StrategicAssessment

2009 -10

2

Alcohol and Drug Misuse in Moray Moray Alcohol and Drug Partnerships Strategic Assessment 2009 Written by: Anna Jermyn Neil Stables Published by: Moray Alcohol and Drug Partnership 252 High Street Elgin Moray IV30 1BE

3

DRUG & ALCOHOL MISUSE

IN MORAY

© The Gazetteer for Scotland, 1995-2007 Used with permission from The Gazetteer for Scotland at http://www.geo.ed.ac.uk/scotgaz/

STRATEGIC ASSESSMENT

2009/10

4

Contents Acknowledgements page 5 Introduction page 6 A Profile of Moray page 8 Alcohol Misuse page 12 Drug Misuse page 22 Drug & Alcohol Services in Moray page 37

Prevention/Early Intervention page 37 Treatment page 42 Continuation Support page 50 Indirect Services page 51

Inferences page 55 PESTELO Analysis page 56 SWOT Analysis page 59 Risk Analysis page 60 Recommendations page 62 References page 65 Appendix 1 – Risk Analysis summary table page 67

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Acknowledgements This Strategic Assessment would not have been possible without the help and advice of many people. We would like to take this opportunity to thank all who shared their expertise, understanding and time with the authors and contributed in any way to the final report. Anna Jermyn & Neil Stables Research and Information Officers The Moray Council August 2009

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Introduction This is the first strategic assessment undertaken into drug and alcohol misuse in Moray. It will inform a wider process designed to support strategic decision-making in relation to managing risks, setting priorities and allocating resources. The aim is to help Moray’s Alcohol and Drug Partnership (MADP) to achieve not only its own outcomes and objectives but also those set by the Moray Council administration and the Scottish Government, ultimately making Moray a safer place to work and live. The information and analysis contained within this report will be most effective when combined with the knowledge and local expertise that exists within the various drug and alcohol agencies within Moray. The result will provide a firm foundation for setting priorities and developing the MADP Strategy 2009-2010. The assessment is divided into 3 main areas in order to ensure a wide range of substance misuse issues are considered. The areas are:

• Alcohol Misuse • Drugs Misuse • Drug and Alcohol Services in Moray

For each of the 3 areas, the current picture is described along with any emerging trends and information gaps. A PESTELO and SWOT analysis are included and inferences and recommendations are put forward for consideration. The most recent available data is used and where possible this has been sourced independently to provide an unbiased picture. For some areas it was not possible to obtain ideal data, either because it is not collected or not available at Moray level. In these cases, data has been obtained from an appropriate source and analysed to provide an indication of the situation in Moray. Drugs and Alcohol Tackling drug-related and alcohol-related harm is one of the Scottish Government’s key public health priorities. Recent research into drug misuse suggests that there are 52,000 problem drug users in Scotland; 40-60,000 children are affected by the drug problem of one or both parents; and there were 455 drug-related deaths in 2007, double that of 10 years previously19. The economic and social cost of Scotland’s drug problem is estimated at £2.6 billion per annum27. The Scottish Government have published a new strategy for dealing with those suffering from a drug-related problem entitled The Road to Recovery and they are providing £94 million over the next 3 years to tackle the drug problem, which represents a funding increase of 14%25. Recent public reports including the Scottish Government’s report ‘Changing Scotland’s relationship with alcohol’30, have highlighted the significant escalation and negative impact excessive drinking is having on Scotland as a whole. As part of the government’s priority in tackling alcohol misuse and reducing the burgeoning cost to the country, which is estimated at £2.25 billion a year26, further investment through NHS Boards has been committed as well as plans for strategic change in how those suffering from alcohol related problems are identified and treated. The Scottish Government are providing £36 million for 2009-10, a 45% increase on the £24.86 million allocated for 2008-09. It forms part of a planned three-year package of £120 million to tackle alcohol misuse more widely – an overall funding increase of 230 per cent compared to the previous period26. While these are seen as a much needed injection of investment into tackling drug and alcohol misuse in Scotland the question now is how best to use this money to enable services at a local level to provide help to those who are affected and to counter the increasing trend in the numbers misusing drugs and alcohol.

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Investment in drug and alcohol services in Scotland has historically favoured drug services in regards to the proportion of funding being spent. The imbalance in investment was highlighted in the Auditor-General’s report for the year 2007/08 and subsequently alcohol services have received a significantly greater increase in funding (230%) compared to drug services (14%) for the next three years. If the allocation of monies were to be based on prevalence or activity data15/28, for example, the level of related hospital discharges or the number of deaths due to substance misuse, then it would indicate that in Moray there is indeed a greater need for resources to be targeted at services dealing with those affected from alcohol misuse.

This relatively simple theory is supported by the information gathered from the local services that provided data for this research, as the majority of clients being referred to local services were for an alcohol related problem. The majority of services in Moray who contributed data offered a ‘joint service’, where referrals were accepted for people with either an alcohol and/or drug misuse problem. Pulling the number of referrals together for all services over a 5 year period (likely that a person has accessed several services so will be counted at least twice), over two thirds (67%) were for alcohol only misuse problems. 7% of referrals were for people with a combined alcohol and drug misuse problem, while 26% of referrals were for drug only misuse. Further breakdown of this data was largely impossible as services used different recording systems and the level of detail recorded also varied, restricting the possibility of establishing a clearer profile of substance misuse in Moray. While the majority of services were forthcoming with data they held on clients such as name, age, substance misusing, location etc, it would have proved a significant piece of work for all services to go through their files over a number of years to provide such detailed information. It also has to be noted that the local service data presented above has to be interpreted with some caution. Not only is there an incomplete set of figures presented due to the lack of quality data provided (due either to the data being unavailable, not recorded, insufficient time to pull together or no response provided), also the recording systems used by the various services are not uniform.

General acute hospital discharges for alcohol and

drug related diagnosis

0

100

200

300

400

500

600

7002003/0

4

2004/0

5

2005/0

6

2006/0

7

2007/0

8

No

. o

f d

isc

ha

rg

es

Alcohol Drug

Alcohol and Drug Deaths - Moray

0

5

10

15

20

25

30

2000

2001

2002

2003

2004

2005

2006

2007

No

. o

f D

ea

ths

Alcohol Drug

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A Profile of Moray Moray is the 8th largest Council area in Scotland, covering an area of 2,238 square kilometres1, from the Cairngorm Mountains in the south to the coast of the Moray Firth in the north. However, in terms of its population, it ranks 25th out of 32 with a population of just 86,8701. The area is mostly rural comprising 70% open countryside and further 25% woodland2. The average population density is low at just 39 people per square kilometre, compared with 66 people per square kilometre nationally1. However, approximately 56% of the population live in the 5 main towns of Elgin, Forres, Buckie, Lossiemouth and Keith3, where the population density is approximately 2500 people per square kilometre4. Overall, Moray is one of the least deprived areas in Scotland, as defined by the Scottish Index of Multiple Deprivation (SIMD), having no data zones in the 15% most deprived in Scotland and just 2 in the 20% most deprived areas, both of which are in Elgin. This represents just 1.7% of Moray’s data zones, the lowest in Scotland with the exception of the three island groups. However, the rural nature of Moray means that 27.6% of its data zones are within the 15% most access deprived in Scotland, due to the financial cost, time and inconvenience of travelling to basic services5. Prosperity Although categorised as one of the least deprived local authority areas in Scotland, the median gross weekly wage in Moray is the lowest in Scotland, at £388.40 compared with £461.80 nationally6. The SIMD states that 9.3% of Moray is income deprived, which accounts for 8,169 residents. However, the level of income deprivation in Moray varies greatly across the area, from 1.5% in Kinloss to 22.7% in one area of Buckie5. The working age population accounts for approximately 61% of the total population of Moray, with around 83% of the working-age population (around 52% of the total population) being economically active. These proportions are very similar nationally. In Moray, 81% of the working-age population is in employment, nearly 14% of whom are self-employed, compared with 76% & 10% respectively for Scotland as a whole. Almost ¾ of employee jobs are in the service industry, a further 15% are in manufacturing and 7% are in construction. Nearly 10% of employee jobs are tourism-related but this includes jobs that are also part of the service industry. Equivalent figures for Scotland show the main difference to be in the proportion of employees in manufacturing, which is nearly 6% lower nationally6. Of the working-age population that is economically inactive, approximately 69% report not wanting a job and over 60% of these are female. The picture is very similar nationally. During 2007/08, 3.4% (1,600) of the economically active population in Moray were unemployed, compared with 4.5% nationally. However, there were a further 2,600 people within the economically inactive (5.1% of the working age population) in Moray who wanted a job. They are not classed as unemployed because they have either not sought work in the last four weeks or are not available to start work. The equivalent figure for Scotland is 5.5%6. In May 2008, 12% of the working age population in Moray were key benefits claimants (claiming one or more key DWP benefits(1)), compared with 16% in Scotland. The most common main benefit in Moray was incapacity benefit, claimed by 3,400 (54%) of key benefit claimants, while 890 or 14% of key benefit claimants were claiming job seekers allowance as their main benefit. The split nationally was very similar to Moray6. In total there were 1,132 JSA claimants at the end of 2008, 73% of whom were male. Approximately ½ of all claimants were aged 25-49yrs and a further 28% were aged 18-24yrs. The majority of claimants, 85%, had been claiming for 6 months or less, a further 10% between 6 and 12 months, and 5% over 12 months6. The SIMD identifies no data zones in Moray that are in the 15% most employment deprived5.

(1) Key DWP (Department of Work & Pensions) benefits include: bereavement benefit, carer’s allowance, disability living allowance, incapacity benefit, severe disablement allowance, income support, jobseeker’s allowance, and widow’s benefit.

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Health General health in Moray is reported as being slightly better than nationally with nearly 93% of Moray’s population reporting good or fairly good health and just 7% reporting not good health. This compares with 90% and 10% respectively for Scotland7. The percentage of the population that has a limiting long-term illness is approximately 3% lower in Moray than nationally, at 17% of the population compared with 20%7. The relationship between health and tenure indicates that a smaller proportion of occupants of social rented accommodation report good or fairly good health than occupants of owned or privately rented/rent free accommodation, at 88% compared with 94%. This is reflected in the incidence of limiting long-term illness, which is 10% higher for occupants of social rented accommodation, at 24%, than for occupants of owned or privately rented/rent free accommodation. The spread across age groups is comparable, with 65-84yr olds representing the largest proportion of each tenure type having a long-term illness. The national picture is similar with 82% of those in social rented accommodation reporting good or fairly good health, 93% of those in owned and 89% of those in private rented/rent free. The proportion of those living in social rented accommodation with a limiting long-term illness is twice that of those living in owned accommodation. As with Moray, spread across age groups is comparable, with 65-84yr olds again representing the largest proportion of each tenure type having a limiting long-term illness7. The standardised death rate in Moray is slightly lower than nationally at 10.5 per 1,000 population compared with 10.8 per 1,000 population. The main cause of death in Moray in females is diseases of the circulatory system, which accounted for approximately ⅓ of all female deaths in 2007. This was closely followed by cancers, which accounted for just over ¼ of all female deaths. In males, the situation was reversed. On a national level, the picture is similar although diseases of the circulatory system are the most common cause of death for both genders, accounting for about ⅓ of deaths, closely followed by cancers8. The SIMD identifies just 1 data zone, 0.9% of the total in Moray that is within the 15% most health deprived; this is in Elgin5. Mid-2007 population estimates suggest that 18% of the population of Moray is aged under 16yrs, 61% is of working age and 21% is of pensionable age. This translates as 16074 under 16s, 52588 of working age and 18208 of pensionable age1. The age split is very similar nationally. 2006-based population projections for Moray, suggest that the under 16 population will reduce by 9% by 2011, the working age population will increase by 1% but the pensionable population will increase by 10%9. This would mean 2011 population numbers of 14627 under 16s, 53114 of working age and 20029 of pensionable age. These changes will mean that the proportion of the population that is of pensionable age will increase by around 3% from approximately 20% to nearly 23%. National figures are again very similar although the projected proportion of the population of pensionable age in 2011 is lower at 20%. Both in Moray and nationally, nearly ⅔ of the pensionable age group is female.

Education In Moray in 2007 there were 6975 primary school pupils and 5945 secondary school pupils, an overall drop of around 3% since 2003 (comprising a 6% drop in primary pupils & a 3% rise in secondary pupils). The number of pupils over 16yrs has increased over the same period by 69%. The number of pupils from ethnic minority groups has increased from 171 in 2004 to 199 in 2007. The drop in primary school pupils is reflected nationally, as is the large rise in pupils over 16yrs. However, the rise in secondary pupils is in contrast to a national drop of 2%10. There are 2 data zones in Moray, 1.7% of the total, that are within the 15% most education deprived in Scotland, both of which are in Elgin5. In primary schools, absence figures for 2004/05 to 2006/07 are very consistent, accounting for around 4.5% of half days, of which an average of 14% is unauthorised. These figures are slightly lower than nationally. In Moray in 2004/05, truancy accounted for 43% of unauthorised absence; this fell to 17% in 2006/07. Putting these figures in perspective, truancy accounted for 7% of total absence in 2004/05, falling to 2% in 2006/07. Nationally, in 2004/05, the truancy rates were similar. However, there has been little reduction nationally over the subsequent 2 years11.

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In secondary schools, the absence rate has risen slightly, from 7.6% of half days in 2004/05 to 9.2% in 2006/07. Of this, the proportion of unauthorised absence has increased from 22% to 29%, although this fell from 32% in 2005/06. Conversely, the national absence rate has fallen slightly over the same period and Moray is now the same as nationally. The proportion of unauthorised absence has remained fairly constant at around 21%. In 2004/05, truancy accounted for 59% of unauthorised absence, falling to 38% in 2005/06 and then rising to 44% in 2006/07. Despite this fluctuation, truancy has consistently accounted for around 13% of total absence in each of the last 3 years. The picture nationally in 2004/05 was very similar. However, as with primary schools, there has been little reduction since then11. Between 2003/04 and 2006/07, the rate of exclusions in Moray’s primary schools has remained fairly constant at 12 per 1000 pupils. Although initially similar, the national rate has risen steadily from 11 per 1000 in 2003/04 to 16 per 1000 in 2006/07. In Moray’s secondary schools, the rate has increased slightly from 59 per 1000 pupils in 2003/04 to 69 per 1000 pupils in 2006/07. Scotland’s rate is much higher than in Moray but has also risen over this period from 105 per 1000 pupils in 2003/04 to 120 per 1000 in 2006/07. The vast majority of exclusions in both Moray and nationally are temporary. In Moray between 2003/04 and 2005/06 only about 6 pupils were removed from the register each year – approximately 1% of total exclusions. However, in 2006/07 just 2 pupils were removed, representing 0.4% of total exclusions. The level nationally has been around 0.5% every year since 2003/0412. Of 1072 school leavers in Moray in 2006/07, 85% went on to positive destinations(2), 12% were unemployed but seeking employment and the remainder were either unemployed and not seeking employment or their destination was unknown. Numbers in all categories have remained fairly consistent for the last 3 years. These proportions are virtually the same nationally although the split within the positive destinations category was slightly different, with a higher proportion going into higher education and training, and less into employment. The proportion going into further education was about the same13. Housing The total number of dwellings in Moray in 2007 was 41,327, a rise of 5% since 2003, slightly higher than the rise nationally of 4%10. In Moray, and nationally, approximately 64% of the population live in owner-occupied accommodation. However, Moray has a smaller proportion of people living in social rented accommodation, at 20% compared with 24%, but a higher percentage renting privately, 11% compared with 6%. A smaller proportion of Moray’s population lives in lone parent families – 8% compared with 13% nationally, and a slightly smaller proportion of people living alone, at 12% compared with 14%. However, the same proportion of people aged 65yrs and over live on their own, in both Moray and Scotland as a whole, at 5.7%7. Between 2001 and 2007, the mean house sale price rose by 144% in Moray, from £58,584 to £142,956. The equivalent national figure is 104%. Over the same period, the number of house sales in Moray rose by 22%, from 1,899 to 2,312. The number of house sales also rose nationally, by 28%. The median house sale price in Moray more than doubled, from £47,000 in 2001 to £116,226 in 2007 and a similar, though slightly smaller, increase was seen nationally. The median price being lower than the mean price is reflective of the large proportion of band A-C dwellings in Moray, approximately 68%, slightly higher than Scotland as a whole at 63%. Correspondingly, the proportion of dwellings in bands F-H is small in Moray, at approximately 6%, half that of Scotland. Between 2003 and 2007 in both Moray and Scotland, the proportion of dwellings in bands A-C fell slightly, while the proportion of dwellings in bands F-H rose slightly10. There are no data zones in Moray that are within the 15% most housing deprived in Scotland. However, 4 of Moray’s data zones (3.4% of the total) are within the 20% most housing deprived in Scotland, 2 in Elgin, 1 in Forres and 1 in Lossiemouth5.

(2) Positive: includes higher education, further education, training, voluntary work and employment. This is in line with the definition of positive destinations set out in Indicator 10 of the Scottish Budget Spending Review 2007: http://www.scotland.gov.uk/Publications/2007/11/30090722/18

11

Recorded crime in Moray In Moray in 2007/08 the total number of crimes recorded reduced by 10% from 2006/07 compared with an 8% decrease in Scotland. The rate of crimes in Moray in 2007/08 was lower than nationally, at 609 per 10,000 population compared with 749 per 10,000 population. The total number of crimes recorded in each of the last 11 years shows a marginally increasing trend in Moray, compared with a reducing trend for Scotland as a whole14. The percentage of crimes cleared up in Moray rose by 4% to 45% in 2007/08, compared with a 1% rise to 48% for Scotland as a whole. The trend in Moray over the last 11 years is virtually level compared with a slightly increasing trend in Scotland as a whole14. Within Moray there are 12 data zones in the 15% most crime deprived, representing 10.3% of data zones in Moray5. Of the 12, 1 is in Keith, 3 are in Forres, 5 are in Elgin and 3 are in Buckie. Overall for 2007/08, Moray was ranked 21st out of 32 local authority areas in Scotland for total recorded crimes per 10,000 population (where 1 has the highest rate and 32 the lowest). Moray’s highest ranking of 2nd was for the crime category crimes of indecency, while their lowest ranking was for non-sexual crimes of violence for which they ranked 25th out of 32. In all crime categories except crimes of indecency for which they ranked higher than Scotland, Moray’s ranking was better than Scotland’s.

12

Alcohol Misuse Alcohol misuse is a bigger problem than drug misuse in terms of the number of people misusing and the harm caused to health. Estimating the size of Scotland’s alcohol problem is not easy due to a lack of national data and under-reporting of consumption. However, recent reports suggest that 1 in 20 deaths is alcohol-related35. During 2006/07 the cost of dealing with alcohol use and misuse in Scotland was estimated at £2.25 billion26. The National Health Service (NHS) report annual national alcohol statistics through their Information Services Division (ISD)28. The statistics are one of the few national publications which provide yearly figures and analysis of alcohol misuse at a local authority level. Alcohol-related Hospital Discharge The number of acute inpatient discharges with an alcohol-related diagnosis has steadily grown nationally since 2003/04. In 2007/08 in Scotland, there were 42,430 alcohol related discharges from general hospitals, an increase of 19.9% from 2003/04. This equated to a discharge rate of 777 per 100,000 population (2007/08). The number of acute inpatient discharges in Moray largely mirrors the national trend, however in 2007/08 there was a drop in numbers for the first time in 5 years – against a national increase. Moray has seen an 8.9% increase in numbers since 2003/04, with a discharge rate of 625 per 100,000 (2007/08). Compared with other Scottish Local Authorities Moray has had the 10th lowest increase in numbers of general acute inpatient discharges with an alcohol-related diagnosis since 2003/04 at 8.9%. Only seven Local Authorities have seen a decrease in the number of discharges, with Dundee City showing the largest drop at 11.8%. Aberdeenshire and Aberdeen City have increased by 14.2% and 17.4% respectively, while Highland has dropped by 0.3%

General acute inpatient discharges with an alcohol-related diagnosis - %

change from 2003/04 to 2007/08

-20

-10

0

10

20

30

40

50

60

Lothian East

Loth

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Fife

Arg

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Highland

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An

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Islands

Dundee C

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%

When looking at the ‘rate of discharges with an alcohol-related diagnosis’ Moray are ranked 12th lowest out of all other Scottish Local Authorities. While Moray had a rate of 625 per 100,000 (2007/08), Angus had the lowest rate at 288 and Glasgow City had the highest rate at 1,379. When comparing with Local Authority neighbours Aberdeenshire (421) continued to have a lower rate, while Highland (892) and Aberdeen City (991) remained well above the Moray rate.

Genereal Acute inpatient discharges with an alcohol-related

diagnosis - rate per 100,000

0

100

200

300

400

500

600

700

800

900

03/04 04/05 05/06 06/07 07/08

Year

Ra

te p

er

10

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Moray Scotland

13

General acute inpatient discharges with an alcohol-related diagnosis -

Rate per 100,000 pop'n (2007/08)

0

200

400

600

800

1000

1200

1400

1600

Glasgow

City

Inverclyde

Ayrshire N

orth

Ayrshire E

ast

Islands

Aberdeen C

ity

Ayrshire S

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Dunbartonshire

Argyll &

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Highland

Re

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ire

Lanarkshire North

Edinburgh C

ity

Lothian West

Midlothian

Borders

Lothian East

Moray

Fife

Dundee C

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Lanarkshire South

Clackm

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Stirling

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Falkirk

Aberdeenshire

Dunbartonshire

An

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per

100

,000

Breaking down the data by age and gender provides a clearer picture of the local problem use of alcohol. Of the 576 inpatient discharges with an alcohol-related diagnosis in 2007/08, 418 (72.6%) were male while 158 (27.4%) were female. The ratio of males to females being discharged with an alcohol-related diagnosis has remained relatively consistent over the last three years, with for every female discharged there is an equivalent 2.6 males having been discharged. For both males and females the most common age groups (using the European Age Standardised Rate per 100,000 pop.) for the number of discharges with an alcohol-related diagnosis are from 45 years and over. There are slight variations between sexes, with most incidents for males being discharged in the 60 and above age category while in the females it is the 45-49 year old age group. As with the overall rate of discharge both male (877 per 100,000) and female (378) rates were below the national averages of 1,138 and 444 respectively for 2007/08. Also when analysing the discharge rates by age category, Moray was below the national average in the majority of categories. Of the three age groups that were above the national average, the only significant difference was the under 15 year age category where rate of discharges in Moray (80 per 100,000) was twice that of the national average (38). In 2007/08 there were a total of 14 young people under the age of 15 discharged, 9 of whom were male and 5 female. Of the 418 males who were discharged with an alcohol-related diagnosis in 2007/08, the majority were aged 30 and over. The largest age group for numbers of discharges were 60yrs & over with 33% of discharges, followed by 45-49 year olds (16%) and 55-59 year olds (12.4%). However, there is a difference in the rate of discharges compared to the actual number of discharges, with the highest rate of discharge in the 45-49 year old category (2002 per 100,000), followed by 55-59 year old (1765) and 60 and over (1484). Also the actual number of 45-49 year old males having been discharged has almost doubled since 2005/06 from 35 to 67, showing by far the largest number and percentage increase over that period. The finds generally suggest that there is an increasing trend in the number and rate of alcohol misuse among middle and older age groups with the rate of alcohol-related hospital discharges peaking at the age of 45-49 years. The actual number of alcohol-related male cases peaks in the 60 and over category, which may be due to the larger population in that age group.

Of the

Number of inpatient discharges with an alcohol-related

diagnosis 2007/08

-

20

40

60

80

100

120

140

160

Under

15

yrs

15

-19

yrs

20

-24

yrs

25

-29

yrs

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-34

yrs

35

-39

yrs

40

-44

yrs

45

-49

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50

-54

yrs

55

-59

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60

yrs

&

ove

r

Rate of male inpatient discharges with an alcohol-related

diagnosis 2007/08

0

250

500

750

1000

1250

1500

1750

2000

2250

Under

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15

-19

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-24

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30

-34

yrs

35

-39

yrs

40

-44

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45

-49

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50

-54

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55

-59

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60

yrs

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ove

r

14

158 female inpatient discharges with an alcohol-related diagnosis in 2007/08 the proportion of discharges are far more evenly spread through the age categories compared with the males. The largest number of female alcohol-related discharges is for 45-49 year olds (13.3%), closely followed by 60 years and over (12.7%) and 55-59 year olds (11.4%). However, the rate of discharge shows a slightly different picture as it is the 20-24 year old age category that has the highest discharge rate with 711 (per 100,000) followed by 45-49 year olds (661) and 55-59 year olds (600). The rate of discharges within the 20-24 year olds age group has risen steeply over the last three years, although the actual number is relatively small with 14 incidents within the age category for 2007/08.

Further analysis of the discharge data shows that 74.1% of alcohol-related discharge patients in Moray were diagnosed with a mental and behavioural disorder due to the use of alcohol. This ranked Moray 10th highest of all local authorities, and above the Scottish average of 70.9%. The ISD 2007/08 report does not break this data down any further, however the 2006/07 report did provided further analysis for that year. The 2006/07 data suggested that alcohol dependence might be a significant problem in Moray, with the rate of alcohol dependence over twice that of the national average. Of the inpatients diagnosed with mental & behavioural disorders due to the use of alcohol, 41% were classed as having alcohol dependence in Moray compared with the national average of 16%. The 2007/08 inpatient discharge figures also found that Moray recorded a relatively high percentage of inpatients with an Alcoholic Liver Disease. In Moray 19.4% of inpatients diagnosed with an alcohol-related condition had an alcoholic liver disease, ranking Moray 7th highest of all local authorities in Scotland, and above the Scottish average of 16.1%.

General acute inpatient discharges with an alcohol related diagnosis -

% Alcohol liver disease (2007/08)

0

5

10

15

20

25

Lothian East

Dundee C

ity

Dunbartonshire

Angus

Renfrew

shire

Fife

Moray

Dunbartonshire

Lanarkshire North

Lothian West

Inverclyde

Renfrew

shire

Glasgow

City

Lanarkshire South

Dum

fries &

Stirling

Falkirk

Midlothian

Edinburgh C

ity

Aberdeenshire

Perth &

Kinross

Ayrshire E

ast

Ayrshire N

orth

Borders

Argyll &

Bute

Highland

Clackm

annanshire

Aberdeen C

ity

Islands

Ayrshire S

outh

Moray has a relatively low number of psychiatric inpatient discharges with an alcohol-related diagnosis. Of the 30 inpatients recorded in 2006/07 43% were diagnosed as having Alcohol Psychoses, compared to the national average of 9.9%. While the rate of discharges in Moray with an alcohol-related diagnosis remains low in comparison with the other Scottish local authorities and the increase in numbers being discharged since

Number of female inpatient discharges with an alcohol-

related diagnosis 2007/08

-

5

10

15

20

25

Under

15

yrs

15

-19

yrs

20

-24

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25

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yrs

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35

-39

yrs

40

-44

yrs

45

-49

yrs

50

-54

yrs

55

-59

yrs

60

yrs

&

ove

r

Rate of female inpatient discharges with an alcohol-related

diagnosis 2007/08

0

100

200

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800

Under

15

yrs

15

-19

yrs

20

-24

yrs

25

-29

yrs

30

-34

yrs

35

-39

yrs

40

-44

yrs

45

-49

yrs

50

-54

yrs

55

-59

yrs

60

yrs

&

ove

r

15

2003/04 has been one of the lowest in Scotland (including a drop from 2006/07), the actual proportion of serious alcohol-related diagnoses is one of the highest in Scotland. The number and proportion of people having been diagnosed as suffering from alcohol liver disease has continued to rise since 2004/05 both nationally and in Moray. The increase has been particularly steep in Moray with an increase of around 87% from 60 cases in 2004/05 to 112 cases reported in 2007/08. This compares with a national increase of 12.7% over the same period. Also the rate of Alcohol Dependence has continued to remain well above the national average. Of all alcohol-related discharges in 2006/07 24% were for alcohol dependence against a national figure of 11%. While there has been a slight drop nationally and in Moray from 2005/06, Moray still has a rate over twice that of the national average. Both alcohol liver disease and alcohol dependence are associated with longer-term use of alcohol. The higher than average prevalence of these diagnoses in Moray combined with the higher rate of alcohol-related discharges in the older age categories indicates that Moray has a greater than average problem with long-term use. There is also a strong correlation between the rate of acute hospital alcohol-related discharges and deprivation quintile. Data for 2004/05 show that the rate in the least deprived category was 55 per 10,000 whilst in the 4th quintile (the most deprived category in Moray) the rate was 160 per 10,000. Alcohol-related Deaths The number of deaths in Moray where alcohol has been attributed as the underlying cause has remained relatively static over the last 7 years. The total number of alcohol-related deaths peaked in 2003 and 2004 with 28, however the number has since fallen to 19 in 2007. Male deaths due to alcohol outnumber female deaths by 4:1 in Moray, which is considerably higher when comparing with the national average of 2.2:1. This suggests that in Moray a significantly higher proportion of males ultimately die due to alcohol-related causes. Per 100,000 population Moray has the third lowest rate of female deaths where alcohol was the underlying cause (7.2) or where alcohol was a contributory cause of death (7.5). Where alcohol was the underlying cause of death in males, Moray (27.9 per 100,000) ranked 17th highest compared to other local authorities. This is the lowest rate in Moray for the last 8 years. However, where alcohol has been found to be a contributory cause of death in males the rate is the highest it has been since 2001 at 55.7 (per 100,000). This ranks Moray the 14th highest compared to other local authorities in Scotland. A report published in 2007, comparing all alcohol-related deaths from 1998 – 2004 placed Moray 14th out of the 426 local authority areas in the UK, and 11th in Scotland. Of the 20 worst local authority areas in terms of alcohol-related deaths over this period, 15 were in Scotland. Alcohol and Crime Grampian Police statistics for the period 2005/06 to 2007/0818 show that the level of alcohol related crime, for example being drunk and incapable, were found to take place mainly in the larger town in Moray.

Alcohol related crimes and offences

0 20 40 60 80 100 120

Elgin

Buckie

Forres

Keith

Lossiemouth

Rothes

Lhanbryde

Fochabers

Cullen

Hopeman

Dufftow n

Number of crimes / offences

2005/06 2006/07 2007/08

16

Of the 587 recorded incidents in the three year period 41% of offences took place in Elgin (241), 28% in Buckie (162), 16% in Forres (92) and 8% in Keith (45). It is unsurprising given the popularity of Elgin for a night out that there is a higher than proportionate number of incidents there. The spread across the rest of Moray generally mirrors the population, with the exception of Buckie, which also experiences a disproportionately high number of incidents. Grampian Police also record data on the number of offences committed by persons aged 24 years and under and whether they were dunk or had been drinking18. The table below shows that on average 58.5% of crimes committed between 2005 and 2008, the accused were either drunk or had been drinking. And of the offences committed serious assault was recorded as the highest crime type where 85.5% of the accused were found to have been drinking prior to carrying out the assault.

Crime and offences committed by accused persons

24 years and under - Drunk or had been drinking2005/06 2006/07 2007/08

Total offences committed

under influence of alcohol

by crime type

Total offences

by crime type

% offences by crime

type committed under

influence of alcohol

Assualt, petty 194 229 196 619 1136 54.5%

Breach of the peace 417 439 409 1265 2008 63.0%

Serious Assault 17 19 11 47 55 85.5%

Vandalism malicious damage etc 104 132 121 357 713 50.1%

All offences committed under influence of alcohol 732 819 737 2288 3912 58.5%

All offences committed 1342 1338 1232

% offences committed under influence of alcohol 54.5% 61.2% 59.8%

For each crime type over 50% of the accused were found to have been under the influence of alcohol. While the actual number of crimes and offences committed has dropped since 2005/06 the percentage of persons under the influence of alcohol when committing the offence has increased by over 5% from 54.5% to 59.8%. Liquor Licences and distribution Within Moray there is a wide range of premises operating liquor licences across the area, the majority of which are on-sale29. The largest grouping of liquor licences is found in the Elgin area, again being the most populated town in Moray and it also includes the districts of Bishopmill and Mosstowie. The second highest number of liquor licences can be found in Speyside, which includes Rothes, Aberlour, Dufftown, Tomintoul and Glenlivet. The probable reason for the high number of liquor licences in this area of Moray is the large number of tourists following the world famous Malt Whisky trail and visiting the Cairngorms national park. Not only are there a number of distilleries operating liquor licences (visitor centres), there are a number of pubs, restaurants and hotels catering for visitors as well as local people. Below is a map of Moray showing the distribution of liquor licences in the area.

17

Data source: Moray Council website – Register of current licensed premises in Moray Map based on ASG areas

When comparing the proportion of on-sale and off-sale licences in Moray with the national average33, Moray has a larger number of licences in force per 10,000 (population aged 18 and over) on both counts. Moray has the 8th highest number of on-sale licences with 34 (per 10,000) compared with the other Scottish local authorities, and well above the national average of 26.

On-sale liquor licences - per 10,000 pop. aged 18 and over

0

10

20

30

40

50

60

70

Shetland Islands

Highland

Orkney Islands

Argyll & Bute

Stirling

Dum

fries &

Perth & Kinross

Borders

Moray

Edinburgh City

Ayrshire South

Eilean Siar

Angus

Dundee City

Glasgow

City

Scotland

Ayrshire North

Aberdeen City

Lothian East

Fife

Aberdeenshire

Renfrew

shire

Ayrshire East

Dunbartonshire

Clackmannanshire

Inverclyde

Midlothian

Falkirk

Lothian West

Lanarkshire South

Lanarkshire North

Renfrew

shire

Dunbartonshire

Moray is ranked even higher in off-sale licences, with 21 licences per 10,000 population aged 18 and over. This ranks Moray 5th highest out of all the Scottish local authorities, and well above the national average of 15.

Forres area – Total liquor licences 60 Off-licence – 18; Hotel – 8; Public House – 17; Other - 17

Speyside area – Total liquor licences 82 Off-licence – 36; Hotel – 15; Public House – 19; Other - 12

Elgin area – Total liquor licences 109 Off-licence – 41; Hotel – 10; Public House – 33; Other - 25

Lossiemouth area – Total liquor licences 33 Off-licence – 11; Hotel – 7; Public House – 11; Other - 4

Buckie area – Total liquor licences 55 Off-licence – 18; Hotel – 14; Public House – 17; Other - 6

Keith area – Total liquor licences 27 Off-licence – 12; Hotel – 7; Public House – 5; Other - 3

Fochabers area – Total liquor licences 22 Off-licence – 10; Hotel – 7; Public House – 2; Other - 3

18

Off-sale liquor licences - per 10,000 pop. aged 18 and over

0

5

10

15

20

25

30

35

40

Orkney Islands

Shetland Islands

Stirling

Highland

Argyll & Bute

Moray

Dum

fries &

Perth & Kinross

Borders

Eilean Siar

Clackm

annanshire

Lothian East

Edinburgh City

Ayrshire South

Dunbartonshire

Falkirk

Scotland

Ayrshire North

Fife

Ayrshire East

Dundee C

ity

Aberdeen City

Aberdeenshire

Lothian West

Angus

Glasgow

City

Inverclyde

Midlothian

Renfrew

shire

Lanarkshire North

Lanarkshire South

Renfrew

shire

Dunbartonshire

The high proportion of liquor licences in operation in Moray may be due to a couple of factors. The spread and number of smaller towns and the associated small convenience stores and public houses, and the tourist-related outlets, particularly in the Speyside area (Malt Whisky trail) i.e. the high volume of pubs, hotels, restaurants and off-licences that accommodate the tourist trade. Comparing the number of liquor licences with the approximate population and geographic size of an area suggests that Buckie has a disproportionately high number at 55. This is at least twice as many as each of Lossiemouth, Keith and Fochabers areas, which are comparable in terms of both population and size. Young People and alcohol The SALSUS 2008 Survey national report was published in June 2009 however no local authority statistics have been presented. The next local level survey will be conducted in Autumn 2010 with the results available the following year. The most recent SALSUS report at a local level is the 2006 report which has been analyses as part of this research. The 2006 SALSUS17 report for Moray provides a large volume of data on the alcohol drinking patterns of 13 and 15 year olds in the area. The following key data was taken from the report to provide a general picture on the drinking habits of young people in Moray. The SALSUS data is further supported and supplemented with local data to help provide further analysis of young people and their relationship with alcohol. In Moray, 65% of 13 year olds and 90% of 15 year olds have had an alcoholic drink at some point in their lifetime, which is slightly higher than the national findings and also higher than Aberdeenshire and Aberdeen City. Boys are more likely to have had an alcoholic drink (80%) than girls (77%), contrary to the national picture where girls (73%) are more likely to have had an alcoholic drink than boys (70%). Based on the SALSUS surveys of 2002 and 200617 the average units of alcohol consumed in the week prior to the survey by Moray 13 and 15 year olds was among the lowest compared to the other local authority areas. While boys were just below the national average (14th lowest out of 32), girls were one of the lowest consumers of alcohol (4th lowest out of 32). Also the 13 year olds in Moray recorded the third lowest average out of the 32 local authorities, while 15 year olds were 8th lowest. While there appears to be a slightly higher rate of young people having had an alcoholic drink in Moray than nationally, the actual levels of consumption are well below the national average. The SALSUS report (2006)17 suggested that young people in Moray feel their parents are more accepting of them drinking alcohol at home compared with the national average. When asked whether they were allowed to drink alcohol in the home, 69% of 13 year olds and 84% of 15 year olds said either ‘Yes, always’ or ‘Yes, sometimes’. This compared to the national average of 57% and 72% respectively. Also the survey found that a significant proportion of young people in Moray think their family ‘don’t mind’ if they had a drink.

19

Moray Scotland Moray ScotlandThey don't like it 13% 12% 22% 20%They don't mind 36% 22% 47% 42%They don't know I drink 16% 36% 15% 25%I don't know 35% 20% 16% 14%

13 year olds 15 year oldsHow does your family feel about you drinking alcohol?

The most frequently reported locations for drinking alcohol were: at the pupils own home (46%), outside, on the street, or in a park or other outside area (42%) and at a party with friends (37%). Pupils in Moray tend to consume alcohol at home more often than nationally. There is a marked difference in how alcohol is obtained by young people in Moray than nationally. 26% of 13 year olds and 42% of 15 year olds buying from a relative or friend compared with a national average of 22% and 29% respectively. 3% of 13 year olds and 12% of 15 year olds buy from a shop compared to national figures of 11% and 23%. There are also far fewer young people in Moray purchasing from off-licences with no 13 year olds reporting that they did so and only 5% of 15 year olds said that they had. This compares with national figures of 7% and 19% respectively.

Of the Moray pupils who had had an alcoholic drink the majority had never tried to buy alcohol (84% of 13 year olds and 71% of 15 year olds), higher than the national averages. Of those who had tried to buy alcohol from a shop, supermarket or off-licence in the last 4 weeks 50% were refused (13 year olds 1% bought while 1% refused; 15 year olds 5% bought while 5% refused). Nationally three quarters of 15 year olds were successful when buying from said outlets, while 60% of 13 year olds had been successful. From the data coming out of the SALSUS reports it would appear that while more young people in Moray have had an alcoholic drink, the actual level of consumption is generally well below the national average. While there appears to be more acceptance of parents/family to allow their children to have a drink, there seems to be a significant number actually drinking in the home where possibly it is under parental supervision and hence the levels of consumption are low in comparison to national levels. Audit Scotland highlighted in their report (2009)27 an example of good practice in tackling underage drinking in Moray through partnership working with Operation Avon. The Operation is a multi-agency approach combining resources from Grampian Police, NHS Grampian and the Moray Council which aims to reduce the amount of street drinking among youths and offers support and advice at an early stage to those who may already be suffering the adverse affects of alcohol misuse. Since the start of the initiative in September 2005 there have been 119 operations carried out throughout the main towns in Moray18. During 2008/09 there were 23 Avon Operations undertaken from which there were 1089 youths spoken to, of which 127 were found to be involved with alcohol. A further 84 letters were sent to parents regards their child’s involvement with alcohol. Also during the year 5 Test Purchase operations were carried out

Source of obtaining alcohol - 15 year olds

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Never buy alcohol

buy from a friend/relative

buy from a shop

buy from someone other than a

friend/relative

buy from a supermarket

buy in a club or disco

buy from an off-licence

buy in a pub or bar

Moray

ScotlandSource of obtaining alcohol - 13 year olds

0% 10% 20% 30% 40% 50% 60% 70%

Never buy alcohol

buy from a friend/relative

buy from a shop

buy from someone other than a

friend/relative

buy from a supermarket

buy in a club or disco

buy from an off-licence

buy in a pub or bar

Moray

Scotland

20

The police also record the number of ‘underage drinking’ calls received using their database STORM. The database logs the number of calls received, the location of the incident and recently introduced procedures enables a judgement to be made on the credibility of the call. Below shows a 3 year breakdown of the calls received regards underage drinking.

Underage Drinking Calls in STORM

0

20

40

60

80

100

120

140

Buckie

Cullen

KeithElgin

Forres

Rothes

Aberlour

Dufftown

Tomintoul

Lossiem

outh

Hopeman

Lhanbryde

Fochabers

Area

Num

ber o

f Cal

ls

2005/06 2006/07 2007/08

The reporting of underage drinking through STORM shows that the highest incidents being reported are in the larger towns of Moray. Not surprisingly Elgin, as the largest town in Moray, has a greater number of reported incidents of underage drinking, followed well behind by Buckie, Forres and Lossiemouth. The number and proportion of calls for each area does generally reflect the population distribution of Moray with the larger towns receiving more calls compared to the smaller towns and villages. This information is used to support and identify where in Moray Operation Avon’s should be targeted. All schools in Moray are registered as Health Promoting Schools, where schools take an active role in promoting healthy activity as well as mental and social well-being. A number of agencies including NHS Grampian (Health Promotions), Grampian Police (School Liaison Officers) and Social Work (Drug & Alcohol Information & Health Improvement Officer), provide educational and awareness inputs to schools around a number of priority areas including Drugs and Alcohol. Analysis of the data on the number and frequency of inputs provided from Health Promotions, School Liaison Officers and the Drug & Alcohol Information & Health Improvement Officer suggests that while the majority of schools incorporate some level of drug and /or alcohol education into their curriculum it is certainly not consistent across the board. While work has recently begun to co-ordinate better the delivery of drug/alcohol inputs into schools, particularly between Grampian Police School Liaison Officers and Health Improvement Services, it would appear that not all schools request the same level of input as others. While the SALSUS survey identified that Moray young people tend to drink less than the national levels, on average however more Moray young people have had a drink at 13 and 15 years of age than nationally. This would suggest that alcohol education should be being targeted at the later stages of primary school and continued to be addressed throughout secondary education. However from this research there is little evidence of alcohol inputs consistently being provided at Primary 6/7 or at Secondary 1/2 in Moray Schools. While some schools may use in-house resources to educate young people on alcohol and drug issues, the lack of input from trained agencies such as the Grampian Police SLOs and NHS Health practitioners may mean that school pupils are possibly not receiving a consistent message. Also SLO’s and Health practitioners will ensure that schools receive inputs from both a police and health angle and that the language used is appropriate and relevant to the young people e.g. drug names.

21

Carers and Substance misuse It is well documented that excessive drinking or drug misuse is closely linked to harm, and it is also clear that substance misuse is no longer a marginal problem. Nor is it one that affects only the substance misuser. Moray Young Carers are the main service in Moray providing help and assistance to young carers, although a similar service run by Quarriers has recently been established in Moray. As at the end of April 2009 Moray Young Carers service had 235 young carers on their register. Out of the 235 young carers 13 were caring for people with a substance misuse problem, 9 who had an alcohol misuse problem and 4 with a drug misuse problem. This represented around 6% of young carers caring for a person with a substance misuse problem. It is believed that the number registered only represents around 12%

of the potential true number

of young carers in Moray. Applying the research by the Princess Royal Trust for Carers34 it is estimated that there could be as many as 2,000 young carers in Moray. If this were to be the case then there could potentially be over 100 young carers in Moray who are caring for an adult with a substance misuse problem. As at the end of May 2009 there were 1,682 adult carers registered with the Moray Carers Project. Of these carers 34 were caring for someone with an alcohol and/or drug misuse problem. 18 cared for someone with alcohol misuse, 11 with a drug problem and 5 who had a joint alcohol and drug misuse problem. Again this is probably a significant underestimate of the real number of people who have had to take responsibility to help care for a person who is suffering from substance misuse.

22

Drug Misuse In 2004, a report was published(3), which provided estimates of the national and local prevalence of problem drug use(4) within Scotland in 2003. It is the second report of its kind, the first being published in 2001. The research uses several data sources and statistical methods to obtain estimates of problem drug use at various levels within Scotland, focusing on 15-54yr olds. The report also provides estimates of the prevalence of drug injecting(5)19. The research suggested that in 2003 there were 310 problem drug users in Moray (95% CI: 182 – 1627), a prevalence rate of 0.66% (95% CI: 0.39 – 3.48). With the exception of the Orkney Isles and Eilean Siar, Moray has the lowest estimated prevalence rate in Scotland. Of the 310, it was estimated that 206 (66%) were male, a prevalence rate of 0.88%, again the lowest in Scotland. The prevalence rate for females in Moray was 0.45%, the second lowest in Scotland. It was only possible to carry out an age breakdown for males, which indicated that of the estimated 206 male problem drug users, the majority, 143 (69%), were aged 15-24yrs, 52 (25%) were aged 25-34yrs and 11 (5%) were aged 35-54yrs. These translate to respective prevalence rates of 3.06%, the 9th lowest in Scotland, 0.84% and 0.09%, both the lowest in Scotland19. The report further estimates that there were 111 injecting drug users in Moray, a prevalence rate of 0.24, 6th lowest in Scotland19. The initial report estimating drug misuse prevalence in 2000, indicated that Moray had 398 problem drug users (95% CI: 247 – 731), a prevalence rate of 0.9% (95% CI: 0.5 – 1.6), suggesting that there was a reduction between 2000 & 2003, of 88 people, reducing the prevalence rate by 0.24%. However, caution is advised due to the wide confidence intervals for Moray, particularly in 2003. SDMD New Client Profile One of the main sources of data relating to drug misuse at a local authority level is the Scottish Drugs Misuse Database, which publishes an annual report – Drug Misuse Statistics Scotland – that provides a lot of information regarding new clients reported to the database by local drug and alcohol services. In Moray, the main agencies that report client information to the database are Moray Council on Addictions, Integrated Drug & Alcohol Service - Social Work and NHS, Criminal Justice Addiction Team, Moray Youth Action and Turning Point Scotland, including Studio 8. However, it should be noted that there has been some inconsistency in reporting in recent years so the accuracy of figures is debateable. Between 2002/03 and 2006/07, the number of new clients reported to the SDMD rose steadily from 56 to 115, an increase of 105%. However, 2007/08 has seen a drop, to 93 making a net increase of 66%. The national picture shows some fluctuation although the overall trend is marginally rising with a net increase between 2002/03 and 2007/08 of 9.5%.

(3) the results of research funded by the Substance Misuse Division of the Scottish Executive and carried out jointly by the Centre of Drug Misuse Research at the University of Glasgow and the Scottish Centre for Infection and Environmental Health (4) For the purposes of the study, problem drug use is defined as opiate and/or benzodiazepine use (which includes the prescribed use of methadone and assumes that all illicit use of those drugs or the use of methadone is considered problematic) (5)defined as the injecting of any drugs, not necessarily opiates or benzodiazepines (but excluding the injecting of steroids

New Clients reported to the SDMD - Moray

0255075

100125150

New Clients reported to the SDMD - Scotland

05,000

10,00015,00020,000

23

The rate per 100,000 population of new clients reported to the SDMD enables a more accurate comparison between Moray and Scotland and provides an indication of the extent of the problem in Moray compared with Scotland. The rate for Moray for all new clients tends to be around half that of Scotland suggesting that the problem in Moray is not as severe as nationally.

An age breakdown illustrates how this situation varies between age groups. The Moray rates for new clients aged 29yrs and under, excluding those aged under 15yrs, tend to be quite similar to the national rates, while those under 15yrs and 35-39yrs tend to show the most disparity.

An age breakdown also demonstrates the variation in the number of new clients in each age group and reveals a shift in the age distribution over the last 6 years. In both Moray and Scotland, the most common age of new clients over the last 6 years is 25-29yrs, although there is some fluctuation in Moray over this time. The age groups 20-24yrs and 30-34yrs, are the next most common in both Moray and Scotland.

The shift in age distribution over the last 6 years is very similar in Moray to nationally, though with some fluctuation, but is more clearly illustrated at national level, as shown on the graph above. It can be seen that the proportions of new clients aged 20-24yrs and 25-29yrs have reduced over the last 6 years, while the proportions aged 35-39yrs and 40yrs & over have shown corresponding increases. There are 2 main differences between Moray & Scotland, in the proportions of new clients aged 15-19yrs and 30-34yrs. In Moray there has been an increase in both age groups, whereas nationally there has been very little change in either age group. The proportion of new clients aged under 15yrs has remained steady, both nationally and in Moray.

Rate of New Clients in Moray relative to

Scotland by Age Group

0%

20%

40%

60%

80%

100%

2005/062006/072007/08

Total

Under 15yrs

15-19yrs

20-24yrs

25-29yrs

30-34yrs

35-39yrs

40yrs & over

Rate per 100,000 population of new

clients reported to SDMD

0

100

200

300

400

2005/06 2006/07 2007/08

EA

SR

per

100,0

00

po

pu

lati

on

Scotland

Moray

Proportion of new clients in each age category - Scotland

0%

5%

10%

15%

20%

25%

30%

Under

15yrs

15-19yrs 20-24yrs 25-29yrs 30-34yrs 35-39yrs 40yrs &

over

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

Median Age of New Clients

0

5

10

15

20

25

30

35

Moray

Scotland

Moray

Scotland

Moray

Scotland

2005/06 2006/07 2007/08

All

Male

Female

24

Despite these differences, there is little difference in the median age of new clients in Moray and nationally with both showing a marginal increase over the last 3 years. The median age of new male clients is slightly higher at 31yrs than that of female clients at 27/28yrs. A gender breakdown shows that in both Moray and nationally approximately ⅔ of new clients are male. The age distribution for males in Moray and both genders nationally is the same as the overall distribution and shows a similar shift over the last 3 years. The small number of new female clients in Moray precludes publication of an age breakdown for reasons of disclosure. Data regarding the employment status of new clients indicate a similar picture in Moray to nationally. The vast majority of new clients are unemployed with the remainder reporting their

status as either employed or other(6). Over the last 3 years there has been a slight shift in the employment status distribution of new clients. Both locally and nationally the proportion of new clients who reported being unemployed has reduced, while the proportions reporting their status as employed or other has increased.

Despite the changes in the employment status of new clients, there has been no alteration in the source of funding nationally, but some change in Moray. The majority of clients report benefits as the main source of funding for their drug misuse problem and in 2006/07 the next most common source both in Moray and nationally, was crime. However, in Moray, between 2006/07 and 2007/08 this proportion fell by 11% from 30% to 19% shifting employment to second most common funding source in Moray. The proportion funding their problem through benefits increased to 63% and is now closer to the national figure of 67%, while there was a 6% drop in those funding their problem through debt. In both Moray and Scotland, around 80% of new clients report living in owned or rented accommodation and around 12%-15% report being homeless. Data on living arrangements indicate that approximately ⅓ of new clients live alone, with parents or with spouse and around 15% live with other drug users. Just over ⅓ new clients in Moray report having a dependent child aged under 16yrs, marginally higher than nationally. Drug Usage Profile The illicit(7) drug profile provides details of the drugs that new clients report having used in the past month. By far the most commonly reported illicit drug is heroin, reported by around 76% of new

clients in Moray and 68% nationally. There has been virtually no change over the last 3 years. Heroin use in new clients aged under 25yrs is slightly lower than for all clients, at 50% in Moray in 2007/08 and 56% nationally. The rate shows a net reduction over the last 3 years, of 10% in Moray and 6% nationally.

(6) Other includes: school, excluded from school, long-term sick/disabled, in prison, housewife/househusband/childcare and retired. (7) An illicit drug means: any illegal drug, over the counter medicines used inappropriately, volatile substance used inappropriately and the use of a prescribed drug that has been prescribed for someone else.

2005/06 2006/07 2007/08 Unemployed Scotland 83% 72% 70% Moray 80% 73% 64% Employed Scotland 12% 15% 16% Moray 19% 19% 26% Other Scotland 4% 13% 13% Moray 1% 8% 9%

Illicit Drug Profile - Moray

0%

20%

40%

60%

80%

100%

Her

oin

Met

hado

ne

Dihyd

roco

deine

Diaze

pam

Amph

etam

ines

Coc

aine

Cra

ck C

ocaine

Ecs

tasy

Can

nabis

2005/06

2006/07

2007/08

25

The next most commonly used drugs are diazepam and cannabis, each reported by around 30-35% of new clients. Nationally, there has been a marginal change in the reported usage of these 2 drugs over the last 3 years, however in Moray, there has been a reduction in the proportion of new clients reporting cannabis use, which is mirrored by a similar increase in those reporting diazepam use. The main illicit drug used – the drug causing the client the most problems at the time of contact, not necessarily the most frequently used drug or the one used in the greatest quantities – was also heroin. In Moray in 2007/08 74% of new clients reported heroin as the main drug used, an increase from 68% in 2005/06. The proportion nationally is slightly lower at 65%, and shows a marginal rise over the same period from 63% in 2005/06. The next most commonly reported main illicit drug was cannabis, reported by around 14% both locally and nationally. There are 2 drugs that are predominantly used in combination with heroin when heroin is the main drug of misuse – diazepam and cannabis. The graph illustrates the proportions of new clients reporting use of each of these 2 drugs as well as those reporting the use of other drugs, which include methadone, dihydrocodeine, other opiates, other sedatives, amphetamines, cocaine, crack cocaine, ecstasy and other drugs. Nationally there has been a slight increase in the proportion of clients reporting combined usage of diazepam with heroin and a slight reduction in combined usage of cannabis with heroin. However, in Moray the proportion of new clients reporting combined usage of diazepam with heroin has increased by 17% between 2005/06 and 2007/08, while combined usage of cannabis with heroin has decreased by 18% over the same period, resulting in diazepam replacing cannabis as the most commonly used drug in combination with heroin. In 2005/06 and 2006/07 both locally and nationally, no more than 10% of new clients reported using any of the ‘other’ drugs in combination with heroin. In 2007/08 the same is true nationally. However, in Moray in 2007/08, combined use of dihydrocodeine with heroin was reported, by 15% of new clients. A proportion of clients are prescribed drugs for the treatment of drug misuse or dependence. In 2005/06 the proportion in Moray was almost half the national figure, 23% compared with 45%. Over the next 2 years, an increase in Moray and a reduction nationally have brought these proportions almost in line, at 34% and 39% respectively. Methadone is the main prescribed drug though the proportions both in Moray and nationally that have been prescribed this drug have reduced over the last 3 years. Prescribing of diazepam has also reduced, by 3% nationally and by 30% in Moray. These reductions are countered by an increase in the prescribing of ‘other drugs’ for treatment purposes. Both police and drugs services have recently warned of a significant increase in the use of diazepam and other benzodiazepines, particularly in relation to polydrug use. This is of particular concern when mixed with alcohol when it can be very problematic and in some cases, provoke

Drugs used in combination w ith heroin (when

main drug of misuse) - Scotland

0%

10%

20%

30%

40%

50%

60%

Scotland

Moray

Scotland

Moray

Scotland

Moray

Diazepam Cannabis Other

2005/06

2006/07

2007/08

Illicit Drug Profile - Scotland

0%

20%

40%

60%

80%

100%

Her

oin

Met

hado

ne

Dihyd

roco

deine

Diaze

pam

Amph

etam

ines

Coc

aine

Cra

ck C

ocaine

Ecs

tasy

Can

nabis

2005/06

2006/07

2007/08

26

violent behaviour. The concern has led to less prescribing of diazepam to drug misusers, a trend seen strongly in Moray. However, alternative sources such as the Internet, and a massive increase in illegal imports, both genuine and counterfeit, has created greater availability and a more consistent supply, and is likely to be exacerbating the problem20. It is therefore encouraging that prescribing of diazepam in Moray has reduced so considerably over the last 3 years. However, the 17% increase in clients reporting combined use of diazepam and heroin is concerning. Data relating to the injecting practices of new clients reveal a slightly different picture in Moray to nationally. A larger proportion of new clients report having injected in the previous month in Moray than nationally, while smaller proportions than Scotland report either having injected in the past but not in the previous month or never having injected. However, the situation is improving in Moray. Over the last 3 years the proportions who have either injected in the past but not in the previous month or who have never injected has increased and the proportion who injected in the previous month has decreased. Over the same period, there has been virtually no change nationally.

Similarly, a larger proportion of new clients from Moray inject heroin than do nationally, around ⅔ compared with around ½, the difference relating to the proportion that inject and use another route. There has been a slight net reduction in the overall proportion who inject over the last 3 years, which also relates to the proportion that inject and use another route – the proportion injecting only has risen very slightly. This is the same nationally but without any overall net reduction.

Data regarding the sharing of needles/syringes reveals a worrying trend in Moray. The proportion of new clients who report sharing needles/syringes in the previous month has nearly doubled over the last 3 years, from 17% to 30%, while the proportion that reports never having shared needles/syringes has reduced from 61% to 47%. Nationally, the situation is reversed. With regard to sharing spoons/water/filters/solutions, the situation in Moray is again slightly worse than Scotland though with similar trends. Despite reductions over the last 3 years in both Moray and nationally in the proportion of new clients reporting sharing in the previous month, Moray still has a larger proportion than Scotland in this group, at 40% compared with 32%. Conversely, over the same period the proportion of new clients reporting never sharing has reduced in Moray but increased nationally so that Moray now has a smaller proportion of new clients in this group than Scotland, at 33% compared with 40%. Those reporting sharing prior to but not during the previous month have increased both locally and nationally to the same level of 28%. Sharing spoons/water/ filters/solutions 2005/06 2006/07 2007/08

Scotland Moray Scotland Moray Scotland Moray In previous month 42% 46% 39% 41% 32% 40% In past but not in previous month 22% 16% 23% 17% 28% 28%

How Recently Injected

0%

10%

20%

30%

40%

50%

60%

Moray Scotland Moray Scotland Moray Scotland

In previous month In past but not in

previous month

Never

2005/06

2006/07

2007/08

Route of use of Heroin

0%

20%

40%

60%

80%

Mora

y

Scotland

Mora

y

Scotland

Mora

y

Scotland

2005/06 2006/07 2007/08

Inject only/

Inject & other

route

No injecting

27

There are 9 facilities offering a needle exchange service in Moray, 7 community pharmacies in various locations throughout Moray, the Integrated Drug & Alcohol Service - NHS and Studio 8, both in Elgin. The service at Studio 8 began in September 2007. Noticeably there is no needle exchange facility in Keith. Over the last 3 years, there has been a considerable rise in the number of needles distributed through these sources, from 24,723 to 46,650(8), and 2008 saw a significant increase in the proportion of needles returned. In 2007, both pharmacies and agencies had about 18% of needles returned and in 2008 these figures had risen to 38% and 99% respectively. First use, Problem Recognition & Seeking Help Unless highlighted, the situation can be assumed to be the same locally as nationally. The majority of individuals, around 80%, were aged under 19yrs (half of whom were under 15yrs) when they first started using illicit drugs, aged 15-29yrs when they perceived their drug use to be a problem and aged 15-34yrs when they first sought help for their problem. The time between first use and perception of problem use varies greatly. Around 40% of individuals perceived their drug use to be problematic within 2 years of misuse, an improvement from <25% in 2005/06. A similar proportion does not perceive their drug use to be a problem until 5 years or more of misuse, a reduction from 50% over the same period. Following the identification of problem drug use, between 35% & 40% of individuals sought help within 1 year and a further 25% to 30% within 1-2 years. However, despite the improvement in the time between first use and perception of problem use, the proportion of individuals in Moray waiting 5years or more before seeking help has increased over the last 3 years from 18% in 2005/06 to 25% in 2007/08. There are 2 main referral sources of new clients: self-referrals and referrals from health services

(which include: GP, primary care, mental health and other). Over the last 3 years Moray has seen a sharp rise in self-referrals, from 1% to 37%, and a fall in referrals from health, from 78% to 49%. The graph shows the proportions of referrals received from various sources (others include: voluntary services, education, housing

& other). It illustrates similar though less significant changes nationally in the proportions of self-referrals and those from health services. Health Profile (inc. Blood-Borne Viruses) Co-occurring health issues provide an indication of the reason a client has presented to a service, in addition to their drug use. The picture is very similar in Moray to nationally. Around 55% of new clients report that drug-related physical health issues led them to present to a service and around

(8) Data is not available for NHS SMS for 2006

Source of Referral of New Clients

0%

20%

40%

60%

80%

100%

Sco

tlan

d

Mor

ay

Sco

tlan

d

Mor

ay

Sco

tlan

d

Mor

ay

Sco

tlan

d

Mor

ay

Sco

tlan

d

Mor

ay

Self Health Social Work Criminal

Justice

Other

2005/06

2006/07

2007/08

Needles Exchanged/Returned

0

10000

20000

30000

40000

50000

Community

pharmacy

Agency

Community

pharmacy

Agency

Community

pharmacy

Agency

2006 2007 2008

Needles

Distributed

Needles

Returned

28

40% report mental health problems as a co-occurring issue. For the last 2 years, data has been collected regarding the co-occurrence of alcohol problems. In 2007/08, 17% of new clients in Moray and 29% nationally reported alcohol problems as a presenting issue. The rate of general acute inpatient discharges with a diagnosis of drug misuse has increased over the last 6 years both in Moray and nationally although the rate in Moray is still less than half the national rate at 48 per 100,000 population compared with 108 per 100,000 population. The vast majority of patients are in hospital for less than 1 week, 90% in Moray compared with 86% nationwide. By far the most common drug type specified is opioids, such as heroin, which accounted for around 91% of discharges in Moray in 2007/08. This has risen from 56% in 2005/06. The equivalent figure for Scotland is 67%, risen from 62% in 2005/06. The majority of admissions were emergency, accounting for around 95% of all drug-related admissions for the last 2 years, a rise of about 20% from 2005/06. The rate of psychiatric discharges with a diagnosis of drug misuse has reduced over the last 6 years in both Moray and Scotland and the Moray rate is approximately ⅓ that of Scotland at 11 per 100,000 population compared with 29 per 100,000 population. Data relating to maternities recording drug misuse indicates that there have been fewer than 5 in Moray in each of the last 5 years, suggesting a maximum rate that is lower than Scotland’s in every year. It also suggests a fairly steady rate in Moray whereas Scotland has an increasing rate. The graph illustrates the situation using the maximum rate in Moray, assuming 5 cases are recorded in each year.

Figures for Scotland indicate that the most common drug type recorded in relation to maternities is opioids, such as heroin, and this shows an increasing trend over the last 5 years. The next most common diagnosis was multiple drug use/other (which includes cocaine, hallucinogens, volatile solvents and

other stimulants and psychoactive substances), which shows a decreasing trend and for the last 2 years has been superseded by cannabinoids. Both cannabinoids and sedatives/hypnotics show an increasing trend over this period.

*Figures for Moray are the maximum rate. As there were fewer than 5 each year, SDMD withholds data to prevent possible identification of individuals.

General acute inpatient discharges by drug type

0%

20%

40%

60%

80%

100%

Scotland

Mora

y

Scotland

Mora

y

Scotland

Mora

y

2005/06 2006/07 2007/08

Opiods

Cannabinoids

Sedatives/Hypnotics

Cocaine

Other stimulants

Multiple/Other

Rate of maternities recording drug misuse

0

2

4

6

8

10

12

2002/03 2003/04 2004/05 2005/06 2006/07

Ra

te p

er

1,0

00

ma

tern

itie

s

Scotland

Moray*

Maternities recording Drug Misuse by Drug Type -

National

0%

20%

40%

60%

80%

2002/03

2003/04

2004/05

2005/06

2006/07

Opioids

Cannabin-

oids

Sedatives/

Hypnotics

Multiple/

Other

29

There is a clear relationship nationally between births recording drugs misuse and deprivation, based on the SIMD categories. There is a slight increase in the rate of all births as the level of deprivation increases but births recording drugs misuse show a much greater rise as deprivation increases; the graph illustrates this difference. Blood-Borne Viruses Data is collected on blood-borne viruses to monitor the incidence of these diseases, specifically Hepatitis B, Hepatitis C and HIV / AIDS. However, data is only published at Grampian level so may not be indicative of Moray. Over the last 6 years, the number of new Hepatitis B virus (HBV) diagnoses among persons for whom injecting drug use was indicated as a risk factor has decreased both nationally and in Grampian, from 38 to 8 and 13 to <5 respectively. However, at present no standard exists for the reporting of HPV to Health Protection Scotland (HPS) and it is therefore difficult to estimate the true incidence and prevalence of the disease. There are several methods of transmission of the HBV and the main method of transmission varies, reflecting the prevalence of chronic HBV in a given area. Where the prevalence is low, as in Scotland, injection drug use and unprotected sex are the primary methods. The prevalence of Hepatitis C Virus (HCV) is much greater than HBV but also shows a reducing trend both nationally and in Grampian. One of the main routes of transmission is injection drug use and in Grampian, the proportion of new cases where this is the probable/possible route of transmission rose from 45% pre-1995 to 78% in 2002 and has since reduced continuously each year to 47% in 2007. The picture for Scotland is very similar though slightly lower than Grampian, with the exception of 2007 when the proportion in Grampian was lower than nationally for the first time. In both Grampian and Scotland, the proportion of cases where the probable/possible route of transmission of HCV is injecting drug use reduces as the age of earliest positive specimen increases. Conversely, with the exception of the under 20yrs group, the proportion of cases where the route of transmission is ‘other’ (which includes sexual contact, body piercing/tattoo, needlestick, bite, perinatal transmission and blood factor/blood transfusion risk) increases with age of earliest positive specimen.

Rate per 1000 births by Deprivation Category

0

5

10

15

20

25

1

Least

Deprived

2 3 4 5

Most

DeprivedDeprivation Category

Rate per

1000 - all

births

Rate per

1000 - births

recording

Drugs Misuse

Number of persons reported to be Hepatitis C

antibody positive - Grampian

0

50

100

150

200

250

300

Pre

1995

1995

2000

2002

2003

2004

2005

2006

2007

All

IDU

Probable/Possible route of transmission of HCV -

Injecting Drug Use

0%

20%

40%

60%

80%

100%

Und

er 20y

rs

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50yrs & o

ver

Scotland

Grampian

30

The proportion of cases where the route of transmission is not known increases with age of earliest positive specimen. The known number of HIV-infected injecting drug users in Grampian at the end of 2007 was 40, 22 of whom were living. The number of individuals in clinical care, i.e. being monitored by their NHS board of residence, was 14 in 2007 but averages at 12 in each of the last 6 years. Between 2002 and

2006, HIV-antibody tests were carried out on injecting drug users and just 3 were positive, a prevalence rate of 0.24%. Drug-related Deaths Data for drug-related deaths is available from 2 sources, Grampian Police - Sudden Death reports, and the Scottish Drugs Misuse Database (SDMD), Drug Misuse Statistics Scotland. Grampian Police have recorded 15 drug-related deaths in the last 3 full fiscal years in Moray, 2 in 2005/06, 8 in 2006/07 and 5 in 2007/08. The majority are the result of heroin overdose. The small numbers of drug-related deaths in Moray make trend analysis difficult. Therefore, a 5-year rolling average is created with data from the SDMD. This indicates a slightly increasing trend over the last 12 years in both Moray and Scotland. Between 2005 and 2007 the SDMD recorded 12 drug-related deaths in Moray and the main cause was drug abuse(9), accounting for 10 of the 12 deaths during this period. Heroin was involved in 9 of the 12, and alcohol in 8. Other drugs, which were each involved in 2 deaths, were diazepam, methadone and temazepam. Drug Treatment Waiting Times Caution is recommended in relation to drug treatment waiting times data as the number of services submitting data varies between areas and across collection periods.

The situation in Moray with regard to waiting times for an assessment date differs to the national picture. The data indicate that over the last 2 years, of those clients offered an assessment date within each quarter, an average of 36% were offered an assessment date within 14 days(10), nearly half the Scottish average of 67%, and an average of 56% were offered an assessment date between 2 & 26 weeks,

(9) Deaths where the underlying cause of death has been coded to specified sub-categories of ‘mental and behavioural disorders due to psychoactive substance use’ (10) Time between date referral received / first date of contact and first appointment date offered for assessment (for those offered an assessment date during the reporting period)

Probable/Possible route of Transmission of HCV -

Other

0%

5%

10%

15%

20%

Und

er 2

0yrs

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50yr

s & o

ver

Scotland

Grampian

Drug-related deaths - Moray

0

0.5

1

1.5

2

2.5

3

3.5

4

1996-

2000

1997-

2001

1998-

2002

1999-

2003

2000-

2004

2001-

2005

2002-

2006

2003-

2007

5-y

ea

r ro

llin

g a

ve

rag

e

Assessment Waiting Times in Moray

0%

20%

40%

60%

80%

Qtr 4

06/07

Qtr 1

07/08

Qtr 2

07/08

Qtr 3

07/08

Qtr 4

07/08

Qtr 1

08/09

Qtr 2

08/09

Qtr 3

08/09

Offeredassessmentdate within 14days

Offeredassessmentdate btw 2 &26wks

Still waitingassessmentdate after26wks

31

compared with a Scottish average of 31%. However, of those still waiting for an assessment date at the end of each quarter, an average 25% had been waiting at least 26 weeks compared with 44% nationally. The situation regarding waiting times for an appointment date for any intervention is better in Moray

than nationally. Of those clients offered an appointment date for any intervention during the qtr, an average of 95% of clients in Moray were offered one within 14 days(11), compared with 88% nationally. The remainder of clients in Moray that were offered an appointment date during the qtr, were offered one between 2 & 26 weeks, as were all

but 1% of clients nationally. Of those clients still waiting for an appointment date at the end of the qtr for any intervention, none in Moray waited more than 26 weeks, compared with 55% nationally. Overall, the delay in the provision of services in Moray seems to relate to the time between referral and assessment appointment. The data suggests that once a client has been assessed, there is little delay in their subsequent treatment - it is getting an initial assessment that takes the time. Looking more deeply into intervention waiting times reveals a slight difference in waiting time depending on the type of intervention. Clients identified for structured preparatory and motivational interventions tend to be offered a first appointment more

quickly than those identified for substitute prescribing. Between January 2007 and June 2008, an average of 99% of structured preparatory and motivational intervention clients were offered a first appointment within 14 days, compared with an average of 87% of substitute prescribing clients. In both cases, over the same period, the remainder of clients were seen between 2 & 26 weeks with none being seen later

than this.

(11)Time between date care plan agreed / decision on treatment is made / date client ready for treatment and the first appointment date offered for any intervention (for those offered an intervention date during the reporting period)

Intervention Waiting Times in Moray

0%

20%

40%

60%

80%

100%

120%

Qtr 4

06/07

Qtr 1

07/08

Qtr 2

07/08

Qtr 3

07/08

Qtr 4

07/08

Qtr 1

08/09

Qtr 2

08/09

Qtr 3

08/09

Offeredappointmentdate for anyinterventionwithin 14 days

Offeredappointmentdate for anyinterventionbtw 2 & 26wks

Still waitingappointmentdate for anyinterventionafter 26wks

Assessment Waiting Times in Scotland

0%

20%

40%

60%

80%

Qtr 4

06/07

Qtr 1

07/08

Qtr 2

07/08

Qtr 3

07/08

Qtr 4

07/08

Qtr 1

08/09

Qtr 2

08/09

Qtr 3

08/09

Offeredassessmentdate within 14days

Offeredassessmentdate btw 2 &26wks

Still waitingassessmentdate after26wks

Intervention Waiting Times in Scotland

0%

20%

40%

60%

80%

100%

Qtr 4

06/07

Qtr 1

07/08

Qtr 2

07/08

Qtr 3

07/08

Qtr 4

07/08

Qtr 1

08/09

Qtr 2

08/09

Qtr 3

08/09

Offeredappointmentdate for anyinterventionwithin 14 days

Offeredappointmentdate for anyinterventionbtw 2 & 26wks

Still waitingappointmentdate for anyinterventionafter 26wks

% of clients offered an appointment within the Qtr

0%

20%

40%

60%

80%

100%

120%

14

da

ys

2 &

26

wks

14

da

ys

2 &

26

wks

14

da

ys

2 &

26

wks

14

da

ys

2 &

26

wks

14

da

ys

2 &

26

wks

14

da

ys

2 &

26

wks

Qtr 4

06/07

Qtr 1

07/08

Qtr 2

07/08

Qtr 3

07/08

Qtr 4

07/08

Qtr 1

08/09

Structured

preparatory

and

motivational

intervention

Substitute

prescribing

32

Homelessness Figures for homelessness due to a drink/drug problem, prior to April 2007 do not provide an accurate reflection of the problem. This is because only one category of priority need could be identified and if an individual’s substance misuse was not the main reason for their homelessness, it was not cited as the principal category. Consequently, just 8 cases were identified between 2002/03 and 2006/07. Post April 2007, 44 individuals have been identified as having support needs relating to drug or alcohol dependency and were referred to Social Work Drug & Alcohol Services, and 39 individuals have lost their accommodation because of drug and/or alcohol problems16.

Drug Use among 13 & 15 year olds in Moray17 The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) is carried out biennially to indicate the prevalence of smoking, drinking and drug use among 13 & 15 yr olds. The most recent survey based on local authority areas was in 2006 and is the second survey to provide information at a local level, the first being in 2002. From a list comprising 15 drugs, including a dummy drug, 7% of 13 year olds (yo) and 30% of 15 year olds (yo) indicated that they had used or taken drugs at some point. Both show a slight reduction since 2002. Boys are slightly more likely to have used drugs than girls. Based on those who had used drugs, the average age of pupils when they first tried using drugs was 13yrs old. Of those who had used drugs 48% reported that they were drinking alcohol at the time. Questions regarding the recency of drug use indicate that 4% of 13yo and 12% of 15yo had used drugs in the month prior to the survey. There is no significant change from 2002 in the proportion of 13yo but there is a significant decrease in the proportion of 15yo. Including those who had used drugs in the previous month, 6% of 13yo and 25% of 15yo indicated having used drugs in the year prior to the survey. There is a slight but non-significant decrease from 2002 in the proportion of 15yo but again, no change in the proportion of 13yo. In both cases, boys are again slightly more likely to have used drugs than girls. The most common drug used by pupils in both the month and year prior to the survey was cannabis, reported by 6% for the past month and 13% for the past year. The next most common drug reported by both age groups was poppers, a form of stimulant, followed by gas, glue or other solvents. There are no changes from 2002. Frequent regular drug use among pupils is quite rare. In 2006 there were no 13yo who reported using drugs at least once a week or once or twice a month, while 2% of 15yo reported using drugs at least once a week and 1% once or twice a month. The largest proportion of 13yo & 15yo pupils who had reported using drugs at some point, stated that they had only done so once. 6% of 15yo and 1% of 13yo reported that they no longer used drugs. The most popular place for pupils to use drugs was outside in a street, park or similar. Other popular places include at someone else’s home, at a party and, for 13yo, at school. Overall, 41% of pupils reported that it would be very or fairly easy to get drugs, although significantly more 15yo than 13yo reported this, 52% compared with 26%. On average, 37% of pupils did not know how easy or difficult it would be. By far the largest proportion of pupils reported that they sourced their drugs from a friend of either the same age or older, 61% of 13yo and 85% of 15yo. 12% of 13yo and 3% of 15yo sourced their drugs from a stranger and disturbingly, 11% of 13yo reported an immediate family member as their source. Of those pupils who had used drugs in the month prior to the survey, 24% reported that they had spent money on them, an average of £8.85. Approximately 42% of pupils who had used drugs used it all themselves but a slightly larger proportion gave some away. A small proportion, 18% of 13yo and 7% of 15yo sold some of their drugs.

33

Although a large majority of pupils reported that they knew where to get information about drugs, there were still 30% of 13yo and 19% of 15yo who did not know where to go. Questions regarding the accuracy of some statements about drugs reveal some knowledge gaps, particularly in 13yo.

Proportion of pupils that agreed with the statements

0%

20%

40%

60%

80%

100%

Taking cocaine isdangerous

Heroin is addictive Inhaling or sniffingsolvents can cause

brain damage

Injecting drugs canlead to HIV

Heroin is moredangerous than

cannabis

13yr olds

15yr olds

Just over half of 13yo do not believe that injecting drugs can lead to HIV and nearly ⅔ do not believe that heroin is more dangerous than cannabis. Since the average age of pupils when they first tried using drugs was 13yrs, these knowledge gaps are of particular concern. Although every question was stated as true by the majority of 15yo, there were still approximately ⅓ who did not believe that injecting drugs could lead to HIV or that heroin is more dangerous than cannabis. Also of concern are the proportions of 15yo who do not think that people who take drugs are stupid (36%) and who do not think that all people who sell drugs should be punished (39%). Drugs & Crime Over the last 6 years, the rate per 100,000 population of all drug-related crime has remained steady both locally in Moray and nationally. The rate in Moray is consistently around half the national rate.

The vast majority of drug-related offences are for possession, accounting for around 80% of drug-related offences in Moray. Around a further 18% are for possession with intent to supply and the remainder are for other drug-related crimes, such as illegal

importation of drugs, production and manufacture of drugs, money laundering related offences and other drug-related offences. The graph shows the contribution made to all drug-related offences by each of these 3 categories. There is a slightly reducing trend in possession offences recorded by Grampian Police, Moray Division. The average number of offences recorded per year over

Drug-related Offences by type

0%

20%

40%

60%

80%

100%

Scotland

Mora

y

Scotland

Mora

y

Scotland

Mora

y

2005/06 2006/07 2007/08

Other*

Possession

Possession w ith

intent to supply

Drug-related offences - Rate per 100,000

population

0

200

400

600

800

1000

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

Scotland

Moray

Recorded Possession Offences Trend

0

100

200

300

400

500

2003/04 2004/05 2005/06 2006/07 2007/08

34

the last 5 fiscal years is 331 and numbers for the last 2 years have been below this average18. The following table breaks down the possession offences by Inspector area with the figure in brackets showing the number of offences that occurred in the title town in that area. It clearly illustrates that the majority of offences occur within the main population bases of Elgin, Forres and Buckie18.

The majority of persons reported for drug possession offences in Moray were male, accounting for around 85% of individuals. In 2006/07 the males ranged in age from 13yrs to 59yrs and the females from 17yrs to 43yrs. In 2007/08 the age range for males was 16yrs to 55yrs and for females was 15yrs to 44yrs. Nearly half of individuals were aged 24yrs or under18. In contrast to possession offences, the trend for drug supply crimes is slightly increasing. The average number of crimes recorded each year over the last 5 fiscal years is 59 and numbers for the last 2 years have been above this average18. The following table breaks down the drug supply crimes by Inspector area with figures in brackets showing the number of crimes that occurred in the title town in that area. The figures show that as the town with the largest population base, Elgin recorded the most drug supply crimes in each of the last 2 years, accounting for 51% and 64% of the totals. Four beat areas within Moray recorded no drug supply crimes over this period, namely Rothes, Tomintoul, Hopeman and Lhanbryde, 2 each within Forres and Lossiemouth Inspector Areas. The increase in Elgin is mainly due to Operation Centaur, a major drugs operation targeting an organised crime group supplying Class A and B controlled drugs to the Moray area18. [It is important to note that the number of drug supply crimes recorded in any year is very dependent on a number of factors including: the number of specific drugs operations carried out by the Police, the availability of drugs in Moray and the quantity of drugs seized being sufficient to evidence a supply charge] The majority of persons reported for drug supply crimes in Moray were male, accounting for around 78% of individuals. The table shows a breakdown of drug supply offenders. The average age for males in both years excludes a sole male in each year aged 54yrs and 60yrs respectively, as these were far outside the norm and would have skewed the average considerably18. Number of

offenders Youngest Oldest Average

Male 33 19yrs 54yrs 33yrs 2006/07 Female 9 16yrs 35yrs 27yrs Male 26 18yrs 60yrs 28yrs 2007/08 Female 8 15yrs 36yrs 24yrs

The most common drug involved in supply charges in each of the last 2 years is heroin, which was involved in nearly 1/3 of all charges, although this is partly because Grampian Police have been targeting the supply of this drug. In 2006/07 there were nearly as many charges involving cannabis resin as heroin, though this reduced considerably in 2007/08. There were slight

Buckie Insp Area

Elgin Insp Area

Forres Insp Area

Lossiemouth Insp Area

2006/07 47 (40) 169 47 (43) 23 (9) 2007/08 42 (30) 174 66 (57) 30 (8)

Buckie Insp Area

Elgin Insp Area

Forres Insp Area

Lossiemouth Insp Area

2006/07 13 (10) 30 11 (11) 5 (2) 2007/08 16 (4) 42 6 (3) 2 (2)

Recorded Drug Supply crimes trend

0

20

40

60

80

2003/04 2004/05 2005/06 2006/07 2007/08

35

increases in charges involving cocaine and amphetamine over this period, while those involving ecstasy reduced slightly18. Drugs seized within Moray as recorded by Grampian Police Force Drugs Squad show 3 significant changes between 2007 and 2008. The amounts of cocaine, ecstasy tablets and amphetamine that were seized increased dramatically, mainly due to a specific operation. In 2007, 37.67g of cocaine, 52 ecstasy tablets and 277.77g of amphetamine were seized. In 2008, these figures increased to 1879.84g, 939 tablets and 6832.5g respectively. The 4 main offenders targeted through the operation have now been imprisoned for their involvement. In addition, there have been significant seizures of cannabis plants at locations in Moray and 3 offenders have been imprisoned as a result. There have been no seizures of benzodiazepines, particularly diazepam, which is perhaps surprising given the rise in combined heroin and diazepam usage over the last 3 years but the simultaneous reduction in prescribing [18]. However, it is not possible to say whether the diazepam is being sourced from the Internet or through illegal supply but it is known that the level of illegal supply across the UK has increased since the quantity seized by police and customs has risen nearly sevenfold between July ’03-June ’06 and July ’06-June ’08. Research investigating a possible link between social work referrals and drug misuse in Moray includes a geographical analysis of drug offences by drug type for 2007 and 2008. The majority of offences for all drug types are in Elgin, with Buckie and Forres also experiencing problems with all drug types while Lossiemouth and Keith have problems with heroin24. Unlike alcohol, the vast majority of drug-related crime relates to the illegality of the drugs themselves rather than the drugs being a contributory factor to the offender’s behaviour. However, there are those who’s offending is the direct result of their drug misuse and although a custodial sentence is an available option, it is not always the most effective. Other options include: Diversion from Prosecution, where an individual is referred to social work or other agencies where criminal justice proceedings are deemed unnecessary. The schemes aim to provide persons accused of minor offences with support and advice in relation to problems associated with their offending. Prosecution is deferred subject to successful completion of a scheme; Probation orders with a condition of drug treatment/education, the main purpose of which is to work with offenders to prevent or reduce their re-offending; Drug Treatment and Testing Orders are a recent addition (available since September 2006 in Moray) designed for drug-misusing offenders who might otherwise receive a custodial sentence. The table shows the incidence of each of these measures over the last 6 years.

*Not available in Moray until September 2006

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

Diversion from

Prosecution cases

referred to Drug

Treatment/Education

0 14 0 4 0 0

Probation Orders

commenced with a

condition of Drug

Treatment/Education

2 1 5 3 0 3

Drug Treatment and

Testing Orders

commenced*

N/A N/A N/A N/A 0 0

36

Parental Substance Misuse The North East Scotland Child Protection Committee (NESCPC) states in their guidelines that “problem substance misusers who are parents are most likely to find that their substance use affects their ability to look after their children… Whilst a parent/carer’s drug or alcohol misuse should not automatically lead to a Child Protection Enquiry or increased levels of intervention, there is increasing evidence of the negative effects in parental problem substance use on the welfare of children. In particular, problem substance use is associated with an increased risk of child abuse and neglect”.21 There are various reasons why this risk is increased including:

Infants in particular are vulnerable to the effects of physical and emotional neglect or injury The parent/carer may not be physically or emotionally available to the child Finances may be spent on alcohol or drugs Lifestyle and behaviour may impact on the child, e.g. by exposing it to drug taking including

injecting, problem drinking, violence and criminal activities Babies born to drug using mothers may suffer from neonatal abstinence syndrome caused by

withdrawal from some substance. The number of children on the Child Protection Register in Moray has increased considerably over the last 7 years, from 28 as at 31/03/02 to 89 as at 31/03/08, a more than threefold increase, which has taken Moray from 13th in Scotland in terms of rate per 1,000 population (aged 0-15yrs) to 31st (where 32nd has the highest rate). This is in distinct contrast to Aberdeen City and Aberdeenshire, who have both experienced a reduction over the same period, of 32% each22. Of the 89 children on the register in Moray in 2008, 43 were affected by parental drug misuse and 40 by parental alcohol misuse. Of these, 16 used both alcohol and drugs. Unfortunately data is not available prior to 2007/08 so no comparison or trends can be determined22. Furthermore, there is a strong link between parental substance misuse and domestic violence. In a study of 54 children, 36 of whom were on the Child Protection Register, 25 of 31 (81%) parental substance misuse cases also involved domestic violence. Of the 31 parental substance misuse cases, 20 involved heroin - 16 (80%) of which also involved domestic violence23. Research investigating a possible link between social work referrals and drug misuse in Moray concluded that such an association is probable and data suggests that there is an increase in those responsible for children who are abusing drugs, in comparison with those abusing alcohol. When comparing the location of drug offenders with social work referrals, the report identifies New Elgin area as an apparent hotspot for drug abusing parents24.

37

Drug and Alcohol Services in Moray The make up of drug and alcohol services in Moray is generally aligned with that of the majority of other local authority areas in Scotland. Moray has a number of drug and alcohol services which are provided either directly by the council, the NHS and police or commissioned from the voluntary and private sectors. The voluntary and private sectors target substantial funding from external sources such as the Big Lottery and Lloyds TSB to run their projects. Services in Moray offer a wide range of services from early intervention, preventative work through to actual treatment and rehabilitation services. There are also a number of generic services provided for people who are socially excluded e.g. homelessness services helping those who have a contributory substance misuse problem. Audit Scotland (2009) identified that while there are a number of services out there aimed at addressing both drug and alcohol misuse, the subsequent complex network of services has made it difficult to effectively and efficiently plan and provide services based on local needs. Added to this are the complex funding arrangements where projects may have separate funding streams, each with different reporting criteria and timescales. Given the scale of drug and alcohol misuse problems in Scotland, the range of agencies involved and the often complex funding arrangements, there is a clear need to clarify the roles, accountability and performance of drug and alcohol agencies and services. From this research it appears that Moray has the same issues. In Moray there are a number of services which deal with substance misuse issues, either directly where the services core priority is to help those with substance misuse problems, or indirectly where substance misuse clients are just one small group of the services client base. During the course of this assessment meetings were held with the majority of drug and alcohol agencies in Moray, both direct and indirect. Although many agencies provide a variety of services, most specialise in a particular field, such as prevention or treatment. The following section details the main agencies under the most appropriate heading – prevention/early intervention, treatment or continuation support – for the work that they do. Where good quality data was available, this is included. Following is a brief outline of some of the other indirect services available in Moray. Prevention/Early Intervention Primary Care - Alcohol Brief Interventions Alcohol Brief Interventions (ABI) are opportunistic interventions when patients present themselves to a health care setting such as in General Practices and Accident & Emergency (A&E). Of those presenting to primary care with a potential alcohol-related condition, at least 25% might be expected to screen positive and be offered a brief intervention. This percentage is primarily based on the number of harmful and hazardous drinkers identified in the Scottish Health Survey 2003 (adjusted to reflect known under-reporting). Given that patients receiving a screening do so because they present with a potential alcohol-related condition, the percentage estimated to be screen positive (i.e. 25%) and who therefore require a brief intervention may be an under-estimate. There is consistent evidence from a large number of studies that brief intervention in primary care can reduce total alcohol consumption and episodes of binge drinking in hazardous drinkers, for periods lasting up to a year. There is limited evidence that this effect may be sustained for longer periods. All groups under study reduced alcohol consumption, but those with brief interventions did so to a greater extent than those in control groups. (www.sign.ac.uk/guidelines/fulltext /74/section3.html) The ABI national HEAT target (H4) is focussed on delivery of ABI by a doctor or trained nurse, A&E and antenatal settings. NHS Grampian is also including other services, including sexual health services. Of the 16 General Practices in Moray, 14 have signed up to provide ABI as part of their work.

38

Providing Alcohol Brief Intervention Not Providing Alcohol Brief Intervention Ardach Health Centre, Buckie Aberlour Health Centre

Seafield Medical Centre, Buckie Tomintoul Medical Centre Cullen Medical Centre

Dufftown Medical Group Elgin Community Surgery

The Maryhill Practice, Elgin Victoria Crescent Medical Centre, Elgin

Fochabers Medical Practice Forres Health Centre

Varis Medical Practice, Forres Glenlivet Medical Practice

Keith Medical Practice Moray Coast Medical Practice, Lossiemouth

Rothes Medical Centre 2008/09 was the first year surgeries were providing ABI, during the year 35 ABIs were carried out, against a target of 600. 23 of the ABIs were provided through Elgin & Lossiemouth practices; 6 in Forres; 2 in Speyside and 4 between the Buckie, Cullen & Fochabers practices. Health Promoting Schools Health Promoting Schools (HPS) is a holistic initiative that aims to improve the health and wellbeing of all students in a school setting through a whole school approach. It focuses on schools as an integral part of the wider community and offers practical ways for children and young people, teachers, parents and community members to contribute to making schools and the wider community healthy settings. It is about physical and mental health, emotional and social well-being. There are 9 priority areas covered by HPS: Mental Health Sexual Health Accident protection Physical activity Healthy eating Drugs Alcohol Tobacco Oral Health Each school chooses 3 priorities on which to concentrate over a period of 2 years. Over the next couple of years, using Quality and Outcomes Framework (QOF) data, the Grampian Youth Lifestyle, Moray report, and S2 questionnaire data, the Health Improvement Officers for schools are working on providing evidence to schools of what the needs may be in their area and encouraging them to select HPS priorities that focus on these needs. Inputs to secondary schools are delivered jointly by the Drug & Alcohol Information and Health Improvement Officer and Health Improvement Assistants. Inputs to primary schools are being delivered jointly by Grampian Police School Liaison Officers (SLOs) or Community Beat Officers, and staff from the Health Improvement Service. The input consists of a 45min presentation focusing on alcohol, cannabis, volatile substances and tobacco, although other drugs are also discussed. The presentation looks at the consequences of alcohol/drug/tobacco use, including physical, psychological, social and legal. The presentation is followed by the D-rug game, which aims to test the pupils on their understanding of what they have heard and discussed during the presentation.

39

There has been a lot of work by Grampian Police SLOs and the Health Improvement Service to coordinate and streamline the delivery of drug/alcohol inputs. This ensures that schools receive inputs from both a police and health angle and that the language used e.g. drug names (inc. street names) are uniform, providing consistent messages around drugs and alcohol. Stats Since May 2008, 17 of the 46 primary schools in Moray have received or have booked to receive a drug/alcohol input. Three of these will be receiving their second input. Primary Schools that have received or are booked to receive the joint input from Grampian Police SLOs and staff from the Heath Improvement Service include: Aberlour, Applegrove, Burghead, Cullen, Greenwards, Hythehill, Kinloss, Millbank, Milnes, Mortlach, Mosstodloch, New Elgin, Portgordon, Seafield, St. Sylvester, Tomintoul and West End. In addition, the Drug & Alcohol Information & Health Improvement Officer has delivered 2 inputs to pupils in 2 primary schools, Kinloss & Milnes, 2 inputs to parents of pupils in 1 primary school, Mosstodloch, and 1 input to teachers in 1 primary school, East End in Elgin. Since April 2006, the Drug & Alcohol Information & Improvement Officer has delivered inputs to pupils in 6 of the 8 state funded secondary schools in Moray and also Gordonstoun School. He has also delivered awareness sessions to teachers in 1 school and parents of pupils in 3 schools. Only 1 secondary school has received no inputs of any kind. The table below details the inputs provided to secondary schools since April 2006 by the Drug & Alcohol Information & Health Improvement Officer and highlights the sporadic and inconsistent nature of inputs. However, schools will often design and deliver their own lessons and will not request the involvement of an outside agency.

Drug & Alcohol Information and Health Improvement Officer In addition to delivering education sessions in schools, awareness training and education sessions are also provided to Youth Groups, Workplace Managers, Foster Parents and anybody who requires an input around drugs & alcohol.

School Drugs Alcohol Drugs & Alcohol

Buckie High

Elgin Academy 1 - S6 2008 1 - S5 2008

1 - S2 2006 1 - P 2006 1 - S2 2007 1 - S5 2008 1 - S6 2008

Elgin High 1 - T 2006

Forres Academy

1 - S6 2006 4 - S6 2007 1 - S5 2007 1 - S2 2007

1 - S5 2006

Keith Grammar

1 - S5 2006 1 - S5 & S6 2008 1 - S5 2008

1 - S5 2006 1 - S5 & S6 2008 1 - S5 2008

1 - S5 & S6 2008 1 - S6 2008

Lossie High 1 - P 2007 1 - S3 2006

Milnes High 1 - S4 2006 1 - S6 2006 1 - S5 2006 1 - P 2007

Speyside High 2 - S4 2009 Gordonstoun 7 - Y12 2007

Key P = Parents Sx = Secondary pupils, year x T = Teachers

40

The officer is also responsible for coordinating campaigns in the Moray area and attending a variety awareness-raising events and health fares. The table below details the work carried out over the last 3 years and illustrates the diversity of those receiving inputs.

Delivered to Drug Awareness Sessions

Alcohol Awareness Sessions

Drug & Alcohol Awareness Sessions Other

Young people - Gateway to work

2006 - 5 2007 - 6

2007 - 5 2008 - 11 (1 adults) 2009 - 2

Other Young People 2006 - 1 2007 - 2 2008 -1 (Rocksafe)

2008 – 3 + Young Persons Drug & Alcohol Awareness Day/Conference 2009 - 1

2006 - 1 (Transition to 2ndry school)

General Public 2007 - 4 (Nat Alc wk) 2008 - 3 (Nat Alc wk)

2007 - 2 2008 - 1 2009 - 2

Workplace 2007 - 1 2008 - 1 2006 - 1 2007 - 1 2008 - 4

2007 - 2 (social awareness prog)

Prison Inmates 2006 - 1

Ambulance/Fire/Police 2007 - 1 (Amb) 2006 - 1 (Fire) 2007 - 1 (police - school resources)

Immigrant Workers 2007 - 2 (general awareness raising)

Foster Carers 2007 - 2

HIAs 2006 - 1 2006 - 1 2007 - 3

2007 - 2 (1xlesson planning, 1xmethaphetamine)

RAF Personnel & Family 2007 - 1

The Moray Council 2007 - 2 (1xlev 1, 1xlev 2) 2007 - 1 (lev 1) 2007 - 4

Carers/Care Workers 2008 - 1 2008 - 9 2009 - 1

More Choices - More Chances 2008 - 2

In addition, there has been a Christmas Alcohol Campaign in each of the last 3 years, which involved a number of inputs over the course of December, see table. Grampian Police School Liaison Officers There are 2 School Liaison Officers (SLOs) within Moray Division of Grampian Police who deliver a range of inputs at schools including drug and alcohol information/education sessions, which accounts for approximately 50% of their workload. A variety of materials are utilised to inform young people, dispel myths and increase knowledge as well as support them in developing skills that will enable them to make the right choices. Following introduction, the SLOs are invited into schools to deliver whatever input is requested. As mentioned previously, there has been a lot of work by Grampian Police SLOs and the Health Improvement Service to coordinate and streamline the delivery of drug/alcohol inputs. This ensures that schools receive inputs from both a police and health angle and that the language

2006 10 2007 10

Christmas Alcohol Campaign 2008 4

41

used e.g. drug names (inc. street names) are uniform, providing consistent messages around drugs and alcohol. The following table details the number of alcohol (A) and drug (D) inputs that have been delivered to Moray secondary schools over the last 3 years and highlights the imbalance between schools and year groups in inputs received. Buckie

High Elgin

Academy Elgin High

Forres Academy

Keith Grammar

Lossie High

Milnes High

Speyside High

S1 A9 A1 A6 S2 A2 A9/D17 D12 A5 A5/D10 S3 D10 A6/D17 A1/D8 D2 A7 D1 D10 D3 S4 A2 A6 D16 A9/D10 D3 S5 A1 D1 A1/D4 A3/D3 S6 D4 Parents A&D1 Staff A2 Healthpoint & SMS drop-in Healthpoint provides a focal point for a wide range of health information, which is available for the general public and professionals. This includes information on improving health, health conditions and procedures, healthy travel, support groups and health-related services and organisations. SMS is a confidential drop-in centre within the Healthpoint, open on Saturday afternoons between 2pm & 4pm. It is staffed by a health information assistant/detached youth worker, nurse and doctor, who offer support on lifestyle issues, tobacco/alcohol, healthy eating, contraception, emergency contraception, pregnancy testing and chlamydia testing. Since June there has been a sexual health nurse available during the week, which has more than doubled the number of clinical visits(12) received at the SMS per month. Although the service is officially for young people aged 12 – 19yrs, a small proportion of visitors are above this age group (approx. 14%) The Healthpoint/SMS drop-in used to be situated in the High Street in Elgin but was moved at the beginning of November 2008 to Dr Grays. Since then, usage of the Saturday SMS service has fallen considerably. Prior to the move there were around 30 visits a month to the weekend drop-in service but since the move this has more than halved to an average 14 visits per month. However, the number of visits to the sexual health nurse during the week has remained fairly similar. The table below shows the number of consultations per month, from April 2008 to January 2009. It is very apparent when the changes to the service occurred.

MONTH WEEKDAY SATURDAY April 0 28 May 0 31 June 1 30 July 47 32

August 55 30 September 31 23

October 24 26 November 16 16 December 26 13 January 27 12

(12) Visit to the nurse, doctor or new sexual health nurse

42

Nearly 90% of clinical visits are by females and the largest proportion, 30% are aged 16yrs. Treatment Moray Council on Addiction Moray Council on Addiction (MCA) was set up in 1979 and is a voluntary organisation and registered charity that has 2 main functions: the provision of 1-to-1 addictions counselling for primary and secondary clients (those with an addiction and the significant others of those with an addiction) from age 12, and the provision of consultations and training to outside agencies. 1-to-1 counselling: Primary: - Trained counsellors assist clients to identify and assess their problem and develop structures to deal with it, creating an individual and unique treatment programme within a confidential environment. The programme can include managing relapse and relapse prevention. Clients may wish to be either completely abstinent or to cut down or control their substance misuse. In addition to working with a client on their addiction, the counsellors are also able to tackle other significant areas with which the client is experiencing difficulty and help with matters such as the development of life skills. Counselling works well alongside other interventions such as clinical detox and employment support. Secondary: - Counselling and support for partners, relatives or friends affected or concerned by someone else’s substance misuse. Counselling is person-centred addiction counselling based on the needs of the client. Cognitive Behavioural Therapy (CBT), Motivational Interviewing (MI) and Solution Focused Techniques are tools utilised in Addiction Counselling. There are currently (March 2009) 31 volunteer counsellors working with MCA. The core counselling service covers clients from all over Moray but they are predominantly seen in the Elgin office Mon - Fri 9-5, Evenings Mon - Thurs 5-9 and Sat 9-12. GP Practice Project: Since September 2003, the GP Practice Project has enabled MCA counselling to be offered out of GP Practices. This alleviates the transport problems experienced by many service users by providing a more easily accessible service, while also strengthening the relationship with GPs. The project employs 1.8wte counsellors and is available from 13 of the 16 GP practices across Moray (as at March 2009). Referrals are primarily from GPs and other Healthcare professionals with the GP referrals being given priority. Training: MCA provide training in addictions counselling to agencies across the north of Scotland. Since the creation of the GP Practice Project, they also provide training to GPs and other healthcare professionals in addiction issues, including early identification of substance misuse problems, screening and brief interventions for hazardous and harmful drinking and counselling methods such as MI, which can then be employed in areas other than addictions.

Number of clinical visits to SMS, by age

0

25

50

75

100

125

150

<13 13 14 15 16 17 18 19 20-

24

25-

29

30-

34

35-

39

40-

44

45-

49

Age (years)

43

Stats Over the last 4 years, the number of clients seen by MCA shows a slightly decreasing trend, despite a slight rise in 2005/06. Over the same period, there has been a slight increase in the proportion of female clients, from 37% in 2004/05 to 40% in 2007/08.

The age distribution for MCA clients shows that the largest proportion of clients falls into the age group 26-35yrs or 36-45yrs and all age groups up to and including 46-55yrs shows a reduction over the last 4yrs.

Excluding those clients who did not provide any information, around 30%, the majority of clients were either married/cohabiting or single. The proportion of married/cohabiting clients has increased slightly over the last 4 years, while the proportion of single clients has reduced. The proportions now are approximately the same. There is a similar situation with the employment status of clients. Excluding those clients who did not provide any information, around 50%, the majority were either unemployed or in full-time employment. The proportion of unemployed clients has increased slightly over the last 4yrs while the proportion of clients in full-time employment has reduced over this period. The proportions now are approximately the same. A breakdown of clients according to problem type reveals that there are many more clients attending MCA with an alcohol problem than with either a drug or a combined alcohol & drugs problem. However, the situation differs depending on whether the client is attending for his/her own problem (primary) or for someone else’s problem (secondary). The following graphs show the proportion of clients reporting with an alcohol problem, a drugs problem or a combined alcohol/drugs problem, for primary and secondary clients and clearly illustrate a difference between the two, in terms of both problem type breakdown and trend.

It is clear from the 1st graph that the majority of primary clients are attending MCA with regard to an alcohol problem, with most of the remainder having a drugs problem. Only a few primary clients have a joint drug & alcohol problem. However, there is a slight but clear downward trend in the proportion of primary clients with an alcohol problem and a corresponding upward trend for those with a drugs problem. The proportion of primary clients with a combined drug & alcohol problem is fairly steady.

Gender breakdown of MCA Clients

0

50

100

150

200

250

300

2004/05 2005/06 2006/07 2007/08

Female

Male

Age distribution of MCA Clients

0

20

40

60

80

Und

er 1

8yrs

18-2

5yrs

26-3

5yrs

36-4

5yrs

46-5

5yrs

56-6

5yrs

Ove

r 65

yrs

Age

not

reco

rded

2004/05

2005/06

2006/07

2007/08

Primary Clients

0%

20%

40%

60%

80%

100%

2004/05 2005/06 2006/07 2007/08

% Alcohol

% Drugs

% Alcohol

& Drugs

Secondary Clients

0%

10%

20%

30%

40%

50%

60%

2004/05 2005/06 2006/07 2007/08

% Alcohol

% Drugs

% Alcohol

& Drugs

44

Due to the numbers of secondary clients being quite small, there is much more fluctuation in relation to this client group. However, the 2nd graph illustrates the much more equal proportions of secondary clients attending in relation to an alcohol or a drug problem and the larger proportion of clients attending in relation to a combined drug & alcohol problem. In contrast to primary clients, there has been a slight upward trend in secondary clients attending in relation to an alcohol problem and a corresponding downward trend in those attending regarding a drug problem. Unsurprisingly, a reducing number of clients attend for 2nd, 3rd etc episodes, with only 1 or 2 having five episodes. Statistics for outcome indicate a difference between the success rate for clients according to whether their discharge is planned or unplanned. The graph illustrates that clients with an unplanned discharge have a much lower success rate than those with a planned discharge. Over the last 4 years, on average 68% of clients with an unplanned discharge had a poor outcome from their MCA attendance, while 65% of clients with a planned discharge had a good outcome. GP Practice Project: The following map shows the distribution of clients across Moray who have received counselling

through the GP Project. There are no particularly obvious anomalies in terms of client numbers in relation to size of location with the exception of Buckie. Mid-2006 population estimates indicate the

Cullen: 2007 – 2 clients, 10 appts. Ave 5 2008 – 6 clients, 49 appts. Ave 8.2

Keith: 2007 – 14 clients, 123 appts. Ave 8.5 2008 – 16 clients, 63 appts. Ave 3.9

Dufftown: 2007 – 6 clients, 54 appts. Ave 9 2008 – 12 clients, 95 appts. Ave 7.9

Fochabers: 2007 – 7 clients, 38 appts. Ave 5.4 2008 – 15 clients, 57 appts. Ave 3.8

Buckie: 2007 – 26 clients, 228 appts. Ave 8.8 2008 – 29 clients, 210 appts. Ave 7.2

Tomintoul: 2007 – 1 client, 16 appts. Ave 16 2008 – 2 clients, 39 appts. Ave 19.5

Aberlour: 2007 – 6 clients, 69 appts. Ave 11.5 2008 – 5 clients, 7 appts. Ave 1.4

Forres: 2007 – 19 clients, 101 appts. Ave 5.3 2008 – 17 clients, 77 appts. Ave 4.5

Elgin W. Maryhill: 2007 – 18 clients, 127 appts. Ave 7.1 2008 – 8 clients, 76 appts. Ave 9.5

Elgin E. Vict Cres: 2007 – 16 clients, 115 appts. Ave 7.2 2008 – 13 clients, 53 appts. Ave 4.1

Lossiemouth –accommodation arranged March ‘09

Outcome Proportions by Discharge Type

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Good Poor Other Good Poor Other

Unplanned Discharges Planned Discharges

2004/05

2005/06

2006/07

2007/08

45

population of Buckie as 8100 and of Elgin as 20330. However, in 2007, the number of clients in Buckie was only slightly less than in Elgin and in 2008, there were more clients in Buckie than Elgin. Young Persons Addiction Counselling This is a brand new service specifically for young people aged 12-24yrs who wish to address their own addictions or are affected by someone else’s addiction. It comes under and complements Moray Council on Addiction and works in partnership with health, social work and Youth Development to reduce the harm caused by dependency. It is located within The Loft Project in Keith but is available in a number of locations throughout Moray with both day and evening appointments. Integrated Drug & Alcohol Service, Social Work This service is part of the integrated service with Social Work and Health. However the service does not come under Children and Young person or Adult Social Work which can be an issue with funding. Several agreements, both informal and formal, exist with other agencies with regard to referrals. A local agreement has been established with police for referrals, in particular Young People with alcohol issues. A large volume of referrals only result in one visit from DA service. A good working relationship exists with Domestic Abuse. A working agreement exists with Accident & Emergency and Ward 2 (10 year protocol). A pro-active service is in place where there is good sharing of data enabling the service to focus particularly on young people who have been drinking. Child Protection issues are immediately addressed if there is a case. There is a set of formal guidelines in place with the Women’s Health Clinic and Ward 3. An appropriate strategy is in place with a timeline of meetings and if necessary a plan is put in place. Partners of those with a substance misuse problem are encouraged to participate in the process. In the last 5 years there have been around 60 referrals of pregnant women who are misusing alcohol. Such cases require intensive care packages and the involvement of several partner agencies. Young people are mainly referred through Social Work services. Many of these youngsters will have pre-existing issues and will already have a plan in place. Those from Police and Hospital can often be a one off. Young people tend not to take up the service first time round and will generally be re-referred to the service. Adults suffering from substance misuse and who have a young family require a considerable amount of time and resources. Any children will be regarded as a high priority and an intensive schedule of meetings and reviews will be set up which the service will be required to attend. Significant amount of administrative work required which limits work on other cases. Service can be hit hard as it only has a staff of 1 senior social worker, 1.5 social workers and 0.5 admin (at time of interview). The referrals received can often be one offs and little time is required while the most intensive cases involve the most work however there are often few of these, creating a pyramid of work.

46

Most first sessions will be in an office or GP surgery. The majority of work is done in the person’s home although the service does encourage the use of neutral venues to show the commitment of the user to the service. For adults referred to the service who have no children, a SSA will be filled out. However the majority will then be referred onto a relevant voluntary service. Adults that are referred to rehabilitation services (where they have no funds) will be assessed by Health (clinical detox) and Social Work (rehab component). The service assess the client for the rehab component, there are very few of these carried out per year. These referrals will come through either GP’s or Hospital. Integrated Drug / Alcohol Service: Assessment / Review Form V3 is used by the service and the information is shared between Health and Social Work services. Each case should be reviewed every 3 months. A Risk Assessment is also completed along with the above form to identify any issues where children are involved. The information is not shared with voluntary services though.

The graph clearly shows there has been a slight shift in the substance misuse problem over the last 5 years. There is a reducing trend in those with an alcohol only problem, an increasing trend in those with a drug only problem, while the proportion of those reporting a problem with both drugs and alcohol has remained fairly steady. Of those with a drug misuse problem, heroin is the most commonly reported drug, by about 60% of clients. Cannabis

is reported by about 13% and diazepam by 3%. Nearly 20% report polydrug use. Criminal Justice Addictions Service The service provided by Criminal Justice Addictions Service is twofold, Criminal Justice Addictions and Throughcare Addictions Service. There is one full-time social worker and one full-time support worker. Clients are referred to Criminal Justice Addictions for various reasons, often as a condition imposed by a court, e.g. as part of a probation order, Diversion from Prosecution or release from prison under licence or a supervised release order. Referrals are also received from the Criminal Justice Social Work team and Community Service Order supervisors. Clients will also voluntarily refer themselves e.g. because they have finished their probation order but want to continue with the addictions work they have undertaken during the period of probation. The Throughcare Addictions Service is linked to the Scottish Prison Service with referrals being made by Phoenix Futures, the agency that provides an addictions service within prisons. People in prison for alcohol and drug-related offences who have received a service whilst in prison can

One off referrals

Child Protection issues involved

Volume of work

Trend in Substance Misuse problem

0

10

20

30

40

50

60

70

80

2003/04 2004/05 2005/06 2006/07 2007/08

% Drug/Alcohol

% Alcohol only

% Drug only

47

volunteer to continue with addictions work following release. Referrals are received from all over Scotland although any outwith Inverness or Aberdeen prisons are usually handled via video conferencing unless there are specific circumstances that require face-to-face meetings. Referrals can also be made by prison nurses and Social Work services in prison, although these tend to come from Inverness. Working with the Throughcare Addictions team can sometimes be a condition of an electronic tag. The support worker works with all Criminal Justice clients, not just addictions clients and provides support and guidance with other issues such as housing, benefits, GP, employability, self-confidence and self-esteem. The clients are encouraged and supported to do things for themselves.

Criminal Justice Addictions - By Age (2006-2009)

0

5

10

15

20

25

30

16-19 20-24 25-29 30-34 35-39 40+Age

No

. o

f P

eo

ple

2006/07 2007/08 2008/09

Criminal Justice Addictions - Age & Gender (2006-2009)

0

5

10

15

20

25

30

35

40

45

16-19 20-24 25-29 30-34 35-39 40+Age

No

. o

f P

eo

ple

Male Female

The volume of clients referred to the Criminal Justice Addictions team has increased year on year since 2006. 36 clients who were going through the criminal justice system were directed through the criminal justice addiction team in 2006/07, this increased by 92% to 69 in 2007/08, and again by 62% to 112 in 2008/09. The majority of clients referred to the service are male, with over 82% in the last three years. The proportion of males to females has remained relatively static during each of the three years. Looking at the age breakdown of clients who have accessed the service in the last three years 60% of them are aged under 30, with the largest proportion aged between 20-24 years (47). This is closely followed by 16-19 year olds (44) and 25-29 year olds (42). The volume of clients decreases as clients get older, although there is a sharp increase in the 40 and over age category which will probably be down to the larger population in that age group. The number of males and females within each age group generally follow the same trend, although there is a larger difference in the 16-19 age category where there were 40 males compared to 4 females being referred to the service.

Over 50% of clients referred to the service over the last three years have come from Elgin. The number of clients coming from Buckie has experienced a similar trend to Elgin, with 19% of referrals in 2008/09 coming from Buckie.

Integrated Drug & Alcohol Service, NHS NHS Drug & Alcohol Services provide a medical treatment service, such as substitute prescribing of e.g. methadone and clinical detox. Treatment is organised and monitored by Community Specialist Nurses (CSNs). For both drugs and alcohol, the vast majority of referrals are received from GPs, about 88% & 97% respectively. Referrals are also received from NHS consultants, prisons, the courts, and

Criminal Justice Addictions - Location (2006-2009)

0

10

20

30

40

50

60

Elgin

Buckie

Forres

Lossiemouth

Keith

Lhanbryde

Aberlour

Rothes

Fochabers

Mosstodloch

NFA

Burghead

Dufftown

Garmouth

Huntly

Town

No

. o

f P

eo

ple

2006/07 2007/08 2008/09

48

Community Health Service providers. All referrals are discussed at a weekly integrated drug & alcohol services meeting of Social Work, NHS and a specialist GP, who determine the best service for the client. If it is then decided that the client is best placed with NHS Integrated Drug & Alcohol Service, they are placed on a waiting list and seen by one of the CSNs. During 2006/07 there were very few referrals logged. This was due in part to staffing issues but also to different recording procedures, whereby a client was only added to the database once they had been seen. A large proportion of clients do not attend their appointment so are therefore never logged on the system. Therefore only data from 2007/08 and 2008/09 was analysed.

The graph shows referrals for the 2 years combined, broken down by age and clearly illustrates a difference between referrals for alcohol and drugs. The age of drug referral clients tends to be lower than that of alcohol referral clients. In fact, 86% of drug referrals were under 40yrs while only 44% of alcohol referrals were under 40yrs. The average age of drug referral clients was 30yrs while alcohol referral clients averaged at 43yrs.

The largest number of drug referral clients fell into the 25-29yr age group, which is in line with the figures from the SDMD. The largest number of alcohol referral clients was aged 40-44yrs, slightly lower than the data for alcohol-related hospital discharges, which suggests 45-49yrs is the most common age group. Turning Point Scotland – Studio 8 Turning Point Scotland is a charity registered organisation which offers a person centred approach in supporting and treating people who are suffering from their own or another person’s drug and/or alcohol misuse. Turning Point Scotland was commissioned by the then Moray Drug and Alcohol Action Team (MDAAT) to provide a direct access drug and alcohol service, based in Elgin but covering the whole Moray area. The service, Studio 8, is committed to providing direct access to information, support and guidance for those who are affected by drugs and alcohol in Moray. It is offered to people 16 years and over, who are affected by their own or another’s substance misuse in Moray. The service currently has 2.8 Project workers and a 16 hour vacancy; 1 Service Co-ordinator (who also carries out project work); 0.5 Service Manager and 1 admin staff. Studio 8 will refer on to a specialist agency or offer a programme of support through a person centred plan. Studio 8 provides 1:1 working with the client setting goals and aspirations that are client led. It is very much a holistic service where most of the clients will come through self-referral. In 2007/08 128 of the 196 referrals received through Studio 8 were self referrals. Studio 8 also offers services such as a Life Skills Group linked in with Criminal Justice. Also more recently there has been an Acupuncture Group set up for those mainly with substance misuse problems who are looking for an alternative to methadone or who are waiting to be seen for treatment and want something to help them in the meantime. A Service User group has also been formed where clients have asked for more education on substance misuse, DVD’s have been sourced and nights organised for clients to drop in and watch. The Drug & Alcohol Information and Health Improvement Officer, has been to one of the nights to offer information on substance misuse. The majority of clients who self-refer come through the door in Elgin. Thus the majority of clients are based in or around Elgin. There are out-reach surgeries in Buckie (Thursday) and Forres,

Referrals to NHS Drug & Alcohol Services by Age

05

1015

2025

3035

4045

Und

er 1

5

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

960

+

Alcohol

Drugs

49

however they offer a very much limited service. The service offers 1:1 project sessions with clients at venues of the clients’ choice, thus ensuring that Studio 8 is an accessible service across Moray. On 1st June 2009 the MADP rolled out the Single Shared Assessment to all services, which Studio 8 expects will help services to be more integrated in sharing information. Studio 8 has a good working relationship with Social Work Children & Families. An arrest referral scheme with Grampian Police is in place for people who are experiencing difficulty in their lives and are in the criminal justice system. There have been a decreasing number of referrals coming through as Grampian Police are referring onto Social Work services where they then may be re-directed to Studio 8 if appropriate. Due to a lack of resources, Studio 8 staff is often unable to attend arrest referrals at time of being in police custody so miss out in giving immediate help or advice. The experience is that often arrest referral cases will drift away if not able to get straight in when in custody. Direct referral into Health services would be preferred and of huge benefit – saving valuable time in getting the client the specialist service. Studio 8 produce quarterly and annual progress reports which provide a breakdown of data on the number of referrals received, where in Moray the referral is from, substance of misuse, age, gender, family situation (i.e. children in family), service being delivered and attendances. The 2007 SWIA inspection held Studio 8 up as a model of good practice. Turning Point Scotland also provides a temporary accommodation service in Moray, Guildry House, for people who are or may be at risk of sleeping rough, with the aim of resettlement into the community. As part of this service, support is provided in relation to substance misuse issues, which as with Studio 8, ensure that clients are accessing the appropriate services needed. Stats In the first two years that Studio 8 has been running there has been a slight dip in the number of referrals to the service from 218 in 2006/07 to 196 in 2007/08. The primary drug of choice has been alcohol, with around 55% of referrals in both years presenting alcohol misuse problems. Heroin has been the other

main drug of choice, with over 32% clients in both years presenting. The service has been accessed by people from all over Moray, with the majority clients referred to the service coming from Elgin, followed by Forres and Lossiemouth. In 2006/07 the largest age range of clients was the 26 to 35 year olds (83 clients),

however there has been a shift in 2007/08 with the largest age range for that year being 16 to 25 year olds (68), closely followed by the 26 to 35 year olds (67).

Primary Drug of Choice referred to Turning Point

0

20

40

60

80

100

120

140

Alc

ohol

Hero

in

MD

MA

/

Ecsta

sy

Pre

scrib

ed

Medic

atio

n

Cocain

e

Cannabis

Valliu

m

Am

pheta

min

es

Vola

tile

su

bsta

nce

s

2006/07 2007/08

Where in Moray Turning Point referrals come from

0

20

40

60

80

100

120

140

Elg

in

Fo

rres

Lossie

mouth

Keith

No F

ixed

Buckie

Lh

an

bry

de

Fo

ch

ab

ers

Hopem

an

Roth

es

Du

fftow

n

Cra

igella

chie

Portk

nockie

Burg

ie

Burg

head

Culle

n

Mossto

dlo

ch

Du

ffus

Buckpool

Portg

ord

on

Chapelto

wn

2006/07 2007/08

50

Continuation Support Scottish Council Voluntary Organisations In Moray there are two key projects currently run by SCVO Moray, these being Moray New Futures (MNF) and Progress to Work (P2W). Both programmes are working with clients who are most distanced from the labour market, who face multiple barriers to work. Referrals come through a number of sources: Criminal Justice, Integrated Drug & Alcohol Services – Social Work and NHS, Careers Scotland, Turning Point Scotland, Housing Department, Throughcare & Aftercare, Prison and Self Referrals. Outreach available at Forres, Buckie and Keith. These are in job centre and the Keith Resource Centre. Engagement rates with younger people are relatively low, mainly due to getting them on board as they have busy lifestyles. A number of clients re-refer, there is no limit to the number of times a person may be referred. Moray College is a valuable partner with a number of short courses, which a number of clients like to go on for a taster of training and the opportunity to socialise. Moray New Futures Moray New Futures (MNF) is a more widely known service through which most referrals will be directed. The service works with people with a wide range of barriers, one of which is drug and alcohol issues. Participation is voluntary and the interventions available are flexible and tailored to the needs of the client. Of the current clients (58) 60% have a drug and alcohol misuse problem. MNF provides a holistic approach for all unemployed people of working age living in Moray with barriers to employment or training. The service provides advice, guidance and personal support for all issues relating to increasing an individual's employability and moving closer to the labour market. MNF referrals have seen a large increase e.g. compared to Nov-Feb last year there has been a 100% increase in clients (33 to 66). This may be due to the credit crunch and the number of lay offs. The establishment of the Skills Development Scotland programme with links to MNF has seen a large increase in referrals coming through this stream. Progress 2 Work (P2W) P2W is an all age service aimed at unemployed ex drug users or those on a treatment programme living in Moray and Aberdeenshire. The service aims to provide a holistic approach to increasing client's employability by providing advice, guidance and support with the aim of moving clients closer to the labour market. Currently a third of clients come through Moray (two thirds Aberdeenshire). If a client re-lapses they are given 8 weeks to get themselves back on the programme and continue with it. One of the busiest times of year is the Christmas and New Year period when a lot of clients will re-lapse. P2W figures have remained relatively static.

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Indirect Services Children 1st – 15 Forward 15 Forward is a holistic service that supports young people who are having difficulty making the transition into adult life. YP are supported to build self-esteem, access education, employment or training, develop life skills and access and maintain safe & appropriate accommodation. They are signposted to existing services and supported to engage with these services. The YP assess for themselves what their difficulties are and how they want to address them. The YP are asked to evaluate their progress on a regular basis and they are then offered more or less support, as appropriate. YP can self-refer to 15-Forward or referrals can be made by anyone who is concerned about a YP aged 15-16yrs. Most 3rd party referrals come from school guidance staff. If the YP identifies drug and/or alcohol issues as something they want to address, they will be directed to specialist agencies. Often the YP do not perceive that they have a problem but they are known to be dabbling with alcohol/drugs. Once the YP turn 16 they are encouraged to self-refer to Studio 8 or in future to the YPAC at The Loft. Stats 04/08/08 (project start date) to 26/02/09: 41 enquiries 33 referrals (9 female, 24 male) 20 Active, 10 Closed, 3 in transition. In addition, 5YP dealt with through group work So far, none has been referred on to drug & alcohol services. The Loft, Keith The Loft project in Keith is a young person project led by the young people for the young people. It is the hub that incorporates intensive support, drop-in provision, training and employment, A2H Project and YPAC. It is supported by a Social Enterprise Café utilised as a training venue for the young people. The service itself is not primarily a drug or alcohol service for young people, however within the building there is a project worker who co-ordinates the A2H project. Many of the young people who access the service who may have mental health issues have also associated drink or drug misuse issues. Aberlour – Moray Youth Action Moray Youth Action provides disadvantaged, excluded and vulnerable young people and their families with support that is goal-orientated, needs-led and person-centred, to enable them to gain and retain control of their own lives and remain in their own homes and communities. They offer 3 types of services: core, transition & get ready for work and from April, Moray Mentoring. Core: Needs-led support for young people aged 12-16 who are vulnerable and challenging in various community settings. Referrals come directly from Social Work Teams through the Resource Panel (which consists of Social Work area managers, Action for Children & Aberlour). Support is offered to develop social skills, help with neglect issues, self-esteem etc. Work is carried out in partnership with education, social work, Moray Youth Justice, Action for Children, Pinefield Park, Health and other involved agencies. Transition & Get Ready for Work: A service for young people aged 153/4 yrs plus providing 1-to-1 needs led support with e.g. life skills, social skills, support with housing and preparation for further education, employment or training. As a follow on for young people aged 16-24yrs, Get Ready for

52

Work programmes are provided in partnership with SCVO and Moray Training. Referrals for these services can be from anyone, including self-referral and are quite often from school guidance staff. Both the above services will, when appropriate, refer young people to Social Work Drug & Alcohol team or, in future, to the MCA Young Person’s Addiction Counsellors based at The Loft in Keith. Moray Youth Action Mentoring Service: A new service due to start in April will provide 1-to-1 continuation support to young people aged 13-18yrs affected by problematic substance use, who will have received or will be receiving professional support from SW Drug & Alcohol team. The mentoring service will support the young people and help improve their life choices, e.g. identifying positive leisure activities within their communities, and will be provided by volunteer mentors through weekly contact of around 2hrs. There are currently 9 mentors trained or in training who will each mentor 1 young person, committed for a 6-month period. Some may mentor 2 young people. Stats There are currently (March 2009) 50 young people receiving a core service, which is about the maximum that can be provided for at any one time. A further 10 young people are receiving support from the transition team. Moray Youth Justice Substance misuse and peer group are the main drivers for offending in young people. Process: Referrals of young people (YP) are received from various sources including Social Work teams, Grampian Police, the Children’s Reporter, Moray Youth Action and Criminal Justice Social Work team. Every referral is discussed at the next Young Offender’s Referral Group (YORG) where it is decided whether MYJ will take on the YP. Prior to the meeting the YP is investigated through Care First, Children & Families team, Police etc, thus putting the YP’s behaviour into context by taking into account their other circumstances. If it is decided that MYJ will take on the YP, they carry out an assessment, using ASSET, which looks at 12 key areas, such as living arrangements, education, physical health, substance use, motivation to change etc, and rates each association with the likelihood of re-offending. Their total score indicates the overall likelihood of the YP re-offending and which areas of their life are most likely to influence this. A YP with a low rating will be carried over to the next YORG meeting while a YP with a high rating will be taken on for a 6-week assessment. The substance use question refers to use of alcohol/tobacco/solvents/drugs, substance use that has a detrimental effect on education or relationships, offending to obtain money for substances etc. A YP with a low substance use rating, who is subsequently taken on following assessment, would discuss the issues with a member of the MYJ team. A YP with a significant substance use rating would be referred to Social Work Drug & Alcohol (SW D&A) Services. Unfortunately there is a low engagement rate with this service. In cases where the YP does not engage with the SW D&A service, MYJ social workers may undertake the work, if they felt it within their experience. Otherwise, they may refer the YP to Moray Council on Addiction (MCA) or in the future, to the new MCA YP Counsellor located in The Loft in Keith. Following termination of intervention work with MYJ, the MYJ team would attempt to set up activities to fill the gap, such as gym membership, mountain biking through Outfit Moray etc. The YP are tracked for 2 years following end of intervention through a weekly list of YP who have offended in Moray.

53

Social Work Throughcare/Aftercare Moray Throughcare & Aftercare provide a service to young people who are looked after and accommodated at their official school leaving date and who have been accommodated for a period of 13 weeks or more from age 14. The Throughcare service helps to prepare YP for when they leave care and make the transition to more independent living. The Aftercare service supports YP who have left care or a supported living environment by providing advice, guidance and assistance in order to help them manage all aspects of their independent life. A YP is referred to the Throughcare/Aftercare service when they reach 14yrs of age and support is provided until they reach 19yrs of age, although this can be extended to 21yrs if necessary, or older until the YP has completed full-time education commenced prior to their 21st birthday. Every YP referred to the service completes a self-assessment called a Pathways Assessment, which asks them to look at various areas of their life and provide information regarding e.g. any concerns they may have. From this a Pathways Plan is produced detailing the support that is required in each area of the YP’s life. A YP may identify a substance use problem themselves as part of this assessment or one of their carers may become aware of an issue e.g. through the YP’s behaviour. The Throughcare/Aftercare service will discuss an identified issue with the YP and work with their carers to provide education, advice of what support is available and how to access it, and if necessary provide support to access these services. If there are serious concerns, the Throughcare/Aftercare workers may link with other services and refer a YP to a specialist service, such as Social Work Drug & Alcohol services (who prioritise the YP because they are ex-care) or Studio 8. The Pathways plan is reviewed initially 3 months after the YP leaves care and then at 6-monthly intervals. Informal reviews take place every 4-6 weeks. If a YP is referred to a specialist drug/alcohol service, progress in relation to this is reviewed along with everything else at the regular review. A2H Project Conduct PSE classes with S4-S6 pupils around Moray (l=Discussing mental health issues and general lifestyle factors etc) Has recently done some joint working with the Drug and Alcohol Information and Health Improvement Officer. Of the young people who either come forward themselves or are referred from guidance teachers with a mental/behavioural issue over 50% have an associated drink or drug issue. Often substance misuse is used as a coping mechanism. The majority of these youngsters experiencing substance misuse are not at a threshold where they are seriously misusing and only require guidance and advice on coping with their issues and not turning to drink/drugs to help. Work is certainly early intervention/prevention – identification of possible substance misuse problems early and providing the necessary advice to help the individual. A small number of clients will be referred onto specialist services if there is an escalating issue with substance misuse.

54

Referrals come mainly through Guidance staff. The service will mainly go to the school to see the young person. There are drop in services at Keith Grammar School, Lossie (going to be starting soon), Elgin Café and The Loft – all informal discussions for young people. Work with young people up to 19 years (although have worked with some for longer who still want the service). Majority of the older clients come through the drop-in service. Criminal Justice also refers clients to the drop in service. The service has had no referrals through from the Elgin Schools or Buckie School. Limited work with actual parents but can be done if there was a request or obvious need for. Moray Young Carers Moray Young Carers contract through Council funding lost after 2007/08, now the service comes under an Education slant as external funding they secured dictates that they do this. Main purpose of service is now focused on raising awareness in school of caring issues and explaining about what some children are doing is a form of caring and that help etc is out there. The service will help young people fill out a Carers Assessment form to establish carers caring responsibilities and needs. The service has established itself within 7 of the 8 secondary schools (Keith has opted out although service has been invited to hold presentations), where along with providing presentations there is also a monthly drop-in service for children to go and get advice. A lot of work is done through the PSE classes, hope is that schools refer young people to them or the young person will approach the service itself. Currently the service is looking to build up contacts with Primary Schools and establish a similar project as is being done with the Secondary Schools. The service is a holistic carer service and does not specifically identify young people who are caring for family members with substance misuse issues. The service has provided one alcohol talk at a secondary school where the Drug & Alcohol Information and Health Improvement Officer helped prepare the talk. Young people who have come forward about caring for a member of family with a substance misuse problem are now mainly referred onto Young Persons Addiction Service (YPAC), part of Moray Council on Addiction (MCA). Previously the referral would have gone straight onto MCA. Schools have generally been very co-operative and have referred young people. Previous when the service was run with the funding from Moray Council any child accessing the service would have had to provide consent from their parents to get involved in activities run through the service which often the parent would have been reluctant to provide (i.e. sign) as they would not want to admit they had a substance misuse problem. Now the group do not offer activities (as yet) and thus young people are able to access the service without parents/family member having to sign consent forms. Currently (at time of meeting) there are 235 young careers registered with the service. Of those 13 care for a family member who has a substance misuse problem. The majority of young carers care for people with a physical/long term disability or who have learning disability. Quarriers have taken over from the work Moray Young Carers previously provided as they won the tender for the contract from the Council. That service is geared towards providing advice and support to both young and older carers such as peer group session and 1-1 support.

55

Inferences

1) People with an alcohol problem are more likely to be employed and maybe because of this, less likely to report their employment status.

2) Moray has a relatively low rate of alcohol-related discharges from hospital, however there is

a proportionately higher than national rate of incidence of serious alcohol-related health problems such as alcohol dependence and alcohol liver disease, indicating longer-term alcohol use.

3) While the number of alcohol-related deaths have dropped in Moray males are still 4 times

as likely to die as a result of excessive alcohol consumption.

4) Higher rate of young people aged 13 and 15 years old having had a drink of alcohol in Moray than nationally. However, the level of consumption is far lower than nationally and the number having had a drink in the parental home also much higher than nationally. This suggests that more young people have had a drink in Moray it may be under parental supervision hence the volume of consumption is low.

5) GP Project client numbers in Buckie are nearly as high as Elgin, despite there being a

much smaller population. Suggests a higher level problem in Buckie and/or more likely to seek help?

6) Correlation between rate of births recording drug misuse and deprivation suggests

a. Higher probability of having children while misusing drugs if live in a deprived area b. More likely to live in a deprived area if take drugs c. More likely to take drugs if live in a deprived area

7) Age breakdown of clients reported to SDMD indicates that approximately 20% are males

aged 15-24yrs. Estimated prevalence figures indicate that 69% of male problem drug users are aged 15-24yrs. Given that the estimated prevalence figures for Moray are based on known problem drug users from 2 sources other than the SDMD, both of which relate to individuals being dealt with in some way by the Criminal Justice system (Social Enquiry Reports and Police stats), the age difference between these 2 groups (SDMD new clients & estimated prevalence figure) would suggest that those being dealt with by the Criminal Justice system are more likely to be young males aged 15-24yrs.

8) The difference in age breakdown identified above also reflects the time taken to seek help

for problem drug use. 9) There is an increased illegal supply of diazepam accessible to Moray residents.

10) The increase in the number of new clients reporting injecting practices

11) More likely to have a good outcome to treatment if discharge is planned.

12) Credit crunch and increased lay-offs could see rise in demand for services and those linked

to employability.

PESTELO Analysis (Environmental Scanning) PESTELO FACTOR CONSIDERATIONS

1. The Road to Recovery: A New Approach to tackling Scotland’s Drug Problem.

1.1. Better prevention 1.2. Improved recovery rates 1.3. Improved safety for children of parents with a drug problem 1.4. Better support for families affected by drug misuse 1.5 Improved effectiveness of service delivery

2. “Changing Scotland’s relationship with Alcohol: a discussion paper on our strategic approach”.

2.1. Reduced alcohol consumption 2.2. Support for families and communities 2.3. Positive public attitudes towards alcohol and more positive choices 2.4. Improved support and treatment

3. Restructuring of Drug and Alcohol Action Teams in accordance with the recommendations to the Scottish Government by the Alcohol and Drugs Delivery Reform Group.

3.1. Restructuring of MDAAT to MADP (Moray Alcohol & Drug Partnership), with a clearer role and responsibilities. More integrated into the Community Planning structure, including decision-making and accountability systems such as the SOA and NHS performance management. For framework see www.scotland.gov.uk/Publications/2009/04/23084201/0

4. Relevant HEAT targets 4.1. Alcohol: Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11. 4.2. Drugs: To offer drug misusers faster access to appropriate treatment to support their recovery.

5a. Integrated Care for Drug or Alcohol users – Principles and Practice update 2008. www.scotland.gov.uk/Publications/2008/05/27154207/0 5b. Essential Care: A report on the approach required to maximise opportunity for recovery from problem substance misuse in Scotland www.scotland.gov.uk/Publications/2008/03/20144059/0

5.1. These 2 reports give guidance on how agencies can best work together to meet the identified needs of an individual person who is experiencing problems with alcohol or drugs. Overarching aim of integrated care is to support drug & alcohol users to overcome their drug or alcohol problem and their associated health and social difficulties by providing effective, coordinated and timely treatment and care.

Political

6a. Getting our Priorities Right www.scotland.gov.uk/Publications/2001/09/10051/File-1 6b. Hidden Harm – Next Steps www.scotland.gov.uk/Publications/2006/05/05144237/0

6.1. These 2 reports provide guidance on working with children and families affected by problem drug misuse.

Economic 1. Economic and Social cost of the problem. 1.1. Alcohol misuse estimated to cost £2.25 billion per annum 1.2. Drug misuse estimated to cost £2.6 billion per annum

57

2. Current economic climate. 2.1. Consequences of poor economy such as increased unemployment and financial problems may lead to increase in alcohol misuse and to a smaller extent drug misuse 2.2. Some alternative funding sources may no longer be available.

3. Increased funding from Central Government. 3.1. £120 million over next 3yrs for alcohol misuse – 230% increase in funding by 2010/11. 3.2. £94 million over next 3yrs for drug misuse – 14% increase in funding by 2010/11.

1a. Links between alcohol and drug misuse and deprivation. 1b. Moray is a low wage economy, with lowest average weekly wage in Scotland.

1.1. Direct correlation between deprivation quintile and acute hospital discharges with an alcohol-related diagnosis. Potential increase in unemployment and other financial problems may lead to increase in alcohol-related harm. 1.2. Historically, although high income groups had a greater number of regular drinkers, low income groups had higher alcohol consumption39.

Socioeconomic

2. Historical links between heavy drinking and consequential alcohol-related problems and certain occupations, some of which are common in Moray.

a) Distillery workers b) Fishermen c) Military personnel d) Oil-rig workers

Up to date research needs to be carried out to determine whether these problems still exist within these industries.

2. Historically, some industries are seen as high-risk in terms of the likelihood of employees developing alcohol-related problems. Four of these high-risk industries are significant in Moray39. a) This industry attracted heavier drinkers as well as encouraging/expecting heavy drinking. However, anecdotally this is no longer an issue39. b) Evidence that fishing industry provides conditions that may encourage heavy drinking, which carries a risk of alcohol-related problems and dependence. Alcoholism was twice as prevalent in fishermen as general male population39. c) Military life provided an environment that encouraged excessive drinking and its perpetuation. Also produces boredom and frustrations and disruptions to family life and separation from partners39. d) Although no hard evidence of heavy or problematic drinking, the industry is dangerous, isolates workers for protracted periods and provides them with large amounts of money to spend when on shore leave39.

Technological 1. Advances in technology have opened up new avenues for support.

1.1. Is full advantage being taken of new possibilities? 1.2. Moray CHP Internet Counselling Pilot Project: Support for self-treatment for addiction – information, web-based support and online counselling.

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Environmental 1. Rurality of Moray

1.1. Low density population, high access deprivation (27.6% of datazones). Limited service availability ex-Elgin. Consideration of other forms of treatment, such as “Home Detoxification”, a more expensive but perhaps better option in rural areas38.

1. Crime 1.1. Alcohol is a common factor in crime, e.g. ⅔ of those accused of homicides in 2006/07 were either drunk or on drink & drugs at the time of the alleged offence; there were 980 casualties (including 30 fatalities) in 2006 due to drink/drug-driving. 1.2. Scottish Government encourages the development of integrated care pathways for offenders and information sharing to ensure continuity of support in custody and in the community.

2. Minimum retail pricing for alcohol. 2.1. Proposal to introduce a minimum pricing policy for alcoholic drinks, linking price to alcoholic strength, to help reduce consumption.

3. Minimum off-sales purchase age for alcohol raised to 21yrs

3.1. Proposal to raise the minimum purchase age for off-sales alcohol to 21yrs to help tackle underage drinking.

4. Action to end irresponsible promotion and below-cost selling (loss-leading) of alcoholic drinks in licensed premises.

4.1. Proposal to end off-sales supplying alcohol free of charge or at a reduced price on purchase of one or more of the product, or of any other product whether alcohol or not. 4.2. Proposal to prevent the sale of alcohol as a loss-leader (below cost selling).

Legal

5. Introduction of a “social responsibility fee” applied to some alcohol retailers to offset costs of dealing with consequences of alcohol misuse.

5.1. Proposal to introduce a “social responsibility fee” on off-sales retailers to contribute to the cost of dealing with the adverse consequences of alcohol.

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SWOT Analysis – Drug and Alcohol Services Moray

Strengths • Well established and range of substance misuse services

available in Moray • Strategic Assessment carried out to determine need, gaps etc • Number of good examples of joint working in place e.g. Operations

Avon, MIB, Studio 8, P2W etc.

Weaknesses • No standardised recording system currently in use across

services • Limited quality data available to assess the local needs of

substance misusers and those affected • Limited accountability of service outcomes and value for money • Rurality of Moray

Opportunities • Formation of the Moray Alcohol and Drugs Partnership • Increase funding opportunities with increase in Scottish

Government funding to Alcohol and Drug services • Utilise the availability of facilities by services across the whole of

Moray to the maximise reach of services e.g. sharing GP Practice rooms with other services

• Employment of ADAP Research Officer • Implementation of both the SMR25a/b and SSA reporting systems

Threats • Credit crunch – reduction in external funding available to

voluntary services in particular e.g. Lloyds TSB • Increased pressure for services to provide evidence on the

assessment of local need – likely to determine future need and funding for services

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Risk Analysis Issues identified through research There are several issues that the authors have identified from their research. In order to prioritise these issues, it is necessary to carry out a risk analysis, which will be done using the 3-PLEM methodology (see Appendix 1). This method uses a probability and impact matrix to consider the seriousness of an issue against the likelihood of it occurring/continuing. Both aspects of each issue are scored between 1 and 3, then multiplied together to give an overall score. The score for each issue determines its grading as low, medium or high priority. In establishing the impact an issue will have on partnership agencies, the community, victim/offender and in this case client/user, various areas are considered:

• Partnership/organisational concerns • Physical risks (to individuals and property) • Psychological risks • Legal risks • Economic risks • Moral/Ethical risks

The likelihood of an issue occurring/continuing is determined by considering areas such as the make-up of the community, the capacity of partnership agencies to control an issue, any identified trends, whether the research has provided a clear picture (e.g. under-reporting?) and the size of the problem. The table below details the issues identified through our research along with their impact, probability and overall scores. The risks identified are detailed in Appendix 2.

Issue Impact Score

Probability Score

Overall Grade

A lack of prevention / awareness-raising work in adult settings such as workplaces, parents evenings. 2 2 4

Inputs to school pupils on alcohol and drugs are sporadic and patchy, i.e. some schools have had very few or no inputs and those that have tend to do so inconsistently.

2 2 4

A lack of training for teachers on behaviours and other signs that may indicate parental substance misuse 2 2 4

A lack of capacity in services offering continuation support and post-treatment services such as employability. 2 3 6

The rurality of Moray often makes accessing services difficult for clients. 2 2 4

The economic recession 2 3 6 Data recording within agencies is inconsistent and in many cases incomplete or inaccessible. 3 3 9

There is a lack of knowledge / awareness in some areas of where a client should best be referred to & how to go about it. 3 1 3

There is a lack of formality in some areas e.g. information sharing protocols do not exist between some agencies. 2 2 4

The location of the Healthpoint is not young person friendly and consequently the number of visitors has reduced significantly. 1 2 2

Substance misuse seems to be disproportionately high in Buckie. 3 2 6

It is unclear whether guidelines relating to children affected by parental substance misuse are fully embedded within procedures

3 2 6

Number of registered young carers looking after a family member with a substance misuse problem is potentially much lower than actual.

2 3 6

Issue Impact Probability Overall

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Score Score Grade Gaps in nationally produced data such as on alcohol consumption, is prohibitive. 2 3 6

Low cost and accessibility of alcohol 3 3 9 Historical relationship between heavy drinking and certain industries may still exist and contribute to Moray’s alcohol problem to some extent.

2 2 4

Historical relationship between heavy drinking and low income may still be contributing to the situation in Moray. 2 3 6

Waiting times are often too long between referral and assessment. 3 2 6

Higher than national rate of injecting and sharing of paraphernalia. Sharing needles/syringes increased over recent years

3 2 6

3 6 9

2 4 6

1 2 3

9

6

4

3

2

1

Impact

Probability

High Priority

Low Priority

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Recommendations As part of the strategic assessment the following recommendations are being put forward for consideration by the Moray Alcohol and Drug Partnership (MADP). The recommendations have been divided into two sections, the first set of recommendations taken from Audit Scotland report ‘Drug and alcohol services in Scotland’ (2009) and the second set based on the local based research undertaken. Audit Scotland The Audit Scotland ‘Drug and alcohol services in Scotland’ (2009) paper offers several recommendations which should be considered at both national and local level. From the report we have identified the key recommendations which we feel may aid the development of more local needs focused drug and alcohol services in Moray. Along with the recommendation we have included reasons why these may apply to Moray. Recommendation - Ensure that all drug and alcohol services are based on an assessment of local need and that they are regularly evaluated to ensure value for money. This information should then be used to inform decision-making in the local area Moray – Limited evidence of local data being collected routinely and robustly and used to inform decision-making on what services are required to meet local needs. There appears to be little evaluation of services being carried out to evidence the efficiency and effectiveness of services, value for money it offers and the outcomes achieved. Information collected on clients has not been routinely shared by all services, which supports the need to establish a central database to capture and analyse the data. The requirement to complete SSA’s will go someway to address this if all partners participate, however further work should be done between agencies to maximise the potential of this data so that it is not just a paper exercise. This could be part of the new Community Analyst role. Recommendation – Ensure that service specifications are in place for all drug and alcohol services and set out requirements relating to service activity and quality. Where services are contracted, this specification should be part of the formal contract. Moray – Service Level Agreements (SLA) are in place for all commissioned services, although clearer performance requirements and regular reviews on whether standards are being met may need to be put in place. Basic data collection protocols should be established and incorporated into the SLA as well as the requirement to evidence that service outcomes have been achieved that were agreed – making the service more accountable. Also there should be a requirement to evidence that services are collecting and basing service changes on the back of service user and community views. Similar requirements should be in place for non-commissioned services as well so that a clear picture of what is going on service by service and as a whole in Moray can be monitored. Recommendation – Regularly review funding arrangements for drug and alcohol services to ensure that they maximise value for money and reflect levels of local need. Moray – Further work is required to identify information on spend, activity and outcomes. Performance reporting guidelines and requirements need to be established for all services which they will be required to report on to the MADP on a quarterly or annual basis. The performance data can be used to evidence the progress being made by services and whether it has been efficient and effective. Recommendation – Use the Audit Scotland checklist detailed in the Audit Scotland report to help improve the delivery and impact of drug and alcohol services through a joined-up, consistent approach. Moray – The Audit Scotland checklist can be used as a tool to further examine the current set up of drug and alcohol services in Moray and how best services can work together to provide a sweep of services based on the local needs of those affected by substance misuse.

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Authors’ Recommendations From the extensive research undertaken the following local-based recommendations are being put forward for consideration. This is not an exhaustive list of recommendations and it is anticipated that further inferences and recommendations will be pulled out from this research by local experts who work with the various drug and alcohol services in Moray. Recommendation – Consideration be given to the compulsory recording and sharing of service information. Consideration should be given to setting up a central database which will be managed by a designated team (e.g. MADP). Partner agencies will be required to feed into the database which can then be used to better establish the current picture of substance misuse in Moray. Various reports should be able to be run on service activity, individual client progress etc on a routine or ad hoc basis. Recommendation – Consideration for more specialist continuation support and post treatment services. In line with the national emphasise on recovery there may be a need to commission additional services or for existing services to create more capacity to include additional post treatments such as employability (especially during the credit crunch). Recommendation – Consideration for an increase in assessment capacity, in particular for people accessing drug misuse services. While Moray has an excellent record for people accessing treatment after they have been assessed there appears to be a number of people experiencing a delay from referral to assessment stage. Currently Moray is underperforming in meeting the 2 week recommended target from referral to assessment. Recommendation – Consideration to be given to increase awareness-raising in the risks of sharing needles/syringes and other drug paraphernalia (spoons/water/filters etc). Proportion of new clients in Moray sharing continues to be well above the national averages. Combined with gaps in young people’s knowledge regarding the dangers of injecting and of different illegal drugs. Recommendation – Consideration of awareness-raising to highlight that looking after someone with a substance misuse problem constitutes caring and as such support is available for people in this position. Currently, the proportion of both young and adult carers who are caring for someone with an alcohol and/or drug problem is very small, possibly because many people are not aware that looking after someone with a substance misuse problem qualifies them for carer support. Recommendation – Consideration of further research into the current substance misuse problem in Buckie. Several factors indicate that the problem may be greater in Buckie area than elsewhere in Moray.

• Number of clients seen through GP Project is disproportionately high • Alcohol-related crime is more prevalent relative to population than elsewhere • Number of liquor licences is higher than in similar sized areas • Over the last 3 years there have been no externally sourced school inputs

Recommendation – Consideration for the establishment of a needle exchange facility in Keith. Recommendation – Consideration of new research into potential links between heavy alcohol use and low income. Recommendation – In view of the high proportion of children on the Child Protection Register who are affected by parental substance misuse, and in line with the SWIA Inspection report 2007, it is imperative that guidelines surrounding the assessment of needs and risks in relation to child protection are embedded within procedures. Recommendation – Consideration for increased awareness-raising and promotion of alcohol and drug services in Moray, in particular through businesses. Research suggests that a significant number of adults accessing services are employed, and with the additional financial pressures and increase in job losses, further awareness-raising of substance misuse services in Moray may be appropriate at this time.

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Recommendation – Consideration for services to maximise the use and sharing of facilities throughout Moray. Several projects are working throughout Moray such as the MCA GP Project, where rooms in GP surgeries have been leased by the service to access service users. However, such facilities do not appear to be used full time. There is an opportunity for other services to maximise their outreach and share facilities and share the possible costs with other services. A mapping exercise would identify who, when and where facilities are being used and the possible scope for sharing. Recommendation – Consideration for a compulsory programme of Alcohol and Drug inputs to schools from Primary 6/7 and through secondary to be delivered in conjunction with the Grampian Police School Liaison Officers, NHS Health Promoting Officers and the Social Work Drug and Alcohol Information and Health Improvement Officer. Research suggests that many young people have their first experience with drugs and/or alcohol before they turn 13 years old. There may be a need to make young people aware of the health and legal consequences prior to their experimenting with such substances. As stated in The Road to Recovery, research also indicates that messages can be most effective if delivered in partnership with a range of agencies. Integrating inputs from different sources is likely to be best, ensuring quality teaching as well as accurate, credible information and messages. The possibility of combining drug and alcohol inputs with other topics e.g. domestic abuse, should also be considered. Recommendation – Consideration to be given to providing parental information stalls at parent evenings for primary 6/7 and secondary 1/2 school pupils. Stalls will provide advice and booklets on relevant drug and alcohol issues which may affect young people. Recommendation – Serious consideration to be given to establishing Information Sharing Protocols between agencies in order to formalise existing arrangements. Recommendation – Consideration to be given to the implementation of a training programme for teachers, on the recognition of behaviours and other signs in pupils that may indicate parental substance misuse. The strong link with Domestic Abuse creates the potential for combining this with Domestic Abuse training. Recommendation – Consideration of new research into potential links between heavy alcohol use and employment in certain industries. Recommendation – Consideration for service directory to be renewed with more information about what each agency can offer. This could then be used to establish where there is obvious cross over between services and where there are possible gaps in service. Further work could then be done to map out a clearer system of where referrals should best be passed onto, promoting a far more structured pathway between services for individuals. Recommendation – Consideration for the relocation of the Healthpoint to a young person friendly location, such as the Elgin Youth Café or The Loft in Keith. Some consideration would have to be made for the provision of the service for over 18s.

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References 1) General Register Office for Scotland: Mid-2007 Population Estimates Scotland. www.gro-

scotland.gov.uk/statistics/publications-and-data/population-estimates/mid-2007-population-estimates-scotland/list-of-tables.html

2) www.elginscotland.org/elgin-moray-scotland/about-elgin

3) General Register Office for Scotland: Mid-2006 Population Estimates for Settlements in Scotland. www.gro-scotland.gov.uk/files1/stats/06mye-settlements-table1.xls

4) General Register Office for Scotland: Scottish Settlements Urban and Rural Areas in Scotland.

www.gro-scotland.gov.uk/statistics/geography/scosett/tables.html 5) Scottish Index of Multiple Deprivation 2006: General Report.

www.scotland.gov.uk/Publications/2006/10/13142739/0 6) NOMIS Labour Market Profile, Moray. www.nomisweb.co.uk/default.asp 7) Census 2001. www.scrol.gov.uk/scrol/browser/profile.jsp 8) General Register Office for Scotland: Vital Events Reference Tables, 2007. www.gro-

scotland.gov.uk/statistics/publications-and-data/vital-events/vital-events-reference-tables-2007/index.html

9) General Register Office for Scotland: 2006-based Population Projections for Scottish Areas.

www.gro-scotland.gov.uk/statistics/publications-and-data/popproj/06pop-proj-scottishareas/list-of-tables.html

10) Scottish Neighbourhood Statistics. www.sns.gov.uk 11) Scottish Government statistics publications: Attendance and Absence in Scottish Schools

2004/05, 2005/06 and 2006/07. www.scotland.gov.uk/Publications/2007/12/11160723/2 12) Scottish Government statistics publications: Exclusions from Schools, 2003/04 to 20006/07.

www.scotland.gov.uk/Topics/Statistics/Browse/School-Education/PubExclusions 13) Scottish Government School Leavers Destination Report, December 2007.

www.scotland.gov.uk/Publications/2007/12/07093501/0 14) Scottish Government Recorded Crime Statistics.

www.scotland.gov.uk/Topics/Statistics/Browse/Crime-Justice/PubRecordedCrime 15) Scottish Drugs Misuse Database: Drug Misuse Statistics Scotland 2006, 2007 & 2008.

www.drugmisuse.isdscotland.org/publications/abstracts/ISDbull.htm 16) The Moray Council, Community Services, Business Support Team. 17) Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2006. Smoking,

drinking and drug use among 13 and 15 year olds in Moray. www.drugmisuse.isdscotland.org/publications/abstracts/salsus.htm

18) Grampian Police statistical report: Statistics for Moray Council DAAT Strategic Assessment, 09

February 2009. 19) Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland.

www.drugmisuse.isdscotland.org/publications/local/prevreport2004.pdf

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20) Drug Agencies warn of increase in use of valium”, www.theherald.co.uk/search/display.var.2506240.0.drug_agencies_warn_of_increase_in_use_of_valium.php

21) NESCPC Guidelines, available at

www.nescpc.org.uk/AboutNESCPC/ChildProtectionGuidelines.asp 22) NESCPC Annual Report 2007/08 available at

www.nescpc.org.uk/PublicInformation/Publications&Reports/PublicationsAndReports-8.asp 23) The Moray Council “Neglect Pilot – Moray Needs Profile” 24) “Link between Social Work referrals and Amphetamine, Cocaine, Ecstasy and Heroin use in

Moray Division. Scoping study – sanitised version”, January 2009, Grampian Police Force Intelligence Section.

25) Scottish Government ’The Road to Recovery: A New Approach to tackling Scotland’s Drug

Problem’, 2008. www.scotland.gov.uk/Publications/2008/05/22161610/0 26) Scottish Government News Release – Funds to tackle alcohol misuse, May 2009.

www.scotland.gov.uk/NEWS/Release/2009/05/13103111 27) Audit Scotland ’Drug and Alcohol Services in Scotland’, 2009.

www.audit_scotland.gov.uk/docs/health/2009/nr_090326_drugs_alcohol.pdf 28) Alcohol Statistics Scotland, 2009.

http://www.alcoholinformation.isdscotland.org/alcohol_misuse/files/alcohol_stats_bul_09.pdf 29) Register of current licensed premises in Moray, 2008.

www.moray.gov.uk/moray_standard/table_42032.html 30) Scottish Government ‘Changing Scotland’s Relationship with Alcohol: Discussion Paper’, 2008.

www.scotland.gov.uk/Publications/2008/06/16084348 31) Scottish Government Report of the stocktake of Alcohol and Drug Action Teams, 2007.

www.scotland.gov.uk/Publications/2007/06/22094551/6 32) Alcohol and Drugs Delivery Reform Final Report, 2009.

www.scotland.gov.uk/Publications/2009/04/23084251 33) Scottish Government Statistical Bulletin Crime and Justice Series: Scottish Liquor Licensing

Statistics, 2007. www.scotland.gov.uk/Publications/2008/08/11160147/0 34) Moray Carers’ Strategy 2007 – 2010. http://www.moray.gov.uk/downloads/file51566.pdf 35) Scottish Government News Release – Alcohol-Related Deaths, June 2009. www.scotland.gov.uk/News/Releases/2009/06/30102232 36) Trends and geographical variations in alcohol-related deaths in the United Kingdom, 1991-

2004. www.statistics.gov.uk/downloads/theme_health/HSQ33web.pdf 37) Alcohol Brief Interventions (SIGN 74) www.sign.ac.uk/guidelines/fulltext/74/section3.html 38) Need and Effective Interventions for Tobacco, Alcohol and Drug Use, West Lothian 2007. West

Lothian Drug Action Team. 39) Alcohol Problems in Employment. Edited by Brian D. Hore and Martin A. Plant

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Appendix 1 Risk Analysis of Drug & Alcohol issues identified through the Strategic Assessment Issue Partnership/

organisational concerns

Physical risks Psychological risks

Legal risks Economic risks Moral/ethical risks

A lack of prevention / awareness-raising work in adult settings such as workplaces, parents evenings.

- Rise in demand on services

- Substance misuse-related Health problems

- Substance misuse-related Mental health problems

- Substance-related crime

- Rise in cost of service provision - Cost of dealing with substance-related crime -Rise in health costs

- Rise in underage drinking - Effect on children of parental substance misuse

Inputs to school pupils from external agencies on alcohol and drugs are sporadic and patchy, i.e. some schools have had very few or no inputs and those that have tend to do so inconsistently.

- Rise in demand on services - Poor educational achievement - Currently not compulsory for external agencies to provide alcohol & drug inputs, can be done internally

- Substance misuse-related health problems - Damage caused through substance -related crime

- Substance misuse-related mental health problem s

- Substance-related crime

- Rise in cost of service provision - Cost of dealing with substance-related crime costs - Rise in health costs - Long-term cost of educational underachievement

- Rise in underage drinking - Educational

underachievement

A lack of training for teachers on behaviours and other signs that may indicate parental substance misuse

- Physical dangers to which children & young people exposed

- Psychological dangers to which children & young people exposed

- Child Protection issues

- Costs associated with Child Protection

- Children & young people enduring effects of parental substance misuse

A lack of capacity in services offering continuation support and post-treatment services such as employability.

- Rise in numbers of repeat clients

- Physical consequences of relapse

- Psychological consequences of relapse

- Rise/no reduction in substance -related crime

- Cost of repeat treatment - Cost of more severe punishments for repeat offenders - Clients not becoming productive members of society

- Clients relapsing because no continuation support available

Issue Partnership/ Physical risks Psychological Legal risks Economic risks Moral/ethical

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organisational concerns

risks risks

The rurality of Moray often makes accessing services difficult for clients.

- Underestimation of size of problem

- Misuse more severe before access service

- Misuse more severe before access service

- Localised substance-related crime

- Longer and/or more extreme treatment required due to increased severity of problem - Cost of dealing with substance-related crime - Health costs

- Social exclusion of those with a substance misuse problem that are non-Elgin based

The economic recession - Potential increase in demand for services - Possible reduction in additional funding sources

- Rise in substance misuse-related health problems - Rise in substance -related crime, particularly alcohol-related

- Rise in mental health problems due to recession leading to substance misuse - Rise in substance misuse-related mental health problems

- Rise in substance-related crime

- Increased demand but less money - Cost of dealing with substance-related crime - Rise in health costs

- Inability to meet demand

Data recording within agencies is inconsistent and in many cases incomplete or inaccessible.

- Inaccurate picture of problem in Moray - Grampian funding share reduced by understatement of size of problem

- Increased health risks due to delay in treatment

- Increased mental health risks due to delay in treatment

- Insufficient service provision due to reduced funding - Inaccurate commissioning of services

- Inability to meet demand/needs of clients

There is a lack of knowledge / awareness in some areas of where a client should best be referred to & how to go about it.

- Inappropriate referrals - Potential confidentiality issues - Clients withdrawing due to delays

- Increased health risks due to delay in provision of appropriate service

- Increased mental health risks due to delay in provision of appropriate service - Disillusionment with services

- Potential for legal action by clients for inappropriate advice/treatment

- Inefficiency (cost of processing inappropriate referrals)

- Poor service delivery for clients

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Issue Partnership/ organisational concerns

Physical risks Psychological risks

Legal risks Economic risks Moral/ethical risks

There is a lack of formality in some areas e.g. information sharing protocols do not exist between some agencies.

- Informal agreements vulnerable to changes - Potential for deterioration in relationships - Perpetuation of poor quality data

- Increased health risks due to referral to inappropriate service or lack of referral to appropriate service

- Increased mental health risks due to referral to inappropriate service or lack of referral to appropriate service

- Potential for legal action by clients for inappropriate advice/treatment

- Inefficient use of limited resources with inappropriate referrals - Possible duplication of service provision because client attends more than one service.

- Potential confidentiality issues

The location of the Healthpoint is not young person friendly and consequently the number of visitors has reduced significantly.

- Lack of take up of the service could lead to its demise

- Rise in young people misusing substances or putting themselves in unnecessary danger due to lack of information

- Rise in young people misusing substances or putting themselves in unnecessary danger due to lack of information

- Rise in substance-related crime

- Inefficient use of resources - not being utilised -Cost of dealing with substance-related crime

- Access to information and advice should be maximised

Substance misuse seems to be disproportionately high in Buckie.

- Higher demand for services in Buckie - Possible cultural origins could present a challenge to agencies in overcoming the problem

- Higher demand for Health services in Buckie

- Higher demand for Mental Health services in Buckie - Stigmatisation of Buckie inhabitants

- Localised substance-related crime

- Cost of dealing with substance-related crime

- Stigmatisation of Buckie inhabitants

It is unclear whether guidelines relating to children affected by parental substance misuse are fully embedded within procedures

- Child Protection issues - Inaccurate picture of problem in Moray - Grampian funding share reduced by understatement of size of problem

- Physical dangers to which children & young people exposed

- Psychological dangers to which children & young people exposed

- Child Protection issues

- Costs associated with Child Protection - Long-term cost of consequences of not identifying & supporting children affected by parental substance misuse.

- Children & young people enduring effects of parental substance misuse

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Issue Partnership/

organisational concerns

Physical risks Psychological risks

Legal risks Economic risks Moral/ethical risks

Number of registered young carers looking after a family member with a substance misuse problem is potentially much lower than actual.

- Much higher demand for carers support services than currently able to provide

- Physical dangers to which children & young people exposed

- Psychological dangers to which children & young people exposed

- Child Protection issues

- Costs associated with Child Protection - Long-term cost of consequences of not identifying & supporting children caring for a family member with a substance misuse problem.

- Children & young people enduring effects of a family member’s substance misuse.

Gaps in nationally produced data such as on alcohol consumption, is prohibitive.

- Incomplete picture due to unknown factors - Unable to plan services accurately

- Potential level of alcohol-related harm unidentifiable

- Potential level of alcohol-related harm unidentifiable

- Inaccurate commissioning of services – inefficient use of limited funding

Low cost and accessibility of alcohol

- High demand on services

- Alcohol-related health problems - Damage caused by alcohol-related crime

- Alcohol-related mental health problems - Psychological damage that can result from alcohol-related crime

- Alcohol-related crime - Higher rate of proxy purchasing

- Costs associated with alcohol-related crime - Costs associated with alcohol-related health / mental health problems

- Underage drinking

Historical relationship between heavy drinking and certain industries may still exist and contribute to Moray’s alcohol problem to some extent.

- High demand on services - Challenge for agencies to tackle relevant industries

- Alcohol-related health problems - Damage caused by alcohol-related crime

- Alcohol-related mental health problems

- Alcohol-related crime

- Costs associated with alcohol-related crime - Costs associated with alcohol-related health / mental health problems

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Issue Partnership/ organisational concerns

Physical risks Psychological risks

Legal risks Economic risks Moral/ethical risks

Historical relationship between heavy drinking and low income may still be contributing to the situation in Moray.

- High demand on services - Challenge for agencies to overcome due to Moray’s low-wage economy.

- Alcohol-related health problems - Damage caused by alcohol-related crime

- Alcohol-related mental health problems

- Alcohol-related crime

- Costs associated with alcohol-related crime - Costs associated with alcohol-related health / mental health problems

Waiting times are often too long between referral and assessment.

- Not meeting national targets - Increased demand on interim services e.g. Studio 8 - Withdrawal of clients due to delay

- Increased physical risks due to delay in treatment - Effect on family and friends due to delay/drop-out

- Increased mental health risks due to delay in treatment - Effect on family and friends due to delay/drop-out

- Reversion to crime

- Longer and/or more extreme treatment required due to increased severity of problem

- Delay leading to drop-out of clients

Higher than national rate of injecting and sharing of paraphernalia. Sharing needles/syringes increased over recent years

- Demand on NHS - Increased risk of BBV - Danger to others of discarded needles

- Psychological effects of contracting a BBV

- Cost of BBV treatment / care

- Needle discard

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