Nottingham Insight

Introduction

This joint strategic needs assessment (JSNA) chapter considers all age illicit drug and alcohol misuse in Nottingham City.

Substance misuse can be defined as: ‘the continued misuse of any mind-altering substance that severely affects a person’s physical and mental health, social situation and responsibilities’.1 It includes both drugs and alcohol.

The objectives of this assessment are to:

• outline the causes and risk factors which influence substance use and misuse across age groups
• describe levels of drug and alcohol use nationally and within Nottingham and related outcomes of substance use including health, social, crime and economic impacts
• outline current service provision, including prevention, targeted interventions and specialist treatment
• present insight and evidence for the future design of services for Nottingham.

1 The National Centre for Biotechnology Information, Drug Misuse: Psychosocial Interventions, (2008) - https://www.ncbi.nlm.nih.gov/books/NBK53217/

Unmet needs and gaps

Unmet needs and service gaps:

• An estimated 63% of the people who use opiate and crack are aged 35-64, yet this cohort accounts for 81% of those accessing structured treatment for opiate and crack use. This suggests there is a potential unmet need in opiate and crack users aged under 35 years.
• Of those aged 15-24 who use opiate and crack in Nottingham City, 93% are not accessing structured treatment.
• Reported drug use is highest among 16-19 and 20-24 year-olds but these age groups account for only 8% of people in structured treatment in Nottingham. There is a potential gap within service provision for this age group.
• Data indicates that ‘Mixed’ ethnicity groups are underrepresented in treatment. There is a potential gap within service provision for this cohort.
• There is an unmet treatment need of 74% for alcohol dependent citizens aged 18 and over. This equates to up to 3,800 dependent drinkers who could benefit from specialist treatment.
• There is an unmet treatment need of 82% for alcohol-dependent adults who are living with children.

Knowledge gaps:

• Substance misuse prevalence estimates of drug use in Nottingham City are based on household surveys, which means they do not include the homeless community.Therefore, we have a limited understanding of the prevalence of substance misuse within this cohort; however, the creation of the Rough Sleeping Drug and Alcohol Treatment Team will allow a better understanding in the future.
• There is a lack of detailed insight into the reasons why people drop out of treatment.
• The impact of the COVID-19 pandemic upon substance misuse patterns remains unknown to some extent. The impact will become increasingly clear as more up to date datasets and survey results are published.
• More accurate data is required on trends and patterns of substance use across various ethnic groups in order to tailor provision to these communities.
• More accurate population data for those who identify as LGBTQ+ is required to better understand whether service provision is matching the need of these communities.
• The data source for prevalence of opiate and crack use is outdated and a refreshed estimate would allow more accurate understanding of unmet need.
• The trends and patterns of substance use among students is not clear. As the estimated number of students using substances (11,800) is high, there needs to be a focus on understanding the level of need among this population.
• Real-time surveillance of drug-related deaths would improve ability to determine and respond to risks in a timely manner.

Recommendations for consideration by commissioners

• Ensure that treatment and recovery interventions consider the needs and preferences of young people and ensure that interventions are person-centred and follow best practice.
• Consult with relevant community groups and agencies to establish a culturally responsive service offer, where there are known substance misuse issues in specific ethnic or cultural groups.
• Ensure that engagement with service users, citizens and partners includes a focus on understanding how services encourage the following groups into treatment, and that findings are used to inform commissioning decisions: 
  • Opiate and crack users
  • Opiate and crack users aged under 35
  • Under 25s (in both drug and alcohol treatment)
  • Dependent drinkers, particularly adults who live with children
  • People in LGBTQ+ communities
  • People of ‘Mixed’ ethnicities

• Consider raising public awareness of alcohol harm and options for support through evidence-based campaigns and awareness-raising approaches, working collaboratively with other partners.
• Take a whole system approach to alcohol intervention brief advice training, ensuring all partners feel confident to have discussions with residents about alcohol and the support available, utilising the NHS England’s making every contact count.
• Consider undertaking research to understand the reasons why people drop out of treatment. This would require in depth analysis and consultation with people who have left treatment in an unplanned way.
• Young people, including the student population, should be a priority group for the local authority’s strategy, given the number of people potentially using drugs.
• Continue and enhance the monitoring of drugs trends, seizures, purity and patterns of use.
• Transform services so they are easy to access, connected and flexible in the way they work with people experiencing substance misuse and wider severe and multiple disadvantage factors (including homelessness, mental ill-health, interaction with the criminal justice system, and domestic abuse), and the system ‘working as one.’

Sam Gould, Partnership Analyst, Nottingham City Council
Samuel.gould@nottinghamcity.gov.uk
Bethan Hopcraft, Public Health Manager (Inclusion Health), Nottingham City Council Bethan.Hopcraft@nottinghamcity.gov.uk