A Needs Assessment for Alcohol and Drug services … adp...South Ayrshire ADP Needs Assessment Local Report (2010) Page 2 of 66 Steering Group for Alcohol and Drugs Needs Assessment

South Ayrshire ADP Needs Assessment Local Report (2010)

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A Needs Assessment for Alcohol and Drug services for

Adults in South Ayrshire

Phase I

Treatment and Recovery

Version No: 2.0 Prepared by Needs Assessment Steering Group Effective from 31 October 2010 Review Date Lead reviewer Dr Maggie Watts

(Assistant Director of Public Health) Dissemination Arrangements

Needs Assessment Steering Group ADP South Ayrshire


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Steering Group for Alcohol and Drugs Needs Assessment

• Maggie Watts – Consultant in Public Health Medicine, NHS Ayrshire & Arran (Chairperson)

• Regina McDevitt – Public Health Specialist, NHS Ayrshire & Arran (Deputy Chairperson)

• Ruth Shepherd – Commissioner/Coordinator, Alcohol and Drug Partnerships Support Team

Representing North Ayrshire ADP

• Alistair Cairns – Operations Manager Addictions, North Ayrshire Council

• Linda Surgenor – Locality Manager, NHS Ayrshire & Arran

• Marlene McMillan – Lead Public Health Practitioner, NHS Ayrshire & Arran

• Angela Gray – Partnership Development Officer for North Ayrshire Alcohol and Drug Partnership

Representing South Ayrshire ADP

• Diane Fraser – Co-ordinator Addictions, South Ayrshire Council

• Peter McArthur - Locality Manager, NHS Ayrshire & Arran

• Faye Murfet – Partnership Development Officer for South Ayrshire Alcohol and Drug Partnership

Representing East Ayrshire ADP

• Liam Wells – Team Leader, Children & Young People, East Ayrshire Council

• Annemarie Ward – Partnership Development Officer for East Ayrshire Alcohol and Drug Partnership

Researchers

• Alister Hooke, Senior Public Health Research Officer, NHS Ayrshire & Arran

• Andy Pulford, Senior Public Health Research Officer, NHS Ayrshire & Arran

• Elena Mayorga, Public Health Research Officer, NHS Ayrshire & Arran

Report Authors

• Regina McDevitt, Public Health Specialist, NHS Ayrshire & Arran

• Ruth Shepherd, Commissioner/Coordinator, Alcohol and Drug Partnerships Support Team

• Maggie Watts, Consultant in Public Health Medicine, NHS Ayrshire & Arran


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CHAPTER 1: INTRODUCTION AND OVERVIEW

In 2009 the Scottish Government recommended an organisational change for the

partnerships charged with the strategic leadership of alcohol and drug issues. For

Ayrshire and Arran this meant moving from an NHS-based alcohol and drug action

team to alcohol and drugs partnerships (ADPs) at local authority and community

health partnership level. With this change came a requirement for ADPs to assess

needs and develop a local strategy for alcohol and drugs. This needs assessment

has been developed on a population basis using public health principles, and

involves an approach utilising epidemiology, service mapping and reviewing best

practice. This report addresses the treatment and recovery aspects of the needs

assessment and will be followed in due course by reports of the needs for prevention

and education, and for protection and controls including community safety. All the

elements will be supported by the views of service users, carers, providers and

planners.

This tailored South Ayrshire report follows on from the Ayrshire and Arran-wide

overview produced in March 2010 and provides specific and comparative data for

South Ayrshire.

Key features of the report are:

• There are rising trends in both alcohol and drug mortality and morbidity over

the past decade. Rates of acute hospital discharges with a diagnosis of acute

intoxication are the highest in Scotland.

• Although lowest of the three local authority areas, South Ayrshire has

considerably greater morbidity than nationally or its comparators of Dumfries &

Galloway or Perth & Kinross.

• The impact on society of alcohol and drug use is considerable, in terms of

children affected by parental use or the wider societal crime linked to alcohol

and drugs. However this impact is less in South that in North or East Ayrshire.

• A wide range of services are provided but information on their impact or

effectiveness is very limited.


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CHAPTER 2: THE EPIDEMIOLOGY OF ALCOHOL AND DRUG USE AND

PROBLEMS IN AYRSHIRE AND ARRAN

This chapter begins by providing a general overview of the population profile in South

Ayrshire, with a breakdown by age groups as the issue of alcohol and drug misuse

varies with age. In addition, future projections for changes to the population profile

are provided, with a view to assisting in the planning of future services. A brief

review of the latest information on the Scottish Index of Multiple Deprivation (SIMD)

for South Ayrshire is also provided.

The chapter presents detailed epidemiological information on a range of aspects of

alcohol and drug misuse in Ayrshire and Arran. This includes:

� Alcohol and drug prevalence data

� Alcohol and drug-related deaths

� Alcohol and drug issues in primary care

� Referrals and discharges due to alcohol and drugs in secondary care

� Information on specialist addictions services (SAMs)

� Information on the impact of alcohol and drugs on communities.

Areas of comparison

Throughout this report South Ayrshire will be compared where possible with other

ADP / local authority areas that have been identified as being suitable comparators.

These areas include Dumfries & Galloway and Perth & Kinross, for reasons such as

having similar population profiles, similar rural and urban areas and/or similar

deprivation levels, especially in the health domains.

Where national data is not available but is available across Ayrshire and Arran, the

comparators will by necessity be East Ayrshire and North Ayrshire.


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2.1 Population Profile for South Ayrshire

General population profile of South Ayrshire (Table 2.1)

The key points about the population of South Ayrshire as at 2009 are as follows:

� The total population of South Ayrshire, calculated as mid-year population

estimates for 2009, was 111,440. There are fewer people in the three youngest

age-categories in South Ayrshire compared to that for Scotland. However, there

is a higher proportion of people in the oldest age category (9.9%) compared to

Scotland (7.7%).

� There are more females (57,995) than males (53, 445) in South Ayrshire, and this

trend is seen in most age categories. However, there are more males than

females in the two youngest age categories, 0-15 and 16-29 years of age.

� Life expectancy in South Ayrshire is better than the Scottish average for both

males and females. The same trend is also seen in Dumfries & Galloway and in

Perth & Kinross.

� The standardised birth rate in South Ayrshire is similar to that for Scotland overall,

though the birth rate in South Ayrshire decreased by 1.2% in 2009 compared to

2008, continuing the year-on-year trend of recent years. Note that the birth rate

for D&G in the same period is considerably higher (5.4%).

� However, the standardised death rate of 12.4 per 1,000 people is also higher in

South Ayrshire compared to Scotland as a whole (10.7 per 1,000).

� South Ayrshire’s population is projected to decrease slightly (1.2%) by 2033

compared to an increase in Scotland’s population of about 7.3% at the same time.

There is a predicted decrease in all age categories in South Ayrshire except the

oldest two age categories. Most significantly, the over-75 year old population is

predicted to increase by about 75% in this 25 year period, from around 11,000 to

19, 000 individuals.


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Table 2.1: Overview of population statistics for South Ayrshire (SA), Dumfries &

Galloway (D&G), Perth & Kinross (P&K), and for Scotland in 2009.

SA D&G P&K Scotland Population size (%)

0-15 years

16-29 years

30-44 years

45-59 years

60-74 years

+ 75 years

TOTAL

18,222 (16.4)

17,279 (15.5)

19,680 (17.7)

24,646 (22.1)

20,598 (18.5)

11,015 (9.9)

111, 440

24,930 (16.8)

20,720 (14.0)

25,836 (17.4)

33,084 (22.3)

28,277 (19.7)

14,663 (9.9)

148,510

24,889 (17.1)

24,728 (16.9)

26,458 (18.1)

31,055 (21.3)

25,407 (17.4)

13,373 (9.2)

145,910

(%)

17.6

18.6

20.2

20.8

15.2

7.7

Births

Number of Births

Annual Change

Rate / 1, 000

1,054

-1.2 %

11.7

1,507

+5.4 %

-

1,425

-1.2%

-

-

-1.7 %

11.6

Life expectancy1

All

Females

Males

78.3

80.9

75.5

78.5

80.5

76.4

79.6

81.5

77.5

77.5

79.9

75.0

Deaths

Number of Deaths

Rate/1,000

Rate/1,000 Females

Rate/1,000 Males

1,379

12.4

12.6

12.2

1,790

12.2

12.3

12.1

1,531

10.8

11.2

10.3

-

10.7

10.8

10.6

Source: General Registry of Scotland (GROS), 2010. 1at birth for period 2006-2008.


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Population profile for each area by Scottish Index of Multiple Deprivation (SIMD)

The Scottish Index of Multiple Deprivation (SIMD)1 is the Scottish Government’s

official tool for identifying small area concentrations of multiple deprivation across

Scotland. The SIMD index identifies the relative level of deprivation experienced by

all 6505 ‘communities’ or data zones that make up Scotland. Interest is focused on

those data zones that are considered to be in the 15% most deprived nationally. The

significance of this group of data zones is that they are the target for regeneration

funding, and specifically for funding disbursed through the Fairer Scotland Fund.

The SIMD is calculated from considering a range of life circumstances of the people

of Scotland including health, education, access to services, housing and crime. The

individual weighted scores for each of these ‘domains’ or dimensions of deprivation

are combined to produce an overall deprivation score or ranking, beginning with 1 for

the most deprived datazone in Scotland and 6505 for the least deprived. Key points

relating to Ayrshire and Arran and to South Ayrshire are outlined below.

Ayrshire and Arran

In 2006, Ayrshire and Arran had a total of 74 data zones in the 15% most deprived

zones, compared to 94 data zones in 2009. Although there has been an increase in

the number of data zones in the 15% most deprived, this does not necessarily mean

that Ayrshire and Arran has become more deprived, but may be because Glasgow

has become less deprived (when one datazone moves out of the 15% most deprived,

another must take its place).

The Health Boards with the largest proportion of their data zones in the 15% most

deprived are Greater Glasgow and Clyde (30.0%), Ayrshire and Arran (19.6%),

Lanarkshire (16.9%), Tayside (13.7%) and Fife (12.1%). The SIMD 2009 has shown

that more of Ayrshire and Arran’s data zones are amongst the 15% most deprived in

Scotland, when compared to 2006. Although there are no signs that poverty and

1 http://www.scotland.gov.uk/Publications/2009/10/28104046/0


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deprivation have worsened in an absolute sense, it would appear that it has not

improved as much as other areas, like Glasgow.

South Ayrshire (Table 2.1.2)

• In SIMD 2009, 6 (4.1%) of South Ayrshire’s 147 data zones were found in the 5%

most deprived data zones in Scotland.

• In SIMD 2009, 19 (12.9%) of South Ayrshire’s 147 data zones were found in the

15% most deprived data zones in Scotland.

• In South Ayrshire, there has been an increase in the number of data zones in the

15% most deprived since the SIMD 2006.

• South Ayrshire has seen large increases in the percentage of their data zones in

the 15% most health deprived.

• South Ayrshire has been included in the list of Local Authorities with the largest

increase in numbers of data zones in the 15% most education deprived.

Table 2.1.2: Summary of South Ayrshire’s SIMD 2009 results

Domain

Data Zones in 15% most deprived

Local Share (%)

Access

Crime

Health

Education

Income Employment

Housing

18

17

22

19

16

18

0

12.2

11.6

15

12.9

10.9

12.2

0 Overall SIMD 19 12.9


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2.2 Alcohol and Drug Prevalence Data

2.2.1 Alcohol

Information on the prevalence of harmful drinking and of alcohol dependence is not

available per ADP area. Prevalence data has been estimated from the Scottish

Health Survey (2003) for six geographical regions, one of which includes

Lanarkshire, Ayrshire and Arran, Dumfries & Galloway, and comprises an estimated

population of 873,290 people2.

� The estimated prevalence of harmful drinking for this region is 25.9%, which

suggests that there are 226,182 people with harmful drinking habits in the area.

� The estimated prevalence of alcohol dependence in this area is 6.5%, which

suggests that there are 56,764 people who are alcohol dependent living in the

area.

2.2.2 Drugs

Data are available on the prevalence of problem drug use by ADP area for 2008.

The number of drug users between 15-54 years for South Ayrshire and for Dumfries

& Galloway and Perth & Kinross has been estimated from the prevalence data3,4.

� South Ayrshire has approximately 1,000 problem drug users (Table 2.2.1).

� The most recent data suggests that despite having a smaller overall population,

South Ayrshire has fewer problem drug users than Dumfries & Galloway but has

more problem drug users than Perth & Kinross.

� The prevalence of problem drug use in South Ayrshire was lower than the

national prevalence rate in 2008.

� The national prevalence rate for problem use increased from 2003 to 2008,

however, the prevalence of problem drug use in South Ayrshire did not change.

� This contrasts with a reduction in problem drug prevalence in both Dumfries &

Galloway and Perth & Kinross in 2008 compared to 2003.

2 Scottish Alcohol Needs Assessment (2009)

3 Estimating the national and local prevalence of problem drug misuse in Scotland (2009),

http://www.drugmisuse.isdscotland.org/publications/local/Prevalence_2009.pdf 4 Estimating the national and local prevalence of problem drug misuse in Scotland (2004)

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


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Table 2.2.1: Estimated number of problem drug users aged 15-64 years in 2006 and

problem drug use prevalence in each local authority area in population aged 15-54

years in 2003 and 2006.

Prevalence in population

aged 15-54 years (%)

Local Authority Area Number of problem

drug users

2008

2003

South Ayrshire 1,055 1.88 1.88

Dumfries & Galloway 1,452 2.03 2.43

Perth & Kinross 873 1.24 1.76

Scotland 55,328 1.98 1.84

Source: Drug Misuse Statistics Scotland, 2004 and 2009


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2.3 Alcohol and drug-related deaths within Ayrshire and Arran

Alcohol-related deaths

The General Registry of Scotland (GROS) reports on the number of deaths

attributable to alcohol or drugs on a regular basis. The number of deaths related to

alcohol as reported to GROS for the eight-year period from 2000 to 2007 and

reported as standardised rates per 100,000 population is given for South Ayrshire,

and two appropriate comparators: Dumfries & Galloway (D&G) and Perth & Kinross

(P&K). The standardised death rate (SDR) for Scotland as a whole is also included

for comparison (Figure 2.3.1).

1. The SDR for alcohol-related deaths in South Ayrshire was lower than the Scottish

SDR from 2000 to 2007 in both males and females.

2. The overall trend is that alcohol-related SDR has increased with time:

2.1. The SDR for males in South Ayrshire has increased from 38 per 100,000 in

2000 to 48 per 100,000 in 2007.

2.2. The SDR for females in South Ayrshire increased from 7.0 per 100,000 in

2000 to 12.4 per 100,000 in 2007. The rate of increase in SDR is less in

females compared to males.

3. The SDR for alcohol-related deaths is almost three-fold greater in males than in

females for all areas, and for Scotland as a whole.

3.1. Alcohol-related SDR for males in South Ayrshire is higher than the SDR for

males in D&G and P&K, with wider differences being seen in SDR between

the three areas in males.

3.2. Alcohol-related SDR for females in South Ayrshire is similar to the SDR for

females in the other two areas.

3.3. There is less of a difference in alcohol-related SDR between males and

females in D&G compared to other areas and the national trend. This is

largely attributable to the SDR for males in D&G being considerably lower

than for all other areas.


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Figure 2.3.1: The standardised death rate per 100, 000 population for alcohol-related

deaths in males and females, for South Ayrshire (SA), Dumfries & Galloway (D&G),

Perth & Kinross (P&K), and for Scotland as a whole.

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007

Alc

oh

ol-

rela

ted

sta

nd

ard

ise

d d

ea

th r

ate

s /

10

0,0

00

SA Male SA Female D&G Male D&G Female

P&K Male P&K Female Scotland Male Scotland Female

Source: GROS 2009

Drug-related deaths

National statistics on drug-related deaths in Scotland are produced on an annual

basis by GROS and are reported here for the period 1999 to 2009. The numbers of

deaths per year are small and are therefore expressed as crude rates pre 100,000

population. The small numbers also mean that trends are better examined on a

three-year rolling basis (Figure 2.3.2). The main points of note for drug-related

deaths are as follows:

1. The national trend is that drug-related deaths have increased from 1999 to 2009.

2. The number of drug-related deaths in South Ayrshire has increased from 4 per

year in 1999 to 8 per year in 2009, though there are fluctuations from year-to-

year.


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3. The crude rate of drug-related deaths in South Ayrshire, and in D&G and P&K, is

less than the national crude rate, but rates are increasing in all areas.

Figure 2.3.2: Drug-related deaths for South Ayrshire, Dumfries & Galloway, Perth &

Kinross, and for Scotland as a whole, based on crude rate per 100,000 population.

0.0

2.0

4.0

6.0

8.0

10.0

12.0

99/01 00/02 01/03 02/04 03/05 04/06 05/07 06/08 07/09

Dru

g-r

ela

ted

cru

de d

eath

ra

te p

er

100,0

00

South Ayrshire Dumfries & Galloway Perth & Kinross Scotland

Source: GROS 2009

Drug-related deaths by selected drug type

Information on the involvement of multiple selected drugs: heroin/morphine,

methadone, benzodiazepines, cocaine, ecstasy, amphetamines and alcohol in drug-

related deaths is reported by GROS. From 2008, the reporting criteria was changed

so that data from this point are not directly comparable with previous years. As the

numbers involved each year are very small (generally less than 10), there are

considerable fluctuations year-to-year and so the data for 2008 and 2009 are

averaged here. The main points about the number and rate of deaths where

selected drugs are involved are:

� Heroin/morphine and methadone are the drugs that contribute most to drug-

related death in South Ayrshire (Figure 2.3.3).


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� The death rate due to heroin/morphine in South Ayrshire is significantly lower

than the rate for Scotland but similar to rates in Dumfries & Galloway and in

Perth & Kinross.

� Deaths due to methadone in South Ayrshire are similar to the rate for Scotland,

and are considerably higher than the rates for Dumfries & Galloway and for

Perth & Kinross.

� Deaths due to benzodiazepines in each of the three areas are lower than the

rates for Scotland, though those in South Ayrshire are the highest of the three

areas.

� Deaths due to cocaine are low in Scotland compared to other drugs, and lower

than the rate for Scotland in each of the three areas.

� In South Ayrshire, the death rate due to amphetamines was considerable higher

than for Scotland in 2008 and 2009, though none occurred in either Dumfries &

Galloway or Perth & Kinross in these years.

� The death rate for alcohol in South Ayrshire is lower than the rate in Scotland

but is greater than the rate in Dumfries & Galloway and Perth & Kinross.

Figure 2.3.3: Drug-related deaths, as a crude rate per 100,000 individuals averaged

across 2008 and 2009 by selected drugs involved for each area and for Scotland.

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Heroin Meth'one Benzo. Cocaine Amphet. Alcohol

Drug Category

De

ath

Ra

te p

er

10

0,0

00

: a

ve

rag

e f

or

20

08

+ 2

009

South Ayrshire Dumfries & Galloway Perth & Kinross Scotland


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Ayrshire and Arran drug death database

A review into the factors contributing to drug-related deaths in Ayrshire and Arran

was undertaken in 20075 by analysis of the Ayrshire and Arran Drug-Related Death

Database, with the following key findings:

• Drug-related deaths were found to occur typically among single males in their

thirties (mean 31 years), who died in their own home or another flat/house with

other people present.

• The majority of drug-related deaths were recorded as not having dependent

children.

• An ambulance attended in 88% of cases.

• Around nine out of ten drug-related deaths were not known to have a history of

previous overdose as far as services were aware.

• One tenth of the 28 drug-related deaths during the study period involved persons

who had been liberated from prison within 28 days of their death.

• Alcohol was found in 55% of toxicology reports on drug-related deaths between

2002 and 2007.

5 Ayrshire & Arran Drug Death Review Group (Pulford 2008)


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2.4 Alcohol and drugs in Primary Care in Ayrshire and Arran

Data on alcohol and drug cases was collected from all local practices in Ayrshire and

Arran using General Practice Administration System Scotland (GPASS), covering the

period from 1990 to 20086. Data were available from 51 out of 59 practices

comprising 341,915 patients, which amounted to 88.1% of all patients across all

practices. There is no national data or data from other local authority areas available

for comparison.

The data divides into four general categories: alcohol abuse or alcohol dependency

cases, and drug abuse or drug dependency cases. The alcohol data was extracted

according to the first alcohol-related diagnosis found, however, drug data were

extracted according to any appearance of the relevant condition (drug abuse or drug

dependency) on a patient’s record. Therefore there is some overlap between the

drug abuse and drug dependency figures since some patients may have had either

condition on record. A diagnosis of substance abuse or dependency does not

necessarily mean that a patient has a current substance problem, only that the GP

has recorded a problem at some point in their history of contact with the patient.

2.4.1 Alcohol misuse

The main points from the analysis of the alcohol abuse and dependency diagnoses

data from GPASS are as follows:

� There were 2,244 patients in South Ayrshire with a history of alcohol or drug

dependency or abuse (Table 2.4.1).

� The number of GP patients in Ayrshire and Arran with a diagnosis of alcohol

abuse or dependency recorded from 1990 to 2008 was between 1% and 2% of

the total number of patients seen in this period.

� Although more females than males visit their GPs, a higher percentage of males

than females had a diagnosis of alcohol abuse or dependency in each ADP area.

� In South Ayrshire, 4.1% of males and 1.9% of females were reported by GPs to

have an alcohol-related diagnosis.

6 NHS Ayrshire & Arran Primary Care Strategy (2009)


Page 17 of 66

� Most patients with a diagnosis of alcohol abuse or dependency were aged

between 35 and 64 years.

� Patients aged 15-34 were next highest for a diagnosis of alcohol abuse but not for

alcohol dependency.

� The number of new cases of alcohol abuse increased from 1990 to a peak in the

early 2000s, and thereafter have declined. The same trend is observed in each

Ayrshire ADP area (Figure 2.4.1a).

� By 2008, approximately 60 new cases of alcohol abuse were recorded for South

Ayrshire patients.

� The number of new cases of alcohol dependency has risen gradually since 1990,

with fewer new cases recorded in South Ayrshire compared to East and North

Ayrshire (Figure 2.4.1b).

� By 2008, approximately 27 new cases of alcohol dependency per year were

recorded for patients in South Ayrshire.

� The number of patients with a diagnosis of alcohol abuse or dependency

increased with increasing SIMD score (increased deprivation) (Figure 2.4.2).

Table 2.4.1 Number and percentage1 of GP patients* in Ayrshire and Arran with a

history of substance abuse or dependency by ADP area.

Patients

Diagnosed with: North Ayrshire East Ayrshire South Ayrshire

alcohol abuse 1,480 (1.3%) 1,777 (1.9%) 1,485 (1.9%)

alcohol

dependency 1,937 (1.7%) 918 (1.0%) 759 (1.0%)

drug abuse 1,346 (1.2%) 968 (1.0%) 506 (0.7%)

drug dependency 1,507 (1.3%) 1,062 (1.1%) 651 (0.8%)

1, as a percentage of total patient numbers, *aged 15 and over.


Page 18 of 66

Figure 2.4.1: Number of (a) new alcohol abuse and (b) new alcohol dependency

cases recorded by GPASS by ADP area from 1990 to 2008.

(a)

0

20

40

60

80

100

120

90-92 91-93 92-94 93-95 94-96 95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08

3-year rolling average periods

An

nu

al n

um

bers

of

new

cases

(3-y

r avera

ges

)

East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP

(b)

0

20

40

60

80

100

120

140

90-92 91-93 92-94 93-95 94-96 95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08

3-year rolling average periods

An

nu

al n

um

be

rs o

f n

ew

ca

ses

(3-y

r av

era

ge

s)



Page 19 of 66

Figure 2.4.2: Number of patients in Ayrshire and Arran from 1990 to 2008 with a

recorded history of an alcohol problem by patient’s Scottish Index of Multiple

Deprivation (SIMD).

0

500

1000

1500

2000

2500

3000

3500

4000

Scottish Index of Multiple Deprivation (SIMD) Quintiles

Nu

mb

er

of

pa

tie

nts

alcohol dependency 155 285 507 1186 1443

alcohol abuse 233 374 743 1437 1899

SIMD 1 SIMD 2 SIMD 3 SIMD 4 SIMD 5

NOTE: SIMD 1 is least deprived and SIMD 5 is most deprived.

2.4.2 Drug misuse

The main points from the analysis of the drug abuse and dependency diagnoses data

from GPAS are as follows:

� There were 1,157 patients in South Ayrshire with a history of alcohol or drug

dependency or abuse (Table 2.4.1).

� A national study7 reported that around 1% of consultations with GPs across

Scotland were related to drug misuse in 2006/07.

o The number of GP patients in Ayrshire and Arran with a diagnosis of either

drug abuse or dependency recorded from 1990 to 2008 was between 1.5%

and 2.5% of the total number of patients seen in this period.

o A smaller percentage of patients in South Ayrshire (1.5%) had a diagnosis of

either drug abuse or dependency compared to North Ayrshire (2.5%) and

East Ayrshire (2.2%).

7 Drug Misuse Statistics Scotland (2008)


Page 20 of 66

� Although more female patients were seen by GPs in the time period, more males

(2.7%) had a diagnosis of drug abuse or dependency than females (1.6%) in each

ADP area. In South Ayrshire, 2.1% of males and 1.0% of females had a

diagnosis of drug misuse.

� The numbers of patients with a history of drug abuse or dependency is highest in

the 35-64 year age group, followed by the 15-34 year age group.

� However, a higher percentage of patients in the 15-34 year age group who saw

their GPs had a history of drug misuse compared to patients in the 35-64 year

age group.

� In South Ayrshire, 2.5% of 15-34 year olds had a history of drug misuse

compared to 1.6% of patients in the 35-64 age group.

� Since 1990, the number of new drug abuse cases have doubled in South

Ayrshire, from approximately 12 a year to 24 a year, although numbers have been

gradually falling over the last decade (Figure 2.4.3).

� The number of new drug dependency cases in South Ayrshire have increased

from around 13 a year in 1990 to around 55 a year in 2000/2001, but have

reduced to around 22 new cases a year by 2008 (Figure 2.4.4).

Figure 2.4.3: Number of new drug abuse cases recorded by GPs by ADP area (1990

– 2008)

0

10

20

30

40

50

60

70

80

90

90-92 91-93 92-94 93-95 94-96 95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08

An

nu

al

nu

mb

ers

of

ne

w c

as

es

(3

-yr

av

era

ge

s)



Page 21 of 66

Figure 2.4.4: Number of new drug dependency cases recorded by GPs by ADP area

(1990-2008)

0

20

40

60

80

100

120

140

160

90-92 91-93 92-94 93-95 94-96 95-97 96-98 97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06 05-07 06-08

An

nu

al

nu

mb

ers

of

ne

w c

as

es

(3

-yr

av

era

ge

s)


� The number of patients with a diagnosis of drug abuse or dependency increased

with increasing SIMD score (increased deprivation) (Figure 2.4.5).

Figure 2.4.5: Number of GPs patients in Ayrshire and Arran from 1990 to 2008 with a

recorded history of drug misuse by patient’s Scottish Index of Multiple Deprivation

(SIMD).

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Num

ber

of patients

drug abuse drug dependency

drug abuse 108 156 376 888 1,255

drug dependency 61 150 405 1,013 1,549

SIMD 1 SIMD 2 SIMD 3 SIMD 4 SIMD 5


Page 22 of 66

Conclusions from GPASS data The number of patients seen by GPs with alcohol or drug misuse issues has increased over time. The number of new patients seen by GPs with alcohol or drug misuse issues is not as great as those seen by specialist services. Almost twice as many males as females had alcohol or drug misuse problems. The more deprived segments of the local population are experiencing considerably greater levels of substance abuse and addiction problems.


Page 23 of 66

2.5 Acute and psychiatric hospital discharges due to alcohol and drugs in

Ayrshire and Arran

In Ayrshire and Arran, acute hospital discharge data (SMR01) and psychiatric

hospital discharge data (SMR04) were collected for all in-patient episodes featuring

an alcohol or drug diagnosis from 1999 to 2008, and analysed by local authority area,

gender, and age group over this ten year period. All in-patient episodes were

identified where any of the relevant ICD-10 codes appeared in any diagnostic

position on a patient’s hospital record. Up to six diagnoses are recorded for any

acute or psychiatric care episode. Data was obtained for all the relevant ICD-108

codes for alcohol and drugs within the available SMR01 and SMR04 data sets, and

constitute the main disease classifications. This analysis therefore is a reasonable

indication of the scale of alcohol and drugs problems in Ayrshire and Arran and

allows analysis of trends over time and comparisons between different sub-groups

within the local population.

Alcohol-related acute and psychiatric hospital discharges

Patients are admitted to acute hospitals for any number of reasons and have alcohol

identified as a cause of admission (either a primary or underlying cause). There are

a greater number of beds available in the acute compared to the psychiatric services,

and there is no specific bed allocation for alcohol problems in acute services. This

means that the alcohol-related acute hospital data gives a better idea of the scale of

the alcohol problem within the local population and does not reflect limits on bed

numbers. Alcohol-related discharges were classed into three broad categories:

mental & behavioural disorders, alcoholic liver disease, and gastro-intestinal

diseases due to alcohol misuse.

The main points regarding alcohol-related acute hospital discharges for residents of

South Ayrshire are as follows:

Alcohol-related discharges in South Ayrshire compared to other areas

� South Ayrshire had a lower European age standardised rate (EASR) of

alcohol-related acute hospital discharge (906/100,000) in 2008 compared to

8 International Classification of Diseases (10

th edition)


Page 24 of 66

the EASR for East Ayrshire (936/100,000) and North Ayrshire

(1,055/100,000).

� However, the nationally comparable figures for EASR alcohol-related

diagnosis for South Ayrshire (969/100,000) was higher than for Scotland

(777/100,000), Dumfries & Galloway (553/100,000) and Perth & Kinross

(523/100,000) in 2007/08.

Time trends for alcohol-related discharges in South Ayrshire

� In South Ayrshire patients, the EASR for alcohol-related discharges from 1999

– 2008 have increased in acute hospitals but gradually decreased in

psychiatric hospitals in both males and females (Figure 2.5.1).

� The number of alcohol-related acute hospital discharges for South Ayrshire

residents increased by 20% from 1999 to 2008, compared to an increase of

58% in East Ayrshire and 80% in North Ayrshire residents respectively.

Figure 2.5.1: European age standardised rates (EASR) for an alcohol-related

discharge in either acute or psychiatric hospital for male and female patients from

South Ayrshire.

0

200

400

600

800

1000

1200

1400

1600

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

EA

SR

alc

oh

ol-

rela

ted

dis

ch

arg

es

Acute (F) Acute (M) Psychiatric (F) Psychiatric (M)


Page 25 of 66

Alcohol-related discharges: age and gender trends

� Males (7,328) outnumbered females (2,824) more than two-fold for South

Ayrshire residents discharged for alcohol-related reasons in this ten year

period.

� However, the number of females with an alcohol-related discharge from acute

hospitals increased by 38% compared to a 16% increase in males from 1999-

2008.

� The majority of patients with an alcohol-related diagnosis were aged between

45-64 or 55-64 years (Figure 2.5.2).

Figure 2.5.2: Percentage of males (M) and females (F) from South Ayrshire with an

alcohol-related discharge by diagnosis: alcoholic liver disease (ALD), mental &

behavioural disorders (B&MD) and gastro-intestinal disorders (GID).

0

10

20

30

40

50

60

15-24 25-34 35-44 45-54 55-64 65-74 75+

Age Bands (years)

Alc

oh

ol-

rela

ted

dis

ch

arg

e b

y d

iag

no

sis

(%

)

ALD (M) ALD (F) B&MD (M) B&MD (F) GID (M) GID (F)

Alcohol-related discharges: trends in diagnosis type

� The majority of patients with an alcohol-related diagnosis in South Ayrshire

from 1999 – 2008 were for mental & behavioural disorders (5,080), followed

by alcoholic liver disease (1,330) and then other gastro-intestinal diseases

(162).


Page 26 of 66

� The EASR of discharge for mental & behavioural disorders in South Ayrshire

patients has increased significantly from 1999-2008, whilst the EASR of

discharge for alcoholic liver disease has increased slightly (Figure 2.5.3).

Figure 2.5.3: European age standardised rates (EASR) of alcohol-related discharges

from an acute hospital for South Ayrshire residents by category of diagnosis from

1999-2008.

0

50

100

150

200

250

300

350

400

450

500

550

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

EA

SR

of

alc

oh

ol-

rela

ted

dis

ch

arg

e

Behavioural & Mental Disorders Alcoholic Liver Disease

Alcohol-related discharges: trends in deprivation (SIMD)

� The EASR of acute hospital discharges for all alcohol-related diagnoses

among the local SIMD1 (most deprived) population rose from 1475 to 1937

per 100,000 population from 1999 to 2008 (an increase of 27.4%), while the

equivalent figures among the local SIMD5 (least deprived) population rose

from 241 to 257 per 100,000 population (an increase of only 6.3%). This

means that the gap between affluent and deprived has widened over 10 years

(Figure 2.5.4).

� To be precise, the gap (defined as the ratio of the SIMD1 rate to the SIMD5

rate) has increased from about 6:1 in the earlier time period (1999-2003) to

about 8:1 in the most recent time period (2004-2008). The equivalent gap at

Scottish level between affluent and poor is estimated to be around 7:1.


Page 27 of 66

Figure 2.5.4: Acute hospital discharges in Ayrshire and Arran for all alcohol-related

diagnoses: all persons, all ages by SIMD category (most and least deprived), 1999-

2008.

0

500

1000

1500

2000

2500

Eu

rop

ean

ag

e s

tan

dard

ise

d r

ate

(bas

ed

on

5-y

ear

roll

ing

avera

ge

)

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Rati

o o

f S

IMD

1:S

IMD

5

SIMD 1 (most deprived) 1475.0 1685.0 1827.0 1870.0 1899.0 1937.0

SIMD 5 (least deprived) 241.0 261.0 275.0 263.0 242.0 257.0

Ratio (SIMD1:SIMD5) 6.1 6.5 6.6 7.1 7.8 7.5

1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008

Drug-related acute and psychiatric hospital discharges

As was the case for alcohol diagnoses, there are a greater number of beds available

for drug-related problems in the acute hospitals compared to the psychiatric hospital

since there are limited beds in psychiatric services for drug-related cases. Trends in

drug-related discharges were analysed by nine categories of drug.

The main points regarding drug-related hospital discharges for residents of South

Ayrshire are as follows:

Drug-related discharges in South Ayrshire compared to other areas

� The European age standardised rate (EASR) for drug-related discharges in

South Ayrshire in 2008 was 209/100,000, which was lower than the rate for

East Ayrshire (241/100,000) and North Ayrshire (327/100,000) respectively.

� The nationally comparable figure for EASR alcohol-related diagnosis for South

Ayrshire (157/100,000) was, however, higher than for Scotland (108/100,000),


Page 28 of 66

Dumfries & Galloway (109/100,000) and Perth & Kinross (91/100,000) in

2007/08.

� Whether per calendar or per financial year, the EASR for drug-related

discharges in South Ayrshire have increased, as have the rates for all

comparator areas.

Time trends for drug-related discharges in South Ayrshire

� The number of drug-related discharges from acute hospitals doubled from 91

in 1999 to 184 in 2008.

� In contrast, the number of drug-related discharges from psychiatric hospitals

decreased from 56 to 18 in the same period.

� Both these trends were seen in male and females (Figure 2.5.5).

� South Ayrshire patients with a drug-related discharge represented 22% of all

such discharges from acute hospitals in Ayrshire and Arran, compared to 33%

from East Ayrshire and 41% from North Ayrshire. A similar trend was seen for

discharges from psychiatric hospital.

Figure 2.5.5: Three-year rolling average of drug-related discharges from acute and

psychiatric hospital for male (M) and female (F) patients from South Ayrshire.

0

20

40

60

80

100

120

1999/01 2000/02 2001/03 2002/04 2003/05 2004/06 2005/07 2006/08

Three-year periods

Dru

g-r

ela

ted

dis

ch

arg

es

: 3-y

ea

r ro

llin

g a

vera

ge

Acute M Acute F Psychiatric M Psychiatric F


Page 29 of 66

Drug-related discharges in South Ayrshire: types of drugs

� The majority of drug-related discharges in Ayrshire & Arran over the last 10

years were for opioids (4,640), followed by stimulants other than cocaine

(483), cannabinoids (478) and multiple drug use (417).

� From 1999 to 2008, the percentage discharges for opioids, cannabinoids and

cocaine have increased, whilst discharges for sedatives, stimulants other than

cocaine and poly-drug use have decreased (Figure 2.5.6).

� Discharges for hallucinogens and volatile solvents have decreased from low

levels in 1999 to negligible levels in 2008.

Figure 2.5.6: Percentage change in type of drug in drug-related discharges in acute

hospitals from 1999 to 2008 for Ayrshire and Arran.

-150.00

-100.00

-50.00

0.00

50.00

100.00

Type of Drug

Pe

rce

nta

ge C

ha

ng

e i

n D

isch

arg

e f

rom

1999

to

2008

Series1 78.10 62.12 -56.52 88.24 -43.75 -133.33

Opioids Cannabinoids Sedatives CocaineOther

stimulantsMultiple drug

Drug-related discharges in South Ayrshire: gender trends

� A total of 901 (65%) males and 487 (35%) females from South Ayrshire were

discharged for a drug-related diagnosis from acute hospitals in the 10 year

period.

� Drug-related discharges from South Ayrshire increased in males from 52 to

128 and in females from 39 to 56 from 1999 to 2008. This represents an

increase in drug-related discharges of 59% in males and 30% in females.


Page 30 of 66

Drug-related discharges in South Ayrshire: gender trends: age profile

� The majority of people from South Ayrshire discharged from an acute hospital

with a drug-related diagnosis were in the 25–29 year age band, followed by

those in the 30-34 year age band (Figure 2.5.7).

� The majority of people from South Ayrshire discharged from a psychiatric

hospital with a drug-related diagnosis were also in the 25–29 year old age

band, followed by those in the 20-24 year age band (Figure 2.5.7).

Figure 2.5.7: The number of drug-related discharges from acute and psychiatric

hospitals for patients from South Ayrshire from 1999-2008.

0

50

100

150

200

250

300

350

5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

5-year Age Bands

Nu

mb

er

of

dru

g-r

ela

ted

dis

ch

arg

es

Psychiatric Acute

Drug-related discharges: trends in deprivation (SIMD)

� Acute hospital discharges for all drug-related diagnoses among the local

SIMD1 population increased markedly from 335 to 520 per 100,000 population

from 1999 to 2008 (a pronounced increase of 45.9% over 10 years), while for

SIMD5 the equivalent figures increased far less markedly from 29 to 35 per

100,000 population (an increase of 19.8%).


Page 31 of 66

� This means that the gap between most and least deprived has widened even

more extensively than was the case for alcohol, with the SIMD1:SIMD5 ratio

increasing from about 12:1 in the earliest time period to about 15:1 in the most

recent time period (Figure 2.5.8).

Figure 2.5.8 - Acute hospital discharges in Ayrshire and Arran for all drug-related

diagnoses: all persons, all ages by SIMD category (most and least deprived), 1999-

2008.

0.0

100.0

200.0

300.0

400.0

500.0

600.0

Eu

rop

ea

n a

ge s

tan

dard

ised

rate

(ba

se

d o

n 5

-yea

r ro

llin

g a

vera

ge)

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Rati

o S

IMD

1:S

IMD

5

SIMD 1 (most deprived) 335.0 402.0 449.0 464.0 484.0 520.0

SIMD 5 (least deprived) 29.0 30.0 32.0 30.0 32.0 35.0

Ratio (SIMD1:SIMD5) 11.6 13.4 14.0 15.5 15.1 14.9

1999-2003 2000-2004 2001-2005 2002-2006 2003-2007 2004-2008


Page 32 of 66

2.6 Shared Addictions Management Services (SAMs): service user profile

All referrals made to NHS Ayrshire & Arran Specialist Addictions Services are logged

on the Shared Addictions Management System (SAMS). Over the four year period

from 2005/06 to 2008/09 a total of 14,703 referrals were made to NHS Addiction

Services. An SMR24 form was completed for 7,123 out of 14,703 clients, resulting in

less than half of the referrals receiving an assessment. For the remaining 7,580

referrals, clients declined or did not attend assessment or were deemed not suitable

for service. This report only contains analysis of the 7,123 referrals with an

assessment.

Main substance type recorded at assessment for South Ayrshire clients

� Of the 7,123 assessments undertaken, 1,855 (26%) were for residents of South

Ayrshire, compared to 2,315 (32%) for East Ayrshire and 2,936 (41%) for North

Ayrshire.

� Of the 1,855 assessments for South Ayrshire, 75% (1,397) were for alcohol, 22%

(415) were for drugs, and 2% (43) were for both alcohol and drugs.

� The second most commonly recorded main drug of misuse at health board level

and across all three local authority areas was heroin.

� Heroin was the main drug recorded at assessment for 14.7% of clients from

South Ayrshire, compared to 19% of clients from North Ayrshire and 22% of

clients from East Ayrshire.

� Cannabis was the next most frequently reported drug at assessment for all areas,

and was 2.5% of assessments for South Ayrshire.

Time trends in alcohol and drug assessments

� The number of assessments for clients in South Ayrshire for either alcohol or

drugs increased year-on-year from 2005/06 to 2008/09.

� The number of assessments for alcohol alone from South Ayrshire clients has

increased in this period (Figure 2.6.1).

� The number of assessments for drugs only for South Ayrshire clients varies year-

to-year but the overall trend has been a gradual decline in this time.


Page 33 of 66

Figure 2.6.1: Assessments by SAMs for South Ayrshire clients for alcohol or drugs.

0

50

100

150

200

250

300

350

400

450

Nu

mb

er

of

cli

en

ts a

ssessed

/ y

ear

Alcohol 299 366 351 398

Drugs 121 97 119 104

2005/06 2006/07 2007/08 2008/09

Age trends in alcohol and drug assessments for South Ayrshire

� The median age of referral for assessments due to alcohol for clients from South

Ayrshire was 43 years, with a minimum age of 17 and a maximum age of 85.

� The age profile of clients from South Ayrshire assessed for drugs was younger

than for alcohol: median age = 30, minimum age = 17 and maximum age = 61.

� The minimum age that clients from South Ayrshire first reported using alcohol or

drugs was 5 and 7 years of respectively, whilst the minimum age that these

clients first sought help was 11 and 7 years respectively (Table 2.6.1).

Table 2.6.1: Alcohol and drug assessments by SAMs for South Ayrshire clients from

2005/06 to 2008/09; Age at key time points.

Age of first use

Age problem

onset

Age first sought

help

Age Points Alcohol Drugs Alcohol Drugs Alcohol Drugs

Minimum 5 7 6 7 11 7

Median 16 15 30 20 37 24

Maximum 59 47 72 61 81 61


Page 34 of 66

Gender trends in alcohol and drug assessments

� In keeping with national trends, more males than females from South Ayrshire

were referred to SAMs for assessment for either alcohol or drugs.

� Clients from South Ayrshire assessed for alcohol misuse comprised 61% males

and 39% females.

� Of those assessed for drug misuse, slightly more were male (66%) and slightly

fewer were female (34%) compared to alcohol assessments.

� The number of both male and female clients from South Ayrshire assessed for

alcohol misuse increased each year from 2005/06 to 2008/09.

� In contrast, the number of South Ayrshire clients assessed for drug misuse

decreased, with a steeper decline in females than in males.

Onward referrals and outcomes from SAMS assessments and interventions

The main trends in intervention type and onward referrals for South Ayrshire clients

assessed by SAMs were:

� The majority (82%) assessed for alcohol problems were assigned home

detoxification, with 9% undergoing alcohol relapse management.

� Nearly 40% of clients assessed for drug problems were assigned home

detoxification and 35% were provided with substitute prescribing.

The main outcomes for clients from South Ayrshire with alcohol issues are as follows:

� A positive outcome was recorded for 32% of clients from South Ayrshire.

� In 3.5% of alcohol cases the client outcome was recorded as chaotic.

� However, the majority of clients (65%) had no data on outcome recorded on

SAMs, with the same trend seen in clients across Ayrshire and Arran.

The pattern for outcomes for South Ayrshire clients with drug problems was:

� There was a positive outcome for 44% of these clients.

� Just over 5% of clients with drug issues still had chaotic outcomes, compared to

6.5% of clients across Ayrshire and Arran.

� However, almost 51% of drug clients had no outcome recorded on SAMs.


Page 35 of 66

2.7 Impact of alcohol and/or drug use on communities

There is considerable evidence to indicate that alcohol and drugs contribute

significantly to rates of general crime, such as assault and theft. A recent study9

estimated the number of thefts (400,000 cases), criminal damage (45,000 and

assault (5,000) that were carried out by problem drug users. In addition, the Home

Office estimated that 40% of violent crime, 78% of assaults and 88% of criminal

damage cases are committed while the offender is under the influence of alcohol10.

Also, alcohol was reported to be a factor in 60-70% of homicides, 75% of stabbings,

50% of fights and 50% of all crime in the U.K11

Reported crime related to alcohol and drug use in Ayrshire and South Ayrshire

� The total number of recorded crimes and offences in Ayrshire is approximately

60, 000 per year, with approximately one third of these occurring in South

Ayrshire.

� From 2004/05 to 2008/09, the average annual number of recorded crimes

directly related to alcohol or drugs in Ayrshire was 4, 066, of which 1,141

(28%) were in South Ayrshire.

� Of all recorded crimes related to alcohol or drugs in South Ayrshire, 69% are

related to drugs (possession and/or supply), 19% are related to drink-driving

offences, 9% are related to drunkenness offences and 3% are related to

licensing offences.

� There has been a 30% decrease in recorded crime due to alcohol or drugs in

Ayrshire overall from 2004/05 to 2008/09.

� At the same time, there has been a 25% decrease in recorded crime due to

alcohol or drugs in South Ayrshire (Figure 2.7.1).

9 www.scotland.gov.uk/socialresearch

10

“Tackling Alcohol Related Crime, Disorder and Nuisance" HMSO (2000) 11

MacAskill, S., Cooke, E. and Hastings, G. : "Prevention of Alcohol Misuse : Informing the Strategy" Report

Supplement (2001)


Page 36 of 66

Figure 2.7.1: Annual number of total alcohol and drug-related (A&D) recorded crimes

and those related to drugs, driving, drunkenness and licensing offences in South

Ayrshire from 2004/05 to 2009/10.

0

200

400

600

800

1000

1200

1400

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10*

Num

ber

of

Crim

es

A&D crime Drugs Driving Licencing Drunkeness

*Data to February 2010. Source Strathclyde Police, Crime Statistics Database, Analytical Unit, Information Management Department. March 2009

The impact of alcohol and drugs on vulnerable persons in communities

Strathclyde police systematically collect data linking alcohol and drugs to three

categories of vulnerable people, specifically those experiencing domestic abuse,

racism and homophobia. From 2005/06 to 2009/10, the total number of vulnerable

person incidents in Ayrshire and Arran were: domestic abuse (15, 677), racist (908)

and homophobic (115). The average number of incidents in Ayrshire and Arran per

year are therefore 3920, 227 and 27 for domestic abuse, racist and homophobic

incidents respectively.

� The number of domestic abuse incidents in South Ayrshire increased from

1,093 in 2006/07 to 1,219 in 2009/10.

� Of all the domestic abuse incidents within Strathclyde, 57% involve alcohol,

1% involve drugs only and around 4% involve both alcohol and drugs.

� In South Ayrshire, the majority, almost 60%, of domestic abuse incidents are

also influenced by either alcohol or drugs.


Page 37 of 66

� From 2006/07 to 2008/09, of the domestic abuse incidents in South Ayrshire

56% were influenced by alcohol, 0.8% by drugs and 2.6% by a combination of

alcohol and drugs.

� In the case of the people involved in domestic abuse incidents in South

Ayrshire, 42% of victims (the minority) and 54% of the accused (the majority)

were influenced by alcohol or drugs.

� The number of racist incidents in South Ayrshire increased from 45 in 2006/07

to 70 in 2009/10.

� In the Strathclyde area, 32% of racist incidents involve the use of alcohol, 1%

of racist incidents involve drugs and 4% involve a combination of alcohol and

drugs.

� The average number of racist incidents reported to police in South Ayrshire

from 2006 to 2009 was 58 per year. Of these, 39% were influenced by alcohol

(higher than the Strathclyde average) and less than 0.5% were affected by

drugs, either alone or in combination with alcohol (lower than the Strathclyde

levels).

� The vast majority of victims of racist incidents (87%) were not influenced by

either alcohol or drugs but the majority of perpetrators of racist incidents (70%)

were affected by alcohol or drugs.

� The number of homophobic incidents in South Ayrshire are generally low but

increased from 3 in 2006/07 to 6 in 2009/10.

� In Strathclyde overall, 42% of homophobic incidents involve the use of alcohol,

0.7% of homophobic incidents involve drugs and around 4% of homophobic

incidents involve both alcohol and drugs.

� An average of 6 homophobic incidents per year were reported to police in

South Ayrshire from 2006 to 2009 (ranging from 3 to 9 incidents per year).

� The majority of victims of homophobic incidents (70%) are not influenced by

alcohol or drugs but the majority of perpetrators of homophobic incidents

(70%) are under the influence of alcohol or drugs.


Page 38 of 66

Drunk and Incapable

A review of the impact of drunk and incapable people on a variety of services, such

as the NHS and local authorities was undertaken in Scotland12 which took a “snap-

shot” of discharges due to acute intoxication from emergency and acute hospitals

across Scotland.

� In 2006 / 2007, there were 92, 116 overall discharges in acute hospitals in

Ayrshire and Arran, of which 1, 224 (1.3%) were for acute intoxication.

� South Ayrshire has the highest rate of acute intoxication discharges per

10,000 discharges in Scotland (155/10,000) which is more than three times

the rate in Dumfries & Galloway (44/10,000) and twice the rate in Perth &

Kinross (61/10,000) respectively (Table 2.7.1).

� The rate of discharges per 10,000 in South Ayrshire is also more than double

the national rate (71/10,000).

� The gender breakdown for acute intoxication discharges in South Ayrshire

was similar to the national gender discharge pattern. However, there were

fewer males in Dumfries & Galloway and more males in Perth & Kinross

compared to South Ayrshire.

Table 2.7.1: Hospital inpatient discharges with a diagnosis of acute intoxication by

local authority area of residence and for Scotland in 2006/07.

Total Rate / 10,000 Percentage

Number discharges Male Female

South Ayrshire 445 155 71 29

Dumfries & Galloway 143 44 64 36

Perth & Kinross 174 61 80 20

Scotland 7, 785 71 75 25

Source: Managing the Needs of Drunk and Incapable People in Scotland (2009)

12

Managing the Needs of Drunk and Incapable People in Scotland: a Literature Review and Needs Assessment (2009)


Page 39 of 66

2.8 Impact of Alcohol and Drugs on South Ayrshire Council services

Child Protection data for South Ayrshire

There are currently (August 2010) 41 children on South Ayrshire’s Child Protection

Register. This excludes temporary registrations from other local authorities.

� Of these 41 children, 22 (51%) are directly affected by their parents/carers

alcohol/substance issues. None of the children currently registered are

affected by their personal substance abuse issues.

� Of the total number of children on the register, 12 have suffered physical

injury, 16 physical neglect, 10 emotional harm and 3 sexual abuse.


Page 40 of 66

CHAPTER 3: ALCOHOL AND DRUG SERVICE MAPPING

Current alcohol & drug service provision for people with alcohol and / or drug

problems in East Ayrshire, North Ayrshire and South Ayrshire

A wide range of support services for people with alcohol and / or drug problems in

East Ayrshire, North Ayrshire and South Ayrshire have been developed and

commissioned based on the local Functional model of Addiction Services for

Treatment & Rehabilitation, which was adopted in 2005 in Ayrshire and Arran.

A mapping exercise was conducted as part of the needs assessment work to

establish what services are currently available to people who are at risk of developing

alcohol and /or drug problems, or are using services which provide support or

treatment and care for people with alcohol and / or drug problems.

A service mapping template was developed and disseminated during January and

February 2010 to relevant services identified by the Needs Assessment Steering

Group and members of the Alcohol and Drug Partnerships. This was followed up by

an interview with the service head or other nominated person. Interviews were

conducted by the Alcohol and Drug Partnerships Support Team.

The service mapping template was designed to gather information on the type of

organisation providing the service, service model, and service information including

financial and staff resources, services available and area covered, numbers of

referrals and source. The Service mapping template was included in a previous

report and will be lodged in the ADP Needs Assessment on-line resource.

A total number of 17 different service providers were approached to complete the

service mapping template. All agreed to complete the template however during

interview where guidance on information required was given, it transpired not all

services could provide the information in the way specifically requested In these

cases the interviewer identified what information available was useful for the service

mapping. This has limited the ability for comparison analysis.

Ttwo service providers did not return the service mapping template following

interview.


Page 41 of 66

A full list of services included in the service mapping exercise can be found in

Appendix 1.

Overview of Current Service Provision

As well as alcohol and / or drug specific services a number of other interventions

support adults with alcohol and drug problems when appropriate. This includes The

Adult Support and Protection (Scotland) Act 2007 which received royal assent in

March 2007. The Act was introduced to protect and benefit 'adults at risk' by

introducing investigative rights and duties, where a local authority suspects that an

adult at risk is being harmed. The Act also introduces a range of post-assessment

interventions, designed to provide benefit to the adult. The legislation also sets up

new multi-agency Adult Protection Committees to oversee adult protection policies

locally.

This section provides an overview of all services included in the service

mapping exercise. Information on the services that took part in the mapping

exercise is arranged according to geographical spread, i.e. whether the services

operate on a pan-Ayrshire basis and/or within either East, North or South Ayrshire.

In addition, the services are categorised based on the Ayrshire and Arran Functional

Model of Treatment and Care as detailed below.

Pre-phase 1 services

Services for people not engaged in specialist treatment

services.

Phase 1 Services Intensive support to service users through the use of 1: 1

and group work sessions. Focus on supported

detoxification and stabilisation.

Phase 2 Services Continuing support to gains made in phase 1 but widens to

include a range of understanding and skills needed to

support recovery

Phase 3 Services Maintenance of treatment and care gains. Support and

signposting to education, training and employment support.


Page 42 of 66

Pan Ayrshire Services

Services that are included in this section provide services across the whole of

Ayrshire and Arran.

The services covered in this section are:-

• Alcoholics Anonymous Phase 1-3 service

• Narcotics Anonymous Phase 1-3 service

• NHS Ayrshire and Arran Alcohol Liaison Service Pre-phase 1 service

• NHS Ayrshire and Arran Inpatient detoxification provision Phase 1 service

• NHS Ayrshire and Arran Addiction Services Loudoun House Phase 1-2

service

• Criminal Justice disposal Structured Deferred Sentence Phase 1-3 service

• Criminal Justice disposal Drug Treatment and Testing Order Phase 1-3

service (DTTO)

• Criminal Justice disposal HMP Kilmarnock Addiction Services Phase 1-3

service

Alcoholics Anonymous

Service provision

Alcoholics Anonymous are a mutual aid fellowship. Members use and share their

own experiences to help each overcome problematic alcohol use. 70 meetings take

place each week in Ayrshire and Arran.

Staffing

As a mutual aid fellowship Alcoholics Anonymous does not employ staff to provide

the service. Members who are in recovery ie long term sobriety ‘lead’ meetings.

Number of clients seen

Alcoholics Anonymous do not keep records of attendance at meetings but it is

reported that there can be between 15 and 50 individuals at meetings held in

Ayrshire and Arran.

Financial information


Page 43 of 66

Alcoholics Anonymous are self-funding and supporting. They do not accept financial

support from any external body.

Narcotics Anonymous

Service provision

Narcotics Anonymous (NA) are a mutual aid fellowship. Members use and share

their own experiences to help each overcome problematic drug use. NA activity in

Ayrshire is relatively limited, there are two meetings are held each week in North

Ayrshire. Due to the nature of the fellowship it is not possible to determine the reach

it has into East or South Ayrshire, although people from these areas are welcome to

attend these meetings. It is reported that a significant number of people from

Ayrshire attend the Glasgow meetings.

Staffing

Narcotics Anonymous is a mutual aid fellowship which does not employ staff to

provide a service. Members who are in recovery ‘lead’ meetings. Peer / mutual

support is a key feature of Narcotics Anonymous.


Narcotics Anonymous do not keep records of attendance at meetings.


Narcotics Anonymous are self-funding and supporting. They do not accept financial

support from any external body.

NHS Ayrshire and Arran alcohol liaison service

Service provision

The service provides:-

• alcohol brief interventions (pre-phase 1 service) as part of the NHS Health,

Efficiency, Access, Treatment (HEAT) target to individuals who have been

screened and identified as drinking more than recommended limits but do not

require the intervention of specialist alcohol services. The intervention is either


Page 44 of 66

provided once people have received their treatment within A & E or as part of a

follow up clinic visit.

• Support to people with alcohol related brain damage

Staffing

The service is provided by seven staff members (six Charge Nurses and one Staff

Nurse). It commenced in 2006 at Crosshouse Hospital, Kilmarnock. Service

provision was extended to cover Ayr Hospital in 2008.


Table 1 Number of people attended service NHS Ayrshire and Arran Alcohol Liaison

Service in 2008/09.

Area Number of patients attended (2008/09)

East Ayrshire 356

North Ayrshire 481

South Ayrshire 291

Total 1128

NB no information has been provided to indicate which aspect of service delivery

patients accessed.


Funding is provided from the Public Health Alcohol Problems Scottish Government

funding. Financial provision for year 2009/10 was £372,928. This funding stream is

due to end in March 2011.

NHS Ayrshire and Arran Inpatient detoxification provision

Service provision

This is on a general psychiatric ward, 5 of which are designated alcohol detoxification

beds. This facility is primarily for individuals who do not have adequate community

support for home detoxification services and patients who have experienced adverse


Page 45 of 66

clinical symptoms as a result of previous alcohol abstention or detoxification and

therefore require close monitoring.

Staffing

This service is provided as part of a range of psychiatric services within Ward 2D

Crosshouse Hospital, Kilmarnock.


It is not possible to separate out this information from the psychiatric SMR 04 returns.


It is not possible to separate out the costs of providing this service as it is part of a

wider psychiatric inpatient service provision. Funding for this service is provided as

part of NHS Ayrshire and Arran mental health services general allocation budget.

NHS Ayrshire and Arran Addiction Services

Loudoun House

Service provision

Loudoun House is a twelve-bedded Dual Diagnosis Residential unit providing

treatment and support to people with complex mental health and alcohol / drug

problems. Loudoun House also provides day patient facilities for an additional 6

people at any one time.

Loudoun House provides a range of therapeutic treatment packages, inclusive of

assessment, structured group workshops, structured day programmes, harm

reduction and relapse prevention strategies

Staffing

There are 15 nursing staff ranging from Ward Manager to Nursing Assistants

delivering this residential and day patient service.


Figures currently included in addiction services locality returns.


Page 46 of 66


It is not possible to separate out the costs of providing this service from the total

budget for service provision by NHS Ayrshire and Arran Addiction Services which is

detailed below.

NHS Ayrshire and Arran accountable income for spent on alcohol and / or drug

services and support 2009/10

Drug Treatment funding £1,360,000

Alcohol problems funding £2,450,000

DTTO £240,000

HIV & Blood-borne viruses* £210,000

Hepatitis C* £340,000

Total £4,376,000

. * part budget

NHS Ayrshire and Arran accountable spend on alcohol and / or drug services

and support 2009/10

Staffing including medical staff £3,500,000

Supplies (including contracts

with TPS and NAC)

£1,400,000

Pharmacy costs £2,850,000

ACA and Addaction contracts £400,000

Total £8,150,000

Alcohol and / or drug services and criminal justice disposals

There are currently three types of alcohol and drug services provided in Ayrshire and

Arran connected to criminal justice disposals. Access to these services is via the

courts in Ayr and Kilmarnock.

Structured Deferred Sentence (SDS) - alcohol related

Service provision


Page 47 of 66

This is a low tariff community disposal designed to address the needs, on a voluntary

basis, of individuals who are assessed as low risk and are in danger of becoming

embroiled in a pattern of alcohol related offending behaviour

Staffing

Services across Ayrshire are provided by a staff group of 2.5 whole time equivalent

(WTE) This staff group consists of a team Leader 0.3 WTE, 0.75 WTE social worker,

1 WTE counsellor and 0.45 WTE admin support. Staff from Ayrshire Council on

Alcohol are funded to provide the alcohol awareness programme.

Number of clients 2008/09

Referred / Assessed Received a service

Males Females Males Females

East Ayrshire 50 12 20 4

North Ayrshire 31 9 17 6

South Ayrshire 13 6 7 2


Funding for SDS comes from the Scottish Government Criminal Justice budget.

Funding for financial year 2009/2010 was £101,988 of which £35,000 is paid to

Ayrshire Council on Alcohol in respect of the delivery of alcohol awareness

programmes

Drug Treatment and Testing Orders (DTTO) Team

The DTTO is a joint venture between Ayrshire Criminal Justice Service and NHS

Ayrshire and Arran Addiction Services.

Service provision

Drug Treatment and testing orders are an alternative to custody made available by

the courts to individuals with serious drug problems who commit crimes to fund their

drug use. The criminal justice service staff maintain overall control of the order

reporting progress to the court as required.


Page 48 of 66

The clinical staff undertake clinical assessment, provision of drug treatment and

evaluation of individuals.

Staffing

Services across Ayrshire are provided by a staff group of 8.85 WTE. This staff group

consists of a team leader 0.75 WTE, 2.6 WTE supervising officers 4 WTE nursing

staff and 1.5 WTE admin support. Medical input is provided by a GP with special

interest via two sessions per week.

Numbers of clients 2008/09

Referred Assessed Received a

service

Discharged

Male Female Male Female Male Female Male Female

East

Ayrshire

14 17 11 12 9 6 8 3

North

Ayrshire

24 8 20 8 9 2 13 3

South

Ayrshire

14 7 11 6 6 4 4 2

Totals 52 32 42 26 14 12 25 8


Funding for DTTOs comes from the Scottish Government Criminal Justice budget.

Funding for financial year 2009/2010 was £453,973 of which £240,000 is paid to the

NHS to deliver the clinical aspects.

HMP Kilmarnock addiction services

HMP Kilmarnock is a private prison for men under contract to Scottish Prison

Service.

Although this establishment is based in Ayrshire on average only 40% of the prison

population incarcerated within HMP Kilmarnock is from Ayrshire and Arran. However

they do provide a range of alcohol and drug services as part of the prison medical

programme which is accessible to all prisoners.


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Service provision

A number of services are delivered as part of the prison medical programme.

These include:-

• Admission / pre release harm reduction

• Alcohol awareness programme

• Drug awareness programme

• 1:1 motivational support

• Substance related offending behaviour programme

Staffing

Addiction services are delivered within HMP Kilmarnock by a staff group of 5 WTE.

This staff group consists of 1 WTE manager, 3 WTE case workers and 1 WTE admin

staff member.


Gender Referred Assessed Received a

service

Discharged

Male 2573 608 732 725


Financial information was not available from this service due to perceived business

sensitivity as the service provider is a private company.


Page 50 of 66

South Ayrshire Services

Services that are included in this section are provided or commissioned services for

the people of South Ayrshire. The services covered in this section are:-

• NHS Ayrshire and Arran Addiction Services South Ayrshire Locality Team

Phase 1-2 service

• Turning Point Scotland – Seastar Support Services – Phase 2 service

• Ayrshire Council on Alcohol Phase 1-2 service

• Addaction Community Alcohol Rehabilitation Service Phase 2 service

• Addaction SMART Recovery Phase 3 service

• Apex Scotland Progress2Work Phase 3 service

• Momentum Accelerate Pilot Phase 3 service

• Care and Share

• SAMH Dual Diagnosis Services

NHS Ayrshire and Arran addiction services South Ayrshire Locality Team

Service provision

NHS Ayrshire and Arran locality addiction services consists of a Community

Addiction Team (CAT) and a Primary Care Addiction Team (PCAT). These teams

provide a range of services for people with alcohol and / or drug problems.

The Community Addiction Team provides the following:-

• Advice, support and treatment for injecting drug users (including needle

exchange delivery and ‘backpacking’ service)

• Medical assessment, interventions and review

• Mental health and addiction related support

• Blood borne virus and Hepatitis C interventions

• Sexual health and good physical health promotion

• Substitute prescribing and support

• Support and treatment for those individuals with chaotic alcohol and drug

problems.

The Primary Care Addiction Team provides the following:-


Page 51 of 66

• Supportive detoxification from alcohol and drugs in the home or community

setting

• Arrange and support hospital based detoxification

• Alcohol and Drug Relapse Management Support

• Additional health related support for clients who are most stable on prescribed

substitute medication

• Screening and delivery of alcohol brief interventions.

Staffing

Services in South Ayrshire are delivered by a staff group of 23.9 whole time

equivalent (WTE). There are 15.4 WTE permanent staff and 8.5 WTE staff on

temporary contracts. This staff group consists of 0.9 WTE medical input, 1 WTE

manager, 1 WTE team leader, 2 WTE allied health professionals, 11 WTE nursing

staff and 8 WTE addiction workers.



service

Discharged

Number % Number % Number % Number %

Male 720 65 442 64 329 64 660 64

Female 403 35 245 36 189 36 369 36

Totals 1123 100% 687 100% 518 100% 1029 100%


It is not possible to separate out the costs of providing this service from the total

budget for service provision by NHS Ayrshire and Arran Addiction Services.

Turning Point Scotland – Seastar Support Services

Service provision

Throughout the process of this service mapping exercise Seastar has been going

through a period of change which will not be concluded until April 2010.

From April 2010 Seastar will be providing a phase two twelve week structured

programme.


Page 52 of 66

Staffing

Services in South Ayrshire are delivered by a staff group of 9.5 whole time

equivalents (WTE). This staff group consists of 0.5 WTE manager, 1 WTE team

leader, 7 WTE project / support workers plus sessional hours and 1 WTE admin staff.



service

Discharged

Number % Number % Number % Number %

Male 125 68.7 120 69.4 77 68.1 96 68.1

Female 57 31.3 53 30.6 36 31.9 45 31.9

Totals 182 100% 173 100% 113 100% 141 100%


This service is jointly commissioned by NHS Ayrshire and Arran and South Ayrshire

Council. Financial provision for year 2009/10 was £334,132, funding is due to end in

April 2011.

Ayrshire Council on Alcohol

Service provision

Ayrshire Council on Alcohol provides 1:1 alcohol counselling, and alcohol related

offending interventions to individuals and family members.

Staffing

The services in South Ayrshire are provided by a staff group of 2.73 WTE.


Information provided was taken from ACA annual report which does not detail

information in the same way as specified in the service mapping template.

280 people were referred and assessed in 2008/09 (184 male and 96 female).

The case load of the core service recorded at 31 March 2009 was as follows:-


Page 53 of 66

Age range Referred

Number %

16-18 3 0.9

19-25 51 14

26-40 121 33.5

41-65 184 51

65+ 2 0.6

Totals 361 100%


The funding envelope comprises £127,180. Funders include NHS Ayrshire and

Arran, South Ayrshire Council and Criminal Justice Partnership.

Addaction Scotland

Addaction provide two services within South Ayrshire:-

1. Community Alcohol Rehabilitation Service (CARS)

Service provision

This is an alcohol service offering advice and information, 1:1 counselling and

support. Work on self-esteem, building relationships and general wellbeing are also

included within the service. Links with local education and employment providers are

in place.

2. SMART Recovery

Service provision

SMART Recovery is a self-help abstinence based programme for people with alcohol

and / or drug problems. People take part in 1:1 and group meetings utilising a peer

support approach with professional support if required. Interventions are based

around cognitive behavioural therapy and rational emotive behaviour therapy.

The following information covers both aspects of services.

Staffing


Page 54 of 66

The staff group comprises 10 staff members for Ayrshire and Arran:- 1 WTE

manager, 8 WTE practitioners and 1 WTE administrator.



service

Discharged


South

Ayrshire

94 57 51 40 46 35 85 52


Funding for Smart Recovery is £121K and is allocated from the Scottish Government

drug treatment ring fenced allocation.

Funding for CARS is £206K and is allocated from the Scottish Government alcohol

problems ring fenced allocation.

Apex Scotland Progress to work (P2W)

Apex Scotland provide Progress2Work services on behalf of Jobcentre Plus.

Service provision

P2W supports clients recovering from drug problems to take up training or

employment opportunities. Apex works with clients to overcome barriers to gaining

training, education and employment opportunities. Apex also provides ongoing

support to clients once in training or employment opportunities to minimise drop out.

Staffing

P2W services in South Ayrshire are provided by a 0.5 WTE employment

development advisor.


Information specific to South Ayrshire could not be provided. 205 clients were

referred across Ayrshire and 84 were assessed as suitable for service.



Page 55 of 66

Funding provided by the Department of Work and Pensions for the service which

covers the whole of Ayrshire and Arran and Dumfries and Galloway is £146,667.

This amount is dependent on the service achieving all of its outcomes.

Momentum Accelerate Pilot

Momentum developed a pilot funded through the Innovation fund to run in financial

year 2009/10. Three 12 week programme were delivered, one 12 week programme

in each area.

Service provision

The pilot was set up to provide a service to people recovering from alcohol problems

to get back into education, training or employment. The twelve week programme

consisted of workshops around confidence building, communication skills, anger

management, team building skills, employability and creative arts. Training and

gaining of qualifications were also built into the programme.

Staffing

The service in South Ayrshire was delivered by a staff group of 4.07 WTE staff and 1

WTE volunteer.



service

Discharged


South

Ayrshire

6 7 6 7 5 6 1 0


Funding for the Accelerate pilot comprised of £27,000 from the Innovation Fund and

an undisclosed amount from the European Social Fund.

Care and Share

Service Provision


Page 56 of 66

Care and Share commenced in February 2008 and meets every Wednesday

between 2-5pm in Riverside Church Ayr. The aim of the project is to provide a safe

place for people who have experienced homelessness, are at risk of being homeless

or are homeless to receive a hot nutritious meal, socialise and support each other

and break down barriers to accessing a range of other services which homeless

people can experience. A range of professions bring their services to the group;

these include sexual health services, oral health services, podiatry, social work

services and alcohol and drug services.

Those who attend the Care and Share Project are given a voucher which will entitle

them to a free lunch at the church café which runs on a Tuesday. On average 20

people will use this additional facility.

Staffing

The basic service provision i.e. provision of a premises and hot meal is provided

entirely by volunteers. Staff costs of professions who attend Care and Share project

are covered by staff members employing organisation.

Care and Share project requires a minimum number of 8 volunteers for a total of 3

hours per week each, 4 volunteers to work in the kitchen with the remaining 4

supporting other activities. It is often the case many more volunteers are available.

Co-ordination of the project is currently carried out by the Church Associate Pastor

who estimates this is taking on average 6hrs per week, funding for this time is

absorbed by the Church.

Number of clients 2009

Limited information is available due to the nature of the project. Records of

professional support and intervention are maintained and kept within the appropriate

organisation.

Records of attendance are kept. During 2009, 1497 attendances were recorded

(1244 males and 253 females) with the average being 29 each Wednesday. It is

estimated 70% have had or have alcohol and /or drug problems. The average age of

attendees is mid 20s to mid 30s.



Page 57 of 66

The funding envelope comprises £14,020. Funders include South Ayrshire Alcohol

and Drug Partnership and South Ayrshire Council.

SAMH Dual diagnosis service

Service provision

A specialist care and housing support service for people who have mental health

problems and who also lead chaotic lifestyles due to problematic alcohol

consumption and/or use of other substances. The service is provided in the service

users’ own homes and is for people aged between 17 and 64 years of age. Through

a range of supports and tasks, the service aims to optimise service user

independence, improve motivation, reduce crisis hospital admissions and ensure

service user safety and well being.

Staffing

The service in South Ayrshire is delivered by a staff group of 3.30 WTE staff.

Management posts cover all SAMH services locally with 3.00 WTE practitioners.

Number of clients



service

Discharged


South

Ayrshire

2 3 2 3 4 11 1 3


The funding envelope comprises £82,000 from South Ayrshire Council and South

Ayrshire Alcohol and Drug Partnership. The latter funding stream ends in March

2011.

Summary of service mapping


Page 58 of 66

From the information returned, services indicate that service provision is available to

residents across both Ayrshire & Arran and South Ayrshire. It is not possible to

determine accurately whether there are any gaps in service coverage as only a few

services were able to give actual number of clients attending from specific areas.

Model and efficacy of service provision

Services were asked to identify which model of service underpinned service delivery.

Most service providers stated they did not operate to a defined model of service,

however service provision did consist of a number of recognised service

interventions. Medical interventions included information and advice, assessment

and care planning, detoxification, substitute prescribing and blood borne virus testing

and treatment. Non-medical interventions consisted of information and advice,

assessment and care planning, one to one counselling, group work support,

Cognitive behavioural therapy, motivational interviewing, relapse management, peer

support, alternative therapies, activity sessions, life skills/ esteem building /

employability support, family support.

Most of the services had carried out an evaluation of their service within the last five

years. Most were internal evaluations, one was externally commissioned on behalf

of commissioners.

Limitations to the service mapping

Not all service providers were captured within the service mapping.

One service did not return their completed service mapping template following the

one to one interview. There were a few other service providers who were not

captured within this service mapping.

None of the services included could complete the template fully, availability of

information depended on information systems used and how data was captured and

stored. This limited the number of comparisons that could be made between all the

completed data.

All of the ADP Support Team was involved in conducting one to one interviews with

service providers. Although there was a universal level of understanding of


Page 59 of 66

information was required from each question, differences arose in data collected if

services couldn’t provide the specifics of what was requested. In these cases the

interviewer considered the information that could be made available and advised

service accordingly.

Considerations

Service commissioning and planning locally continues to be based on the Functional

Model of Treatment and Care. However, this is currently being reviewed so that a

recovery focused model of care can be implemented across Ayrshire and Arran.

Bibliography

� Treatment and Rehabilitation Paper for the Alcohol and Drug Action Team. Prepared by

Treatment and Rehabilitation (Addictions) Group (November 2004)

� Functional Model for the planning, development and delivery of Addiction Services

across Ayrshire and Arran. Prepared by Treatment and Rehabilitation (Addictions)

Group (August 2005)

� Tackling Drugs in Scotland: Action in Partnership The Scottish Office, March 1999

� Plan for Action on Alcohol Problems Scottish Executive January 2002


Page 60 of 66

Appendix 1: Needs Assessment – Local Treatment Services Mapping Exercise Functional Model of Treatment and Care – Current Services arranged into phases

East North South Phase A & E Alcohol Liaison

A & E Alcohol Liaison

A & E Alcohol Liaison

Pre-phase 1

NHS Addiction Services Community Addiction Team NHS Addiction Services Primary Care Addiction Team Drug Testing & Treatment Orders HMP Kilmarnock

NHS Addiction Services Community Addiction Team NHS Addiction Services Primary Care Addiction Team North Ayrshire Addiction Services Drug Testing & Treatment Orders HMP Kilmarnock

NHS Addiction Services Community Addiction Team NHS Addiction Services Primary Care Addiction Team Drug Testing & Treatment Orders HMP Kilmarnock

1

SEASTAR Turning Point Scotland Ayrshire Council on Alcohol Addaction (Community Alcohol Rehabilitation Service) HMP Kilmarnock

North Ayrshire Addiction Service Ayrshire Council on Alcohol Addaction (Community Alcohol Rehabilitation Service) HMP Kilmarnock Fullarton Community Health House CRAFT

SEASTAR Turning Point Scotland Ayrshire Council on Alcohol Addaction (Community Alcohol Rehabilitation Service) HMP Kilmarnock

2

Addaction (SMART Recovery) Momentum Accelerate Condition Management Apex Scotland Alcoholics Anonymous Narcotics Anonymous Structured Deferred Sentence

Addaction SMART Recovery Momentum Accelerate Fullarton Community Health House CRAFT Condition Management Apex Scotland North Ayrshire Women’s Aid Structured Deferred Sentence Alcoholics Anonymous Narcotics Anonymous

Addaction (financial inclusion pilot) Addaction SMART Recovery Momentum Accelerate Condition Management Apex Scotland Structured Deferred Sentence Arrest Referral and Diversion Alcoholics Anonymous Narcotics Anonymous

3


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CHAPTER 4 REVIEW OF EVIDENCE-BASED PRACTICES Information gleaned from reviewing the scientific literature, conducting clinical or

epidemiological studies and from considering expert opinion is vital in working

towards more effective and efficient services. Evidence-based practices can be

defined as interventions that have shown consistent scientific evidence of being

related to preferred client outcomes.

The Scottish Government is placing greater emphasis on outcome improvement and

accountability. Future funding for community agencies will increasingly be tied to

treatment outcomes. There will continue to be increased pressure on agencies and

researchers to collaborate on projects that connect science and services within

treatment settings. This alone indicates a need for practitioners to increase their

awareness and use of scientific research findings.

It is also important to note, however, that client retention in addiction treatment is also

tied to positive outcomes. The longer patients are engaged in treatment activities, the

better the outcomes are. If specific treatment methods demonstrate improved

retention rates they may be preferable to some existing practices.

The following tables summarise the evidence from scientific literature about service

interventions applicable for use with people who have alcohol and drug problems.

The interventions are:


Page 62 of 66

Brief intervention Short 10-15 minute opportunistic assessment and intervention

about harmful and hazardous alcohol consumption.

Social skills

training

Group therapy teaches basic skills in dealing with work, family

and other interpersonal interventions.

Community

Reinforcement

Approach (CRA)

Cognitive behaviour approach utilising specific types of

counselling and skills training tailored to individual needs.

Behavioural

contracting

Client agrees to engage through a contract in recovery

orientated activities or to alter a specific behaviour.

Cognitive

behavioural

interventions

A range of talking therapies containing two specific

components.

1. Identifying the specific needs that alcohol and drugs are

being used to meet

2. Developing skills that develop alternative ways of meeting

those needs.

Motivational

Enhancement

therapy

Seeks to evoke from clients their own motivation for change

and to consolidate the personal decision and planning for

change.

12-step

facilitation

therapies

This refers to independent treatment interventions designed to

familiarise people with the 12-step philosophy and encourage

participation in 12-step activities.

Contingency

management

The systematic reinforcement of desired behaviours and the

withholding of reinforcement or punishment of undesired

behaviours through incentives.

Pharmacological

therapies

Medications designed to treat or stabilise alcohol or drug

problems

Systems

Treatment

Refers to treating the client in their natural social environment


Page 63 of 66

Intervention Setting Mode of

Delivery Staffing Resource Target Client

group Effectiveness Cost

effectiveness Brief Intervention

Primary Care

1:1 On-line

Non-addiction professionals

Staff training 2-3 days with follow-up supervision

All adults screened and found to have harmful / hazardous / early dependence

56 controlled trials 14+ meta-analysis or systematic reviews

Yes

Social skills training

Community or hospital settings Schools

1:1 and groups

All staff groups and peers

Training in peer leadership communications Anger management Conflict resolution Assertiveness and relaxation techniques.

Whole population School students

RCTs meta-analysis qualitative studies

Yes – economic evaluations

Community Reinforcement Approach (CRA)

Community crucial to involve concerned significant others

1:1 and groups

Trained MI and CBT staff

Training in CRA techniques

Harmful and hazardous and dependent drinkers (people with severe alcohol dependence may need pharmaco-therapy)

RCTs meta-analysis qualitative studies

Yes – economic evaluations Meta-analytic reviews.


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Intervention Setting Mode of Delivery

Staffing Resource Target Client group

Effectiveness Cost effectiveness

Behavioural contracting

No specific setting works better than others

1:1 and groups. Works best in combination with other interventions and concerned significant others.

All staff groups and peers

None Anyone with any level of alcohol and / or drug problem

Controlled studies Qualitative studies

Yes Meta-analytic reviews.

Cognitive Behavioural Interventions (includes a range of talking therapies13)

No specific setting – determined by clinical need

1:1 – normally offered in six sessions

All staff groups

Training required determined by clinical need

Heavy/ hazardous but not dependent alcohol and / or drug users

Controlled studies Qualitative studies Highly ranked in meta-analysis for relapse prevention

Yes Strong level of empirical support

Motivational Enhancement Therapy

Community and hospital settings

1:1 and groups

Need to be a certified counsellor i.e. COSCA qualification

Cost of training

Mild to moderate alcohol and drug problems

Meta-analysis Qualitative studies

Yes

13 CBI includes for example family therapy, behavioural couple therapy, marital relational therapy, relapse prevention


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12-Step facilitation therapy


1:1 – normally offered in 12 – 15 sessions

Specialist alcohol and drug staff, general staff and peers

Trained in 12-step facilitation techniques. Manual and facilitator time

Moderate to severe and dependent alcohol and / or drug problems

Controlled studies Qualitative studies Meta-analysis

Yes -

Contingency management


1:1 and groups

All staff groups

Financial resource for incentives

Dependent alcohol and / or drug use.

RCTs Controlled studies Qualitative studies Meta-analysis. Good evidence base in connection with opioid, alcohol and stimulant use.

Some criticism about the associated costs.

Pharmacological therapies14

Clinical in-patient or out-patient

1:1 Psychiatry specialists GP with special interest and Nurse practitioners

Pharmaceutical and associated on-costs

Dependent opioid or alcohol users

11 RCTs Qualitative studies from psychiatry

Yes –positive health gains

14 Pharmacological therapies include methadone, buprenorphine alone or in combination with naloxone (Suboxone), disulfiram (Antabuse), benzodiazapines and antidepressants


Page 66 of 66




Systems treatment

Community And clinical settings

1:1 and groups

All staff groups

Staff time, manuals etc

Harmful and hazardous, Dependent alcohol and / or drug users. Families and concerned significant others

Qualitative Studies Meta-analytical studies

Yes – positive health and societal gains

A Needs Assessment for Alcohol and Drug services … adp...South Ayrshire ADP Needs Assessment Local Report (2010) Page 2 of 66 Steering Group for Alcohol and Drugs Needs Assessment

Documents