohol was the third leading risk
factor for disease and mortality after
tobacco and high blood pressure in
Europe in 2012 and accounted for an
estimated 7.6% of all men’s deaths and
4.0% of all women’s deaths, though
there is evidence that women may be
more vulnerable to some alcohol-
related health conditions compared to
men (WHO, 2014).”

Drunk at least twice in life among 15-
year-olds, 2013-14
0
5
10
15
20
25
30
35
Girls Boys
United Kingdom EU27 “Adolescent alcohol use is a major health
concern in many European countries. Early and
frequent drinking or drunkenness is associated
with negative psychological, social and physical
health issues, such as violence, accidents,
injury and use of other substances (Inchley et
al., 2016). Alcohol use has been shown to
affect learning performance. Binge drinking, as
well as high frequency of drinking, reduce
achievement scores. Alcohol consumption also
reduces attendance and increases probability
of having difficulty in school or dropping out
without having graduated (Balsa et al., 2011;
Chatterji et al., 2005).”

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