Alcohol & Substance Misuse

All drug use increases the risk of harm – to the individual, those around them, and to wider society. Drug misuse includes illegal substances such as cannabis, cocaine and heroin, as well as the misuse of legal substances such as prescription, and over-the-counter medications. Alcohol is a drug. Alcohol misuse is a significant problem generating physical, psychological and social harm, to the user, and to those around them. Drug and alcohol harm is multi-faceted, and every drug (including alcohol) has a different harm profile. 

Initially, people experiment with drugs or alcohol for a variety of reasons: out of curiosity, because of peer pressures, or rebelliousness, and this typically occurs at a young age. Up to half of young people may have experimented with illegal drugs or solvents by the time they are 16. Continued use of drugs occurs for many reasons; relaxation, to become intoxicated, for pleasure, escapism, to lose inhibitions, enhance socialising, to self-medicate and relieve pain, to improve mood, or in some cases, to relieve cravings linked to dependence. Poverty, unemployment, and social deprivation are significant factors that contribute to substance use.  People with pre-existing mental health conditions, including anxiety and depression, are particularly at risk (Source: RSPH, Taking a New Line on Drugs). 

For the individual, possible impacts of drug and alcohol use include; dependence, a wide range of physical and psychological health impacts (cancer, cirrhosis, heart disease, psychosis, paranoia, self-esteem issues); and premature death. Drug and alcohol use is linked to the loss of relationships, and tangibles such as housing and employment. For a drug user’s family and friends, there is increased risk of injury through mechanisms such as; foetal harm, transmission of blood borne viruses, domestic violence, and road crashes. For wider society there is harm from crime, economic costs (such as healthcare costs, loss of workforce productivity) and disruption to community cohesion (Source: Nutt et al. 2010). For all these reasons and more, tackling drug and alcohol misuse is a national priority. 

The societal cost of harmful drinking is estimated at £21 billion a year; with 10.8 million adults drinking at levels which pose some risk to their health. Similarly, the estimated costs of drugs to society is over £19 billion – more than twice the value of the market itself (Source: Department of Health & Social Care). The UK low risk drinking guidelines reflect a level of alcohol consumption that will limit health harms, and harms to family, friends and wider society. 

• The National Government Drug Strategy – From harm to hope focusses on three themes: breaking drug supply chains; delivering a world-class treatment and recovery system; and achieving a generational shift in demand for drugs. The strategy aims to reduce drug-related crime, deaths, harms and overall drug use between 2022 and 2032. 
• The Misuse of Drugs Act 1971 controls the use and distribution of dangerous and harmful drugs, with the aim of preventing drug misuse. 
• The Psychoactive Substances Act 2016 defines and contains provisions for offences relating to, and provisions for, dealing with psychoactive substances. 
• The Orange Guidelines are the UK guidelines on the clinical management of drug misuse and dependence. The guidelines are used by clinicians providing treatment for individuals using, or who have a dependence on, drugs. 
• Relevant NICE guidelines include: Alcohol-use disorders and Drug misuse prevention. 
• The Lincolnshire Drugs Strategy 2021-25 provides a local response to the national strategy. 
• Core20PLUS5 is the NHS England and NHS Improvement approach to supporting a reduction in health inequalities (HI) at National and the System level. 

Alcohol 

Nationally, 1 in 4 adults regularly drink over the Chief Medical Officer’s (CMO) low-risk guidelines (14 units per week). 27% of drinkers binge drink on their heaviest drinking days. Only 20% of the population report not drinking at all (Source: Alcohol Change UK). The most recent data for Lincolnshire (2015-2018) is relatively dated but, at that time, 12.9% of people reported abstaining from drinking. Over the same time period, 1 in 6 adults reported binge drinking, and 1 in 5 drinking more than the CMO’s low-risk guidelines (Source: OHID). An estimated 6,936 adults are alcohol dependent in Lincolnshire. 

There is no recent local data on the prevalence of alcohol use among children and young people (CYP). Nationally, in 2021, 40% of school pupils reported having ever had an alcoholic drink. An average of 6% of children aged 11-17 years report usually drinking at least once a week, rising from 1% of 11 year olds – to 14% of 15 year olds (Source: NHS Digital). 

During the pandemic, there was a global trend of increased alcohol consumption (and use of other substances). Depression, anxiety, hopelessness, and social isolation were all observably related to increases in substance use (Source: Roberts et al, 2021). Lincolnshire’s treatment services have seen levels of dependency increase since the start of the Covid-19 pandemic, and more users are presenting with complex issues. 

Around 11% of the estimated number of adults who are alcohol dependent in Lincolnshire access specialist treatment services. In the most recent year for which data are available, just under one third of people completed treatment successfully, and did not re-present within 6 months. This is lower than the England average. No-one wanting access to treatment for alcohol in Lincolnshire has to wait more than 3 weeks (Source: OHID).  

Generally, hospital admissions related to alcohol are much lower in Lincolnshire than England averages (Source: OHID): 

• Alcohol-related hospital admissions are significantly below the England average. The 5 year trend is stable for males but is worsening for females. 
• Alcohol-specific hospital admissions are significantly below the England average, and the trend is worsening for males and females.  
• Admissions for alcohol-related unintentional injuries are significantly lower than the England average and trending steady.  
• Admissions for mental and behavioural disorders due to the use of alcohol are lower than the England average but on an increasing trend for all persons, particularly for women. 

Alcohol-specific mortality is statistically significantly lower than the England average, and trending steady. Alcohol-related mortality is comparable to the national average (Source: OHID). 

There are a range of “harms to others” linked to the use of alcohol. For example, alcohol-related crime and anti-social behaviour has increased in adults, compared to pre-pandemic levels in Lincolnshire. Many violent offences occur at night, particularly at weekends, in the early hours of the morning. Alcohol is a factor in 44% of night-time offences; drugs are a factor in 7% of incidents (Source: A Public Health Approach to Violence Reduction in Lincolnshire: A Strategic Needs Assessment). Alcohol-related crime is most common in Skegness, Ingoldmells and Chapel St Leonards, Boston and Lincoln, North Hykeham and Waddington. 

In the year to August 2022, 16 young people in Lincolnshire received an alcohol-related criminal conviction (e.g. drunk and disorderly, or a motoring offence). This can only represent the tip of the iceberg as many young people are convicted of offences where alcohol influenced their behaviour but is not recorded in their conviction. In addition, five alcohol-related offences were managed through the youth justice Joint Diversionary Panel over the same period. 

A range of other harms (financial challenges, relationship breakdown, domestic abuse, child neglect) will be experienced across Lincolnshire, but there are limited-to-no data available to inform this JSNA. 

Drugs 

Nationally, 1 in 15 adults use cannabis, 1 in 45 use cocaine and 1 in 1000 use opiates. Approximately 300,000 individuals in England are addicted to heroin and/or crack cocaine. In Lincolnshire, an estimated 1,400 people use crack; 3,241 use opiates; and 3,669 are opiate and/or crack users (OCU); be aware, these figures from 2016/17 are relatively old, so an understanding of the current position, particularly regarding emerging drugs, is inexact. 

There is a concentrated demand for drugs in Lincoln, Boston, Skegness, and Grantham. The most recent drug market profile estimated 40,809 drug users aged 16-59 in Lincolnshire (Source: Lincolnshire Police Drugs Market Profile 2021). 

Local data on drug use among CYP is scarce. However, national data reports a fall in the prevalence of lifetime and recent illicit drug use (Source: NHS Digital). In 2018, 24% of CYP reported ever taking drugs, falling to 18% in 2021. 6% reported drug use in the last month, compared with 9% in 2018. Low wellbeing was most likely among pupils who had recently smoked, drunk alcohol or taken drugs – much lower than for children who had done none of those things. Pupils who frequently met up with people outside of school or home, were more likely to have recently smoked, drunk alcohol or taken drugs. 

Only half of adult OCU in Lincolnshire are in contact with specialist treatment services but 4.8% of opiate users successfully completed treatment, not re-presenting within 6 months in the past year. This is significantly better than the national average. No-one wanting to access treatment in Lincolnshire has had to wait more than 3 weeks for alcohol treatment (Source: OHID). Where records are available, access to treatment for some marginalised groups is comparable to the national average (e.g., LGBTQ++). Overall, access for ethic groups is low, but much higher in Boston as would be expected from the demographics. 

Dual diagnosis, where people experience severe mental ill health and drug or alcohol problems, is a challenge in Lincolnshire. Particular groups are more likely to experience dual diagnosis; the homeless or at risk of rough sleeping, and young people leaving care. To illustrate, almost half of young people leaving care in Lincolnshire have coexisting mental health difficulties and drug or alcohol needs. 

During 2020/21 there were 148 young people receiving treatment in Lincolnshire. The majority of referrals come from Education or Children and Family Services. Most children in contact with the specialist service use multiple substances; the 4 most common being; cannabis (88%), alcohol (37%), cocaine (22%) and ecstasy (31%). The number of children accessing specialist treatment in Lincolnshire has declined in recent years. 

In 2020, 1750 drug offences were recorded by Lincolnshire Police; roughly two-thirds relating to possession and one-third to supply, production, and import of drugs (Source: Drugs Market Profile 2020). The prevalence of drugs and drug use is increasing nationally. There is no evidence to suggest Lincolnshire is an exception to that. Crimes involving drug users have shown a slight downward trend since the start of the pandemic and remain 10% lower than pre-pandemic levels. Drug-related crimes are clustered in Lincoln, North Hykeham and Waddington, Skegness, Ingoldmells and Chapel St Leonards, and Horncastle. Anecdotal evidence from treatment providers suggests that those with drug dependency continued offending to support their dependency during lockdowns, but perhaps switched offending behaviours (for instance, to stealing higher value items from supermarkets, commercial burglaries, or sex work) (Source: Strategic assessment: Community safety and safeguarding in Lincolnshire, 2021). There were 103 convictions for drug-related offences (e.g., possession, possession with intent to supply, cultivation and driving offences) for young people in Lincolnshire in the year to August 2022. An additional 41 drug-related offences were managed through the Joint Diversionary Panel over the same period. 

In Lincolnshire, the death rate from drug misuse is significantly worse than the England average for males and females. Furthermore, it is unclear why the number of deaths in treatment is higher than expected in Lincolnshire. Possible explanations include an ageing cohort of drug users; new trends in taking specific drugs, like gabapentinoids or benzodiazepines, alongside heroin or morphine, increasing risks of overdose; or increased cocaine use (Source: Strategic assessment: Community safety and safeguarding in Lincolnshire, 2021). 

Drug and alcohol misuse is a local priority and significant work has been undertaken across the system (for example by the police and public health) where we are building a good understanding of local intelligence and securing additional funding to prevent misuse, and boost treatment and recovery services. The Safer Lincolnshire Partnership (SLP) identifies the prevention and treatment of drugs and alcohol misuse as a strategic priority. Aligned to the National Strategy, From Harm to Hope, the SLP Core Priority Group will operate as Lincolnshire’s Combating Drugs Partnership; to be known locally as the Drugs and Alcohol Partnership. At the time of writing, SLP is reviewing local needs to inform an action plan for drug and alcohol misuse prevention and treatment. 

The substance misuse treatment provider for adults in Lincolnshire is Lincolnshire Recovery Partnership (LRP). They provide advice, brief interventions, and longer-term structure treatments. They offer psychosocial and pharmacological interventions, harm minimisation (including a needle syringe programme), prevention education, and support for sustainable recovery.

LRP works closely with Lincolnshire Partnership Foundation Trust (LPFT) supporting people with dual diagnosis. There is a joint-funded We Are With You Mental Health Liaison Service to provide specialist support to this cohort. The LRP Young Persons’ service works in partnership with Future4Me supporting young people who access the youth offending service. Inpatient rehabilitation and detox are available when clinically indicated. LRP also provide training to individuals and community groups in the use of Naloxone – a life-saving antidote for opiate overdoses. 

Double Impact offers support for maintaining a drug and/or alcohol-free life. The organisation comprises of experts by experience, with over 50% of the staff in recovery themselves. That lived experience, alongside peer support and education, positions people in the best possible situation whilst emerging from problematic substance misuse. 

A Carer’s Service, delivered by Carers First, supports people that are caring for those who are misusing drugs and/or alcohol by offering  a statutory carer’s assessment. 

Community Alcohol Partnerships (CAPs) have been established in Boston, Spalding and Skegness, bringing together local councils, police, retailers, schools, public health and community groups to reduce the alcohol related harm of young people, improve health and wellbeing and enhance local communities. Workstreams have included; ‘Challenge 25’ campaigns and training, raising the profile of public health, and encouraging diversionary activities. 

One You Lincolnshire (OYL) provide support to people over 18s who drink 14+ units per week and would like to make changes to that behaviour. OYL offer one to one health coach sessions, a ‘drink less’ app, and virtual workshops. 

Lincolnshire Police are developing an out of court disposals offer (a disposal is the outcome of a sentencing procedure). The offer provides an alternative consequence to accused people for committing an offence related to drugs or alcohol, or who are under the influence of drugs or alcohol when they commit an offence. An alternative consequence would allow individuals to elicit support instead of receiving a punishment and consequently not be able to address problematic substance use. 

The Stay Safe Partnership brings together the organisations and voluntary agencies that deliver age-appropriate safety workshops, staff training, e-learning and online resources. As part of this, LCC fund WAWY staff to deliver age-appropriate, drug and alcohol education to all schools in Lincolnshire. During the 2021/2022 academic year, 305 alcohol and drugs awareness sessions were delivered, reaching 9334 Year 7 and Year 8 students. 325 sessions about drugs reached 10,104 students in Year 9 and Year 10. 

Key partners include; Lincolnshire Police, HMPPS, OPCC, Trading Standards, District Councils Licensing, LCC Public Health, LCC Adults and Children’s Social Care, We Are With You, the ICB, GPs, Lincolnshire NHS Trusts, OHID and education providers.  

Local services engage with the public to capture views of the quality of their services as services are delivered.

• Alcohol misuse: There is unmet need in tacking prevalence and in remediating associated harms. These are high in Lincolnshire and should be prioritised. Reducing alcohol misuse requires all-age approaches to prevention and access to high quality treatment to support those already experiencing harm. 
• Why are less young people accessing treatment services in recent years? We need to understand the reasons behind this trend. Is it declining need? Or barriers to accessing treatment? There is a gap in recovery support services for young people. 
• Treatment service caseloads are high with limited specialist capacity. This necessitated the focus of care to be on supporting opioid users, leaving help for alcohol users less well supported. We are piloting new posts using government grant funding. This should improve treatment capacity and quality into 2023, and enable services to refocus on clients suffering alcohol harms. 
• Understanding and addressing the needs of more vulnerable people, and people with complex drug and/or alcohol-related problems will greatly assist the reduction of health inequalities. For example, people who are, or are at risk of rough sleeping; women and girls in contact with the criminal justice system; and adults with a learning disability and/or autism at greater risk of adverse outcomes (e.g. cuckooing) but for whom standard treatment is inappropriate.
• The number of drug-related deaths in Lincolnshire is high so we need to understand the circumstances surrounding drug related deaths and identify opportunities to prevent future deaths, working in multi-agency partnerships and improve outcomes.
• There is a gap in the provision of support for family and carers. Addressing this gap is a priority. This is an essential component of a systems approach to reducing drug and alcohol-related harm. 

The next steps for Lincolnshire include: 

• Establishing the Lincolnshire Drug and Alcohol ‘Core Priority Group’ (CPG). The CPG will report to the SLP and the National Joint Combating Drugs Unit (as the Lincolnshire Combating Drugs Partnership). The Drug and Alcohol CPG will have responsibility for developing and delivering Lincolnshire’s strategic approach to reducing drug and alcohol-related harm. The approach will include prevention and treatment activity across a range of health and social outcomes. 
• The Drug and Alcohol CPG will continue to deliver the Lincolnshire Drug Strategy, but expand their work to include prevention and treatment of alcohol related harms. 
• Working with the Office for Health Improvement and Disparities (OHID) and the Department for Levelling Up, Housing and Communities (DLUHC) to implement initiatives paid for by new grants to support the aspirations of ‘From Harm to Hope’. This work is being led by LCC supported by the Drug and Alcohol CPG.  
• Reduce drug-related deaths. The appointment of a drug-related deaths coordinator will establish a review process for drug-related deaths allowing the system to spread lessons-learned, preventing future avoidable deaths. 
• Recommissioning Drug and Alcohol Treatment, Recovery and Family Support Services will be led by Public Health at LCC. This will involve engagement with many and varied stakeholders affording many opportunities to shape new services and how they will work with system-wide partners. The system must embed an holistic approach to those experiencing harm.