1. BA (Hons) Youth Studies: Health and Justice Modules Lecture : Substance misuse and harm reduction

2. 15 July 2016 2 Facts and Figures The overall number of under-18s accessing specialist substance misuse services in England during 2008-09 was 24,053. Drug and alcohol use among young people is declining, but increased availability of services means many more young people are getting help. Almost nine out of ten young people are receiving help for problems associated with the misuse of cannabis and/or alcohol. NTA, 2010

3. Young People in treatment by Substance 15 July 2016 3

4. Numbers in Treatment by Age and Substance 2008-2009 15 July 2016 4

5. Substance Misuse and Young People “Substance misuse is often a peer-related activity and using drugs has been found to be the predictor of serious or persistent offending among boys aged 12-17 (Flood-Page etal, 20000. There is also evidence that young people who are ‘heavy’ or ‘binge’ drinkers are more likely to be involved in violent offences (Honess etal, 2000)” in Whyte, 2009 p40 There is a high level of substance misuse generally by children in the UK, “while for the majority, this is largely experimental, a significant majority will develop substance misuse problems” Stephenson, 2007: p112 It is hard to accurately link substance misuse to offending by young people 15 July 2016 5

6. Substance Misuse and Young People “Most young people who use substances do not experience long-term or significant harm and most reduce or stop using drugs over time and reduce their alcohol use” (Keeling, 2004) in Stephenson, 2007,p113 OCJS household survey reported that 66% of 10-17 year olds who had taken a drug in the last year had committed an offence compared to 23% who had not taken a drug. “Frequent drug users were more likely to offend than occasional drug users.” ibid “Frequent substance misuse may be associated with young people in vulnerable groups, in particular those at risk of offending and reoffending.” Stephenson, 2007, p.124 15 July 2016 6

7. Factors that increase vulnerability to substance misuse having a family member that misuses drugs and/or alcohol having behavioural, mental health or social problems being excluded from school or a persistent truant being a young person who commits criminal offences being ‘looked after’ being homeless being involved in commercial sex work or sexual exploitation being from some Black or Minority Ethnic groups. YJB, 2008, p.8 15 July 2016 7

8. Harm reduction- a definition “Harm reduction combines work aimed directly at reducing the number of drug-related deaths and blood-borne virus infections, with wider goals of preventing drug misuse and of encouraging stabilisation in treatment and support for abstinence. Providing effective substitution treatments and effective support for abstinence are complementary aims of such a balanced response.” (Dept of Health & NTA, 2007) 15 July 2016 8

9. Harm Minimisation Harm Minimisation is about educating substance users to the risks of taking substances and helping them look at ways of reducing risks to themselves and others. It is not necessarily about not using drugs, it is about using them more safely and limiting the risks they may cause. The ultimate form of harm reduction remains abstinence (NOMS, 2007) 15 July 2016 9

10. Areas of Harm Reduction 15 July 2016 10 User Family Friends Society

11. 15 July 2016 11 Consent to Treatment Even where a court mandates a treatment an offender has the option of refusing treatment and receiving an alternative sentence. Informed consent means the person giving the consent must: understand the reason for the intervention, what is likely to happen without it, the range of possible alternative interventions, and the benefits, composition and any possible negative consequences

12. 15 July 2016 12 Consent to Treatment “ Active participation of parents/carers should be encouraged, both because their consent may be legally required and because it has been shown to improve the effectiveness of treatment interventions for substance misuse (McIntosh et al, 2006)” Young people aged 16 or 17 years can usually consent to treatment, unless they have severely diminished ability to understand the treatment, in which case the parental responsibility holder would be required to consent to their treatment until they reach 18 years of age. in YJB, 2008, p.24

13. Gillick guidelines Young people under 16 have a right to confidential medical advice and treatment if the provider assesses that: the young person understands the advice and has the maturity to understand what is involved the young person’s physical/mental health will suffer if they do not have treatment it is in the provider’s best interest to give such advice and treatment without parental consent the young person will continue to put themselves at risk of harm if they do not have advice and treatment the young person cannot be persuaded by the doctor or health professional to inform parental responsibility holders, nor allow the doctor to inform them. 15 July 2016 13

14. 15 July 2016 14 to escape from problems; to alleviate boredom; for ‘the buzz’; to feel more confident; to ease physical pain; to look hard to fit in; as a result of peer pressure; out of curiosity; and to follow the example of others. Reasons given for using drugs

15. Motivations for not using drugs 15 July 2016 15 Relating to their lifestyle aspirations and relationships: other people’s disapproval; legal consequences; role as parent; career aspirations. Relating to the practicalities of being a user : availability of time; financial cost. Relating to the physical and psychological effects of drugs: personal experiences with drugs; current health conditions/difficulties; fear of effect on health; fear of addiction; fear of losing control. Relating to some of the perceived benefits of using drugs: sources of ‘buzz’; sources of support/coping mechanisms.

16. 16 Drugs Worker Role To provide advice and support around harm reduction, relapse prevention and interventions to all young people entering the criminal justice system assessed as having a problematic drug or alcohol need. To provide targeted interventions and co-work Specialist cases. To provide support, advice and training at universal level to colleagues within the Youth Offending Service. To provide an holistic approach when conducting drug assessments. To access appropriate treatment and service provision

17. 15 July 2016 17 References BRITTON, J. and FARRANT, F. (2008), Substance Misuse Source Document, London YJB HAMMERSLEY, R. MARSLAND, L. and REID M., (2003), Substance Misuse by Young Offenders, Findings 192, London; RDS Home Office HOME OFFICE,(2007), Identifying and exploring young people’s experiences of risk, protective factors and resilience to drug use, London; RDS Home Office MILLER, T., JONES, A, DONMALL, M. and ROXBOROUGH, M. (2008), Changes in offending following prescribing treatment for drug misuse, London; NTA NSPCC, (2009), What do 'Gillick competency' and 'Fraser guidelines' refer to? Available at http://www.nspcc.org.uk/Inform/research/questions/gillick_wda6128 9.html accessed on 28.2.2010 http://www.nspcc.org.uk/Inform/research/questions/gillick_wda6128 9.html

18. 15 July 2016 18 References NTA, (2009), Reducing Drug-Related Harm: an Action Plan, Available at http://www.nta.nhs.uk/areas/harm_reduction/default.aspx Accessed on 1.3.2010http://www.nta.nhs.uk/areas/harm_reduction/default.aspx NTA, (2010), Substance Misuse among young people The data for 2008-09 ; London, NTA NOMS, (2007), IDTS Resource Pack, Session 2 Harm Reduction. London ; Ministry of Justice STEPHENSON, M., GILLER, H., and BROWN, S., (2007). Effective Practice in Youth Justice. Cullompton: Willan Publishing. WHYTE, B., (2009). Youth Justice in Practice; Making a Difference. Bristol: The Policy Press.