Adult Substance Misuse Needs in Norfolk Districts: Great Yarmouth

Transcription

1 Adult Substance Misuse Needs in Norfolk Districts: Great Yarmouth By Claire Gummerson (Research and Information Officer for Norfolk Drug and Alcohol Action Team)

2 Great Yarmouth An Overview The Great Yarmouth district includes the seaside towns of Great Yarmouth, Caister-on-Sea and Gorleston-on-Sea. The population of Great Yarmouth was estimated to be 96,300 in mid In general the age profile in Great Yarmouth is similar to Norfolk but with slightly more people aged 0-15 than seen normally. There is a similar rate of people from ethnic minorities in Great Yarmouth as the rest of the county with 91% of the population white British. The mean household income is lower in Great Yarmouth than the Norfolk average ( 27,000 compared to 30,000). There is also a greater rate of crime 19 crimes per 100,000 of the population compared to 13 in Norfolk. (See Substance Misuse and Deprivation on page 10 for more information) Introduction This report focuses on the characteristics of substance misuse in Great Yarmouth and identifies some of the specific issues for this district. Please read The Norfolk Drug and Alcohol Partnership Adult Substance Misuse Needs Assessment 2012 for more information on the situation in the county as a whole, and for greater detail on some of the themes identified. This can be found in the Reports and Research section of the N-DAP website: Prevalence of Substance Misuse in Great Yarmouth Drugs Given the stigma associated with substance misuse and the illegal nature of some drugs it is difficult to accurately estimate the scale of the problem in Norfolk. Drug dependency is defined as a cluster of behavioural, cognitive, and physiological phenomena, such as a sense of need or dependence, impaired capacity to control substance-taking behaviour and persistent use despite evidence of harm. The prevalence of drug dependence in 2007 was 3.4% (approximately 2,000 people in Great Yarmouth). This is more common among males than females (4.5% of men and 2.3% of women). Most dependence was on cannabis only (2.5% or 1,500 people in Great Yarmouth), rather than on other drugs (0.9% or 540 people in Great Yarmouth). 1 It is not possible to say exactly how many Opiate and Crack Users (OCU) live in Great Yarmouth; but the National Treatment Agency (NTA) estimate that 0.8% of Norfolk s adult population are users of opiates or crack, and therefore there are approximately 500 OCU in Great Yarmouth. 2 However, as this estimate is based on the Norfolk average and the number of adults living in Great Yarmouth, it does not take into account the particular characteristics of the county, age profile and levels of deprivation. As such the true figure may differ from this estimate. Alcohol A recent study estimated that in Norfolk 12.5% of those aged over 16 are engaged in increasing risk drinking, 3 which was 11.1% in Great Yarmouth (approximately 8,600 people). This study found that 3.1% of Norfolk s population were higher risk drinkers, 4 which is 3.8% in Great Yarmouth (2,300 people). So while Great Yarmouth has a lower proportion of increasing risk drinkers they have a 1 National Centre for Social Research (2007) Adult psychiatric morbidity in England 2 The National Treatment Agency (NTA) calculates this using the ONS mid-year population estimate for Norfolk (853,400) and estimates problematic drug use of the section of the population aged (537,700). ONS estimates Great Yarmouth s population in mid-2010 aged to be 60, Increasing risk drinking is defined as consumption of between 22 and 50 units of alcohol per week for males, and between 15 and 35 units of alcohol per week for females. 4 Higher risk drinking is defined as consumption of more than 50 units of alcohol per week for males, and more than 35 units of alcohol per week for females 2

3 higher proportion of higher risk drinkers than the county average, in fact this is the highest rate of all districts in Norfolk. However there are also 15% of people in Great Yarmouth completely abstain from alcohol, compared to 13.8% in Norfolk as a whole. 5 So while a significant proportion do not drink at all, those who do drink tend to drink more. A subset of drinkers will meet the diagnostic criteria for alcohol dependence. The definition of dependence on alcohol is the same as that for drugs (see above) and therefore includes behaviours such as a sense of need or dependence, impaired capacity to control substance-taking behaviour and persistent use despite evidence of harm. A recent study estimated that 5.4% of the population in England is mildly dependent on alcohol (3,200 people in Great Yarmouth), 0.4% of the population are moderately dependent (240 people in Great Yarmouth) and 0.1% severely dependent on alcohol (60 people in Great Yarmouth). Prevalence is higher among men than women (any dependence 8.7% of men and 3.3% of women). 6 Alcohol Related Harm in Great Yarmouth Each year the North West Public Health Observatory releases a report on alcohol related harm, known as Local Alcohol Profiles England (LAPE). The following information is based on the 2011 version: Over the last year Norfolk has seen an increase of 7% in alcohol related hospital admissions from 1,416 per 100,000 of population in 2008/09 to 1,522 in 2009/10. This represents an increase in all seven local authorities. Great Yarmouth with 1,947 per 100,000 of population and King s Lynn and West Norfolk with 2,022 per 100,000 of population are both statistically significantly higher than the national average of 1,742. Great Yarmouth is statistically significantly worse than the national average for five of the 23 alcohol related harm indicators on the LAPE, these include Alcohol-specific Mortality in males, mortality from chronic liver disease in males, hospital admissions for alcohol attributable conditions, alcohol related violent crimes and the number of working age people claiming incapacity benefits. The rate of hospital admissions for alcohol related harm in Great Yarmouth (1,957 per 100,000 of the population) is the second highest in the county and above the average for Norfolk (1,522), the Eastern region (1,482) and the country (1,743). Overall in Norfolk there has been a consistent yearon-year rise in alcohol related hospital admissions over the last three years, with a 7% increase between and (the latest available data), this was a 10% increase in Great Yarmouth. 5 Beynon, C et al. (2011) Topography of drinking behaviours in England 6 National Centre for Social Research, Adult psychiatric morbidity in England (2007). This study used a combination of the Alcohol Use Disorders Test (AUDIT) and the Severity of Alcohol Dependence Questionnaire (SADQ-C) to estimate the prevalence of alcohol dependence. 3

4 Great Yarmouth has the highest rate of alcohol attributable mortality and alcohol specific mortality of all the districts in the county, for both males and females. This is most significant for alcohol specific mortality among males, where the Norfolk average is 12 per 100,000 of the population, the regional average is 9, the national average 13 but the rate in Great Yarmouth is 25 Alcohol related hospital admissions of Under 18s Over the last two years (2007/ /10) 161 people under the age of 18 were admitted to hospital for alcohol specific causes in Norfolk. This works out as 34 young people per 100,000 of the population; this is similar to the regional rate of 35 and far lower than the national rate of 62. The rate varies widely across the districts in the county with the highest rate being in Great Yarmouth, double the county average at 68, and the lowest being Broadland with 13 and South Norfolk with Local Alcohol Profile England (2011) [accessed 14/09/2011] 4

5 The graph above shows a general trend of rate of under 18s admitted to hospital with alcohol specific conditions falling for most districts. However, the one area that has seen a rise is Great Yarmouth with by far the highest rate in the county, seeing a consistent increase since NORCAS are running a project in Great Yarmouth and Waveney called NORCAS Street aimed at reducing alcohol related harms in young people. This was created in response to a need identified following a piece of research carried out in The project is joint funded by Comic Relief and Great Yarmouth and Waveney PCT and comprises of two part-time workers providing outreach to areas identified as hotspots for youth ASB, and one worker based on the Children s Ward in the James Paget Hospital. The hospital worker is currently being recruited but the outreach workers have been active since March 2011 and have so far engaged with young people. Drug related deaths in Great Yarmouth Official figures on drug related deaths use the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) definition which includes accidents and suicides involving drug poisoning, as well as poisonings due to drug abuse and drug dependence; but not other adverse effects of drugs (for example anaphylactic shock). The range of substances it contains is wide, including legal and illegal drugs, prescription drugs and over-the-counter medications. Using this definition there were 29 drug related deaths in Norfolk in 2009 (slightly more than the 25 seen last year but far lower than the unexplained 2007 peak of 41). This gives us a rate of 4.5 per 100,000 of population, to put this in context this is far lower than some areas of the country, the highest being Brighton and Hove with Great Yarmouth has the second highest rate of drug related deaths per 100,000 of population (8.8) of the districts in the county (just below Norwich with (9.7) and followed by the rest with rates between 3.6 and 1.2). 5

6 N-DAP Funded Specialist Drug and Alcohol Treatment in Great Yarmouth Both TADS Great Yarmouth and NORCAS Great Yarmouth have permanent bases in Great Yarmouth. TADS offers specialist prescribing, psychosocial interventions and some tier 2 services. NORCAS runs the structured day programme and other non-clinical tier 2 and 3 services. TADS and NORCAS also run a number of clinics in various health centres and GP practices. The Matthew Project hold a group for the family and friends of people with substance misuse problems. TADS also carries out daily outreach to Herring House Trust and James Pageant Hospital. Treatment Provider NORCAS TADS NORCAS NORCAS NORCAS NORCAS Address Post code Services Provided How often? 59, North Quay, Great Yarmouth The Willow Centre, Northgate Hospital, Great Yarmouth Central Surgery, Sussex Road, Gorleston The Salvation Army, Tolhouse Street, Great Yarmouth Martham Medical Centre, Hemsby Road, Martham Nelson Medical Centre, Pasteur Road, Great Yarmouth 31 Caister Rd Great Yarmouth, Norfolk NR30 1JB Tier 2 & 3, Structured psychosocial including SDP, drug and alcohol NR30 1BU NR31 6QB NR30 2SQ Matthew Project NR30 4DA TADS Central Surgery NR31 6QB Full Tier 3 service Tier 2 & 3, Structured psychosocial, drug and alcohol Tier 2 drug and alcohol NR29 4PA Tier 2 & 3, Structured psychosocial, drug and alcohol NR31 Tier 2 & 3, Structured psychosocial, 0DW drug and alcohol Family and Friends group Monday to Friday all day (evening Thurs) Permanent base Wednesday afternoon Monday, Thursday and Friday mornings Tuesday Friday Tuesdays Shared care clinic Weekly 2-3 hours variable TADS Millwood Med Practice NR31 8HS Shared care clinic One session every two weeks TADS South Quay Surgery NR30 2RG TADS Gorleston medical NR31 Practice 6QB Shared care clinic Community Based clinics Full day every two weeks Monthly TADS Herring House Trust NR30 1NR Assessment/treatment/detox/health screens/relapse prevention. Daily TADS James Pagent Hospital NR31 6LA Alcohol liaison Permanent base Other Drug and Alcohol Services There are two Alcoholics Anonymous (AA) groups that meet at a venue in Great Yarmouth and two that meet in Gorleston-on-sea. There are no Narcotics Anonymous (NA) groups that meet in Great Yarmouth. 6

7 People in Substance Misuse Treatment Groups and key definitions Clients in treatment for their substance misuse can be divided into three broad client groups based on the substance they are primarily experiencing problems with: 1) Opiate and Crack Users (OCU) When a person enters drug and alcohol treatment they are asked to state up to three substances that they are experiencing problems with. OCUs are people who state that any of their three problem substances are either an opiate or crack cocaine. This group frequently experiences wider social problems alongside their substance misuse such as unemployment and housing problems. They are likely to remain in treatment for longer than other groups and to have more repeat episodes of treatment. This group used to be known as Problem Drug Users (PDU) but have been reclassified OCU as it is a clearer definition. Overall 50% of those in treatment in Norfolk over were OCU clients. 2) Primary Alcohol Clients People in this group state that their primary problem substance is alcohol; they may also report less problematic use of another drug (but not opiates or crack as this would make them an OCU). Alcohol clients are generally older than drug clients, move through the treatment system more quickly than OCU and are more likely to be employed and not to have housing problems. Overall 42% of those in treatment in Norfolk over were alcohol clients. 3) AACCE and Other Drug Clients AACCE stands for Alcohol, Amphetamine, Cannabis, Cocaine and Ecstasy. In 2007, Parker, H coined the term ACCE to describe a type of client thought to be distinct from the opiate using OCU. ACCE stands for Alcohol, Cannabis, Cocaine and Ecstasy; it was later updated to include amphetamine (AACCE). It was noted that nationally, fewer and fewer under 18s were entering treatment for problems with opiates and instead appeared to be using the range of drugs encompassing AACCE. This trend can also be seen in Norfolk (see N-DAP Adult Needs Assessment 2012 for more detail). These clients may have alcohol as a secondary or tertiary problem substance, (they do not have opiates or crack as a problem substance as this would make them and OCU). AACCE clients are generally younger than OCU or alcohol clients. They have more in common with alcohol clients than OCUs in terms of being more likely to be employed and not to have housing problems. There are a small amount of other drug clients, these do not comfortably fit into the other categories; largely they have a primary problem substance of prescription or over-the-counter drugs such as Benzodiazepines and anti-depressants. For ease of analysis they have been added to the AACCE group. Overall 7% of those in treatment in Norfolk over were AACCE clients and 1% were other drug clients. 7

8 Norfolk District Comparison The districts in Norfolk have different client groups in treatment: Great Yarmouth is similar to KL&WN in that it has an equal proportion of OCU and alcohol clients. Norwich has by far the highest proportion of OCU clients, in most districts there are more alcohol clients than OCU clients but the number in Norwich skews the figure for the county. North Norfolk has the highest proportion of alcohol clients In general the proportion of AACCE clients remains largely the same across the county. The number of people receiving treatment as a proportion of the total adult population varies widely across the county, suggesting the biggest need for drug and alcohol treatment exists in the more urban areas of the county (Norwich, KL&WN, Great Yarmouth); but is still very much required in more affluent rural areas like Breckland and North Norfolk: 8

9 In general the levels of substance misuse service provision match the levels of drugs and alcohol related harm in the county districts. Norwich and Great Yarmouth have the highest rates of harm, the greatest concentration of treatment and support services, and as such the highest rates of people in drug and alcohol treatment. However, there are some areas of the county (particularly South Norfolk and Broadland) where there are very limited levels of service provision and it is questionable whether there is sufficient service coverage to meet the needs of the population. Broadland and South Norfolk have similar population sizes to Breckland, but far lower numbers in treatment (both alcohol clients and OCU). One of the challenging aspects of providing services in a rural county is working around the effects of a poor public transport system, which needs to be taken into account when evaluating the spread of services. Whether provision is meeting need in the more rural parts of the county ought to be investigated further, with greater consultation at a local level, and with particular reference to transport links. 9

10 People in Substance Misuse Treatment in Great Yarmouth Great Yarmouth has the second highest rate of people in drug and alcohol treatment per 1,000 of the population in the county with 12.5 people in every 1,000 in treatment. There were 751 people living in Great Yarmouth who received treatment for their drug or alcohol problems in : Great Yarmouth has the same proportion of AACCE clients as the N-DAP average of 8%; less OCU clients than average (46% compared to 50% on average) and an equal amount of alcohol clients. In terms of gender the Great Yarmouth district has more males in treatment than the N-DAP average with 71% being male compared to 67% in Norfolk as a whole. There are a slightly larger proportion of BME clients in Great Yarmouth than in the county as a whole with 11% of clients in drug and alcohol treatment being BME in Great Yarmouth compared to 7% in the county. In terms of the nationality of clients living in Great Yarmouth, the most common group after UK is Portuguese followed by Lithuanians, Americans, Irish and Polish, these are largely OCU clients. Great Yarmouth has a similar age profile of clients to the N-DAP average, the peak age group is with 37% (6% aged 18-25, 26% age 25-35, 32% aged 35-45, 24% aged 45-55, 9% aged 55-65, 2% aged older than 65). Great Yarmouth has the second highest proportion of clients with housing problems in the county (77% of client have no housing problems at treatment start, compared to 80% on average); and the lowest rate of clients in paid employment (16% compared to 21% on average) in the county on par with South Norfolk. Substance Misuse Treatment Interventions Provided There are a range of drug and alcohol services available in Norfolk from low intensity interventions, such as offering advice and support and needle exchange, to high intensity interventions in the form of psychosocial treatments and substitute prescribing, and some clients access residential treatments. A full explanation of drug and alcohol support modalities can be found in Models of Care, 8 and Models of Care for Alcohol Misusers, 9 (however these documents are expected to be replaced in 2011). Many clients will go in and out of treatment over the year, which makes it difficult to accurately assess exactly what modalities of care have been provided. For the purposes of this analysis a 8 NTA, Models of Care from Treatment of Adult Drug Misuser (2006) 9 Department of Health, Models of Care for Alcohol Misusers (2006) 10

11 snapshot has been taken of treatments received by people in the system at the end of 2010/11. In Great Yarmouth 44% of all modalities were a psychosocial or other structured treatment, and 55% specialist prescribing modality (this is the largest rate of specialist prescribing in the county compared to a count average of 50%). Specialist prescribing for drug clients There is a wealth of evidence to suggest that substitute prescribing for opiate dependence is an effective intervention that saves lives. When used as part of a well-devised and responsive care plan, Opiate Substitution Therapy (OST) forms a key part of the recovery of many clients experiencing problems as a result of their use of opiates. 10 However, it is felt that for too many people OST has become the end of their recovery journey rather than the beginning and concerns have recently started to emerge at a national level concerning a perceived lack of aspiration for clients on OST. This stems from the central role of the recovery agenda in the 2010 Drugs Strategy and its focus on clients achieving abstinence and spending less time in treatment. Analysis shows that the proportion of drug clients being prescribed for five years or more is much higher in Norfolk than the regional average, and the district with the second highest rate of longterm prescribed clients is amongst those living in Great Yarmouth: The graph above shows that the proportion of drug clients that have been receiving a prescription for more than five years is much larger in Norfolk than the region (26% compared to 17%) and even higher in Great Yarmouth with 32%. This rate is second only to King s Lynn and West Norfolk who have 35%. 10 Degenhardt et al Mortality among regular or dependent users of heroin and other opioids: a systematic review and metaanalysis of cohort studies (2010) Burnet Institute 11

12 Substance Misuse and Deprivation in Great Yarmouth Norfolk is ranked as the most deprived county in the eastern region on most summary measures, and Great Yarmouth is considered the most deprived district in the county. Two areas in Great Yarmouth (Regent and Nelson) are ranked the two most deprived LSOAs in the Eastern region. According to indices of multiple deprivation calculations 22% of people in Great Yarmouth live in deprived areas compared to 6% in Norfolk on average. In February 2011 (most recent data) 22% of people in Great Yarmouth were claiming benefits, compared to 14% in the county on average. A recent government study concluded that the majority of seaside towns have above-average levels of deprivation. This study found that Great Yarmouth has a low proportion of workers with high level skills, a high rate of benefit claimants, suffered from seasonal unemployment, is a residential base for Norfolk and Suffolk s migrant agricultural workers, stands out as having an unusually high share in social housing by the standards of seaside towns, and overall Great Yarmouth is considered to have one of the weakest local economies of all of the towns in the study. 11 The relationship between poverty, deprivation, widening inequalities and problem drug and alcohol use is well established; factors include low job opportunities, few community resources, fragile family bonds and psychological problems. Not all marginalised people will develop a substance misuse problem, but those at the margins of society, such as the homeless and those in care, are most at risk. 12 A robust national study found that levels of drug dependence are related to household income. In men, the prevalence of drug dependence increased as household income decreased, ranging from 2.1% of those in the highest income bracket to 9.6% of those with the lowest incomes. A similar pattern was seen in women although the highest prevalence of drug dependence was found in the second lowest income group (4.6%). Only 0.1% of women with the highest incomes were assessed as drug dependent. 13 Conclusion It is clear that deprivation is a significant factor in making Great Yarmouth the district with the highest levels of drug and alcohol related harm in the county outside of Norwich city. The district has the highest rate in the county of many of indicators of alcohol related harm including alcohol attributable mortality and alcohol specific mortality of all the districts in the county (males and females), and also the highest rate of alcohol related hospital admissions of under 18s. Great Yarmouth has the second highest rate of people in drug and alcohol treatment, the second highest rate of clients with housing problems, and the second highest rate of drug related deaths. There is also a high rate of people that have been in treatment for more than four years. 11 CLG (2008) England s Seaside Towns: A benchmarking study 12 Scottish Drug Forum (2007) Drug and Poverty: A literature Review 13 National Centre for Social Research (2007) Adult psychiatric morbidity in England 12