National
Assembly for Wales / Cynulliad Cenedlaethol
Cymru
Health
and Social Care Committee/
Y Pwyllgor Iechyd a Gofal Cymdeithasol
Inquiry
into alcohol and substance misuse /
Ymchwiliad
i gamddefnyddio alcohol a sylweddau
Evidence
from Cardiff and Vale University Health Board – ASM(Q) 33 /
Tystiolaeth gan Bwrdd Iechyd Prifysgol Caerdydd a'r Fro –
ASM(Q) 33
1.
Do you currently work for an
organisation which works with people who misuse alcohol or other
substances? If so, please state which organisation and whether we
should treat your response as being on behalf of that organisation,
or as a personal response from you.
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Cardiff & Vale University Health Board.
This response is from Cardiff & Vale Public Health Team, and is
supplemented by the Cardiff & Vale Substance Misuse Area
Planning Board
The APB designs, develops and commissions all
substance misuse services across Cardiff and the Vale, and acts as
the responsible partnership for the delivery of the national
substance misuse strategy at a local level
The Public Health Team work on a population
level to reduce levels of harmful alcohol consumption, and the team
is also the lead provider of a Tier 1 Substance Misuse Universal
Services package, which provides education, training, awareness
raising and support for a range of organisations, young people and
adults across Cardiff and the Vale of Glamorgan
The APB addresses substance misuse needs as
they affect the whole population of the area.
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2.
Which client group(s) do you
work with? (For example, under 18s, older persons, homeless, or
female only)
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Within the Universal Services package, we have
a team (Switched On), who work universally with young people under
18 years, and with vulnerable young people up to age 25. The
workforce development and volunteering projects in the package work
primarily with practitioners through delivery of training and
volunteering, but these practitioners may work with adults or young
people.
The Public Health Team and the APB works with
all population groups and ages across Cardiff and the Vale.
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3.
What are the main reasons why
your clients take drugs or drink excessively? Please tick all that
apply.
If you work with more than one client group or
you feel that there are other reasons as to why your clients take
drugs or drink excessively, please comment in the box
below.
P
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Peer pressure
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P
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A way to deal with stress
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P
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Client(s) already substance reliant
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P
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Mental health
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P
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Boost confidence
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P
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Relieve social anxiety
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P
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Environmental factors (for example - excessive drinking and/or
drugs normalised in the home/community)
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P
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Relationship problems
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P
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Financial concerns
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P
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Self-medication
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P
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Escapism
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P
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Other (please comment) Loneliness and isolation, bereavement
(particularly in the case of older people)
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Comments
As we work with such a wide range of people,
young people and adults, all of the above could apply and some
people we work with will have more than one reason why they take
drugs or drink excessively.
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4.
Are there certain groups of
people who are more likely to be affected by drugs and excessive
drinking? If so, which groups might they be?
The harm caused by excessive alcohol
consumption is a population-wide problem1, and it has
both a direct and indirect impact for individuals, their families
and communities. Heavy drinkers (ie people regularly exceeding
government guidelines and ‘binge’ drinking) may be the
group most at risk of harm (violence is particularly an issue
within this group), but potential long-term health consequences may
be seen amongst the wider population of people who drink moderate
levels of alcohol, including developing diseases such as
cancer2.
There are more children aged 15 years who
drink alcohol in Wales than in England, Scotland or the Republic of
Ireland. As well as the health implications of children drinking
themselves, children are also vulnerable to violence and the wider
effects of alcohol in the home if they parents who drink.
Excessive alcohol consumption is also
increasingly being recognised as a growing problem amongst people
aged 50 and over. During 2012-13 24.4% of all referrals for alcohol
misuse to treatment services were for people aged 50 and
over3.
Alcohol is strongly linked to inequalities,
and it is people from deprived groups who suffer the greatest harm
from alcohol use than people from higher socio-economic
groups1. There is very clear evidence that there are
more health-related harms and higher mortality rates amongst more
deprived communities.
Alcohol use is far more prevalent than drug
use – current referral rates to treatment services are 75%
for alcohol, vs 25% for all other substances (Opiates, Stimulants,
Cannabis, New and Emerging Substances, Steroids etc etc)
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5.
Does a particular stage of
your clients’ lives influence their likelihood of taking
drugs or drinking excessively? If so, what stage might that be?
(i.e. age, relationship breakdown, unemployment etc.)
As we work across the population and all age
groups, it is very likely that there will be particular points in
people’s lives where they drink or take drugs excessively.
This may include experimentation as a young person, being
influenced by peer pressure and the culture of ‘binge
drinking’ and also going to university where there is often a
culture of excessive alcohol consumption. In Cardiff & Vale the
population groups who most frequently reported very heavy drinking
(males over 12 units, females over 9) between 2008 and 2012 was
males aged 16-24 and 24-44 years, and females age
16-244.
For adults, crisis points in people’s
lives can lead them to excessive drinking or drug taking, such as
relationship breakdowns, bereavement, loneliness, unemployment and
financial worries.
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6.
What barriers exist for your
client(s) when trying to access support and services?
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For young people that the Switched On service
supports, one of the barriers to them accessing support and
services is the stigma of attending a treatment service and
therefore being seen to have a ‘problem’. There is also
a barrier for them of wanting to access support in the first place.
There is often a reluctance to go to a service if they don’t
know what will happen when they get there. This is something the
Switched On team try to address by introducing a young person to
treatment service staff if they have indicated that they would like
to receive support for their substance misuse.
For some older people in Cardiff and Vale,
barriers to accessing services include feeling that they are not
necessarily age-appropriate, both in terms of the service itself
and the staff who are providing the service3.
There is currently a waiting time of around 10
days for an assessment for treatment, but it can take up to 6 weeks
to access treatment following assessment. Local development
and improvement of care pathways, and staff training are needed to
resolve this as much as any requirement for resources.
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7.
What barriers exist for services
when trying to access support for client(s)?
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Knowing where to signpost clients is crucial
for professionals who are working with people who may need support
with substance misuse, and although in Cardiff and Vale there is a
single point of entry into substance misuse services, this is not
necessarily known by the practitioners. Having age-appropriate
services would address a barrier for people working with older
people who feel that services are not for them.
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8.
What do you consider to be barriers
for staff and frontline services in working with your client
group(s), or substance misuse generally?
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The speed of change in the emerging evidence
base – the way substance use and addiction is effectively
addressed is almost completely different now, to how it was managed
15 years ago. It takes some services time to adjust to these
changes.
Collaborative working remains a challenge
– substance users have multiple needs that can never be
addressed by any one agency or organisation. We are not yet
at the point where joint care management and collaborative working
is the default position.
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9.
Where do you think efforts should be
targeted to address the issue of alcohol and substance misuse in
Wales?
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To target alcohol misuse, there are a range of
interventions which are based on strong evidence of effectiveness
and should direct efforts:-
1)
Minimum unit pricing – this would target the products known
to be consumed by the people most at risk of the highest harm from
alcohol, and would have an impact upon the heaviest drinkers.
Reducing the affordability of alcohol will reduce consumption and
its associated harms amongst people at risk1.
2)
Promotion and marketing restrictions – regulation of alcohol
advertising would help to protect children from significant
exposure to adverts which are currently on television, in
magazines, newspapers, and most significantly, increasingly
appearing on social media. There is a great deal of evidence that
advertising encourages young people to drink and encourages them to
drink at a younger age1.
3)
Controlling availability of alcohol through licensing – there
is evidence that increasing the rigour of existing alcohol
licensing legislation can have an impact on drinking behaviour and
lead to reductions in consumption5, 7. Licensing can
also have an impact on reducing alcohol-related crime and violence.
Currently the 4 licensing objectives in Wales enable responsible
authorities (including Health Boards) to make representation on an
application in a fairly limited way. Public health needs to be made
a core licensing objective, enabling licensing committees to
consider the impact on health and wellbeing of the local population
when considering applications, and be able to take into account the
evidence of availability of alcohol increasing consumption and
therefore potentially restrict numbers of licensed premises.
4)
Delivery of screening and brief advice and interventions –
NICE recommend that NHS professionals should routinely carry
out alcohol screening as an integral part of practice, followed by
brief advice and/or referral to a specialist service as
appropriate6,7. There is good evidence of the
effectiveness of opportunistic early intervention and brief advice
from health professionals. The delivery of brief interventions and
screening opportunities should be prioritised by local
commissioners.
5)
Reduce
the blood alcohol limit for driving in Wales to 50mg/100ml –
Welsh Government should lobby UK governmen t to reduce the legal
blood alcohol limit to 50mg7. International evidence has
demonstrated that a reduction in blood alcohol limits is
accompanied by major falls in road fatalities5.
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For substance misuse
generally, effort needs to be put into:
ü Capitalising on
effective practice, such as the Cardiff Alcohol Treatment Centre,
which is a model now being developed and adapted across the UK, and
within the international community.
ü Workforce development,
prudent skills mixes, and CPD approaches that educate the workforce
into the latest proven effective practices in the management of
addictions.
ü Developing the
competence and capacity of general public service staff to
identify, and respond to signs of substance use, including the
delivery of brief interventions.
ü Promoting the use of
community led initiatives, mutual aid approaches and social
enterprise in order to make tackling substance misuse an issue that
is owned by and addressed by, the communities in which it
occurs.
ü Engendering a cultural
shift that clearly shows that we empower service users to achieve
their own recovery, in contrast to the expectation that people come
into services to have treatment “done to
them”
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10.
In which local authority area do you
work? If you work outside of Wales, please write your local
authority area below.
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Blaenau Gwent
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Merthyr Tydfil
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Bridgend
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Monmouthshire
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Caerphilly
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Neath Port Talbot
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X
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Cardiff
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Carmarthenshire
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Newport
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Ceredigion
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Pembrokeshire
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Conwy
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Powys
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Denbighshire
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Rhondda Cynon Taf
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Flintshire
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Swansea
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Gwynydd
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Torfaen
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Isle of Anglesey
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Wrexham
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X
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Vale of Glamorgan
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If you would like to be kept updated about the
progress of the Committee’s enquiry into alcohol and
substance misuse in Wales, please leave your name and email address
below:-
Please note that the APB as a substance misuse
policy implementation and commissioning partnership would be
willing to submit oral evidence to the committee as part of this
process. Please contact Conrad Eydmann, Head of Substance
Misuse Strategy and Delivery: XXXXXXXXXXXXXXXXXXXX
Cheryl Williams, Principal Health Promotion
Specialist XXXXXXXXXXXXXXXXXXXX
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References
1.
University of Stirling (2013) Health First, An evidence-based
alcohol strategy for the UK.
2.
Public Health Wales Observatory (2014) Alcohol and Health in Wales
2014, Wales profile. PHW
3.
The Wallich (2014) Research and Scoping Exercise into the Impact of
Alcohol on Older People across Cardiff and the Vale of
Glamorgan.
4.
Public Health Wales Observatory (2014) Alcohol and Health in Wales
2014, Cardiff and Vale UHB summary. PHW
5.
Bailey, J at al.
Achieving positive change in the drinking culture of Wales
2011
[Online]. Available at:
http://www.alcoholconcern.org.uk/publications
Glyndwr University and Bangor University
6.
National Institute for Health and Clinical Excellence.
Alcohol use disorders: preventing the development of hazardous and
harmful drinking.
NICE public health guidance 24, 2010. Available
at:www.nice.org.uk/guidance/PH24
7.
Annual Report of the Director of Public Health 2011. Alcohol and
its impact on our community, July 2012. Cardiff & Vale
University Health Board.