VOL: 103, ISSUE: 16, PAGE NO: 23NICE has published public health intervention guidance on how to reduce substance misuse among vulnerable and disadvantaged under-25s (NICE, 2007). The guidance is aimed at a wide range of professionals - NHS and non-NHS practitioners and others who have a direct or indirect role in reducing substance misuse. This includes those working in local authorities and the education, voluntary, community, social care, youth and criminal justice sectors.
NICE has published public health intervention guidance on how to reduce substance misuse among vulnerable and disadvantaged under-25s (NICE, 2007). The guidance is aimed at a wide range of professionals - NHS and non-NHS practitioners and others who have a direct or indirect role in reducing substance misuse. This includes those working in local authorities and the education, voluntary, community, social care, youth and criminal justice sectors.
Illicit drug use in the UK is most prevalent among young people aged 16-24 (Roe, 2005). In 2003 24% of vulnerable young people reported using illicit drugs frequently during the preceding 12 months, compared with 5% of their less vulnerable peers (Becker and Roe, 2005). There were significantly higher levels of drug use among those who belonged to more than one vulnerable group. Becker and Roe (2005) define five groups of vulnerable young people: those who have ever been in care; those who have ever been homeless; truants; those excluded from school; and serious or frequent offenders.
The guidance outlines the 'significant health risks' associated with substance misuse. These include anxiety, memory or cognitive loss, accidental injury, hepatitis, HIV infection, coma and death. Substance misuse may also increase the risk of other sexually transmitted infections.
In England and Wales class A drug use cost an estimated £15.4bn in economic and social terms in 2003-2004 (Gordon et al, 2006). According to NICE, there are more than 70,000 problematic drug users in England between the ages of 15 and 24.
YOUNG PEOPLE AT RISK
Factors that predispose children and young people to substance misuse include the following (Canning et al, 2004):
- Environment (for example the availability of drugs);
- Family (such as sibling and/or parental substance misuse and lack of discipline);
- Individual experience (for example early sexual encounters and peer group pressure to misuse substances);
- Mental health (for example low self-esteem, depression);
- Education (such as low parental expectations).
The guidance is aimed at reducing substance misuse among vulnerable and disadvantaged children and young people. Those at particular risk include:
- Those who are - or have been - cared for by local authorities, fostered or homeless, or who move frequently;
- Those whose parents or other family members misuse substances;
- Children and young people from marginalised and disadvantaged communities, including some black and minority ethnic groups;
- Those with behavioural disorders and/or mental health problems;
- Truants and those excluded from school;
- Young offenders (including those in prison);
- Those involved in commercial sex work;
- Children and young people with other health, education or social problems at home, school and elsewhere;
- Those already misusing substances.
TACKLING THE PROBLEM
The guidance comprises five main recommendations for tackling the problem. First, local strategic partnerships should agree a strategy to reduce substance misuse among vulnerable and disadvantaged people under 25. This should be based on a local profile of the target population and supported by a local service model that defines the role of local agencies and practitioners, the referral criteria and referral pathways.
The second recommendation is that practitioners and others who work with the target population in the NHS and other sectors (including school nurses) should use existing screening and assessment tools to identify vulnerable and disadvantaged children and young people under 25 who are misusing - or who are at risk of misusing - substances. These tools include the Common Assessment Framework and those available from the National Treatment Agency. Professionals should also work with parents or carers and a range of other educational and medical services and specialists to provide support.
They should refer children and young people as appropriate to other services (such as social care, housing or employment), based on an agreed plan.
SUPPORT AND THERAPY
The third recommendation focuses on providing a family-based programme of structured support for vulnerable and disadvantaged children and young people aged 11-16 who are assessed to be at high risk of substance misuse, involving their parents or carers. NICE recommends that practitioners and others who work with target groups in the NHS and other sectors (including school nurses) should offer such a programme over two or more years, and that it should be drawn up with the parents/carers of the child or young person and led by staff competent in this area.
It also should include at least three brief motivational interviews each year aimed at parents/carers, assessment of family interaction and an offer of parental skills training. It also should encourage parents to monitor their children's behaviour and academic performance, and should continue even if the child moves schools.
Practitioners should offer more intensive support (such as family therapy) to those families that need it.
The fourth and fifth recommendations are concerned with group-based behavioural therapy and motivational interviewing.
The guidance states that practitioners trained in group-based behavioural therapy should offer this to children aged 10-12 who are persistently aggressive or disruptive and are at high risk of substance misuse. The therapy should take place over one to two years, before and during the transition to secondary school. The sessions should take place once or twice a month and last about an hour.
Practitioners trained in this therapy should also offer the parents/carers group-based training in parental skills. This should take place on a monthly basis over the same time frame as that for the children. The sessions should focus on issues such as stress management and communication, and give advice on how to set targets for behaviour.
The final recommendation instructs practitioners trained in motivational interviews to offer one or more of these to vulnerable and disadvantaged children and young people under 25 who are problematic substance misusers. This also includes young people attending secondary schools or further education colleges. Each session should last about an hour and the young person should be encouraged to cover a variety of issues including setting goals to reduce or stop misusing substances.
- Local strategic partnerships should develop and implement a strategy to reduce substance misuse among vulnerable and disadvantaged people under 25.
- Practitioners who work with target groups should use existing screening and assessment tools to identify those who are misusing substances or at risk of doing so. They should work with parents, carers and other services in order to provide support and refer children to other services.
- Practitioners should offer a family-based programme of structured support over two or more years to vulnerable and disadvantaged young people aged 11-16 who are at high risk of substance misuse.
- Professionals trained in group-based behavioural therapy should offer this intervention to children aged 10-12 who are persistently aggressive/ disruptive and are at high risk of misuse. They should also offer parents or carers group-based training in parental skills.
- Practitioners trained in motivational interviewing should offer one or more of these interviews to vulnerable and disadvantaged young people under 25 who are problematic substance misusers, according to the young person's needs.