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Pedagogy in Practice: Addiction and substance use - session evaluation

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1. Both substance misuse and substance use disorders harm the health and well-being of individuals and communities. Addressing them requires implementation of effective strategies

Substance misuse is the use of alcohol or illicit or prescription drugs in a manner that may cause harm to users or to those around them. Harms can include overdoses, interpersonal violence, motor vehicle crashes, as well as injuries, homicides, and suicides-the leading causes of death in adolescents and young adults (aged 12 to 25). In 2015, 47.7 million Americans used an illicit drug or misused a prescription medication in the past year, 66.7 million binge drank in the past month, and 27.9 million self-reported driving under the influence (DUI) in the past year.

Substance use disorders are medical illnesses that develop in some individuals who misuse substances-more than 20 million individuals in 2015. These disorders involve impaired control over substance use that results from disruption of specific brain circuits. Substance use disorders occur along a continuum from mild to severe; severe substance use disorders are also called addictions. Because substances have particularly powerful effects on the developing adolescent brain, young adults who misuse substances are at increased risk of developing a substance use disorder at some point in their lives.

Implications for Policy and Practice

Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it. Although they cannot address the chronic, severe impairments common among individuals with substance use disorders, education, regular monitoring, and even modest legal sanctions may significantly reduce substance misuse in the wider population. Additionally, these measures are cost-effective. Many policies at the federal, state, local, and tribal levels that aim to reduce the harms associated with substance use have proven very effective in preventing and reducing alcohol misuse (e.g., binge drinking) and its consequences. More than 300,000 deaths have been avoided over the past decade simply from the implementation and enforcement of effective policies to reduce underage drinking and DUI. Needle/syringe exchange programs also represent effective and cost-effective prevention strategies that have been shown to reduce the transmission of HIV in communities implementing them, without increasing rates of injection drug use. These programs also provide the opportunity to engage people who inject drugs in treatment. These types of effective prevention policies can and should be adapted and extended to reduce the injuries, disabilities, and deaths caused by substance misuse.

2. Highly effective community-based prevention programs and policies exist and should be widely implemented

This Report describes the significant advances in prevention science over the past two decades, including the identification of major risk and protective factors and the development of more than four dozen research-tested prevention interventions that can be delivered in households, schools, clinical settings, and community centers. Three key findings from the Report are especially important in this regard. First, science has shown that adolescence and young adulthood are major "at risk" periods for substance misuse and related harms. Second, most of the major genetic, social, and environmental risk factors that predict substance misuse also predict many other serious adverse outcomes and risks. Third, several community-delivered prevention programs and policies have been shown to significantly reduce rates of substance-use initiation and misuse-related harms.

Prevention programs and interventions can have a strong impact and be cost-effective, but only if evidence-based components are used and if those components are delivered in a coordinated and consistent fashion throughout the at-risk period. Parents, schools, health care systems, faith communities, and social service organizations should be involved in delivering comprehensive, evidence-based community prevention programs that are sustained over time.

Additionally, research has demonstrated that policies and environmental strategies are highly effective in reducing alcohol-related problems by focusing on the social, political, and economic contexts in which these problems occur. These evidence-based policies include regulating alcohol outlet density, restricting hours and days of sale, and policies to increase the price of alcohol at the federal, state, or local level.

Implications for Policy and Practice

To be effective, prevention programs and policies should be designed to address the common risk and protective factors that influence the most common health threats affecting young people. They should be tested through research and should be delivered continuously throughout the entire at-risk period by those who have been properly trained and supervised to use them. Federal and state funding incentives could increase the number of properly organized community coalitions using effective prevention practices that adhere to commonly defined standards. The research reviewed in this Report suggests that such coordinated efforts could significantly improve the impact of existing prevention funding, programs, and policies, enhancing quality of life for American families and communities.

3. Full integration of the continuum of services for substance use disorders with the rest of health care could significantly improve the quality, effectiveness, and safety of all health care

Individuals with substance use disorders at all levels of severity can benefit from treatment, and research shows that integrating substance use disorder treatment into mainstream health care can improve the quality of treatment services. Historically, however, only individuals with the most severe substance use disorders have received treatment, and only in independent "addiction treatment programs" that were originally designed in the early 1960s to treat addictions as personality or character disorders. Moreover, although 45 percent of patients seeking treatment for substance use disorders have a co-occurring mental disorder, most specialty substance use disorder treatment programs are not part of, or even affiliated with, mental or physical health care organizations. Similarly, most general health care organizations-even teaching hospitals-do not provide screening, diagnosis, or treatment for substance use disorders.

This separation of substance use disorder treatment from the rest of health care has contributed to the lack of understanding of the medical nature of these conditions, lack of awareness among affected individuals that they have a significant health problem, and slow adoption of scientifically supported medical treatments by addiction treatment providers. Additionally, mainstream health care has been inadequately prepared to address the prevalent substance misuse-related problems of patients in many clinical settings. This has contributed to incorrect diagnoses, inappropriate treatment plans, poor adherence to treatment plans by patients, and high rates of emergency department and hospital admissions.

The goals of substance use disorder treatment are very similar to the treatment goals for other chronic illnesses: to eliminate or reduce the primary symptoms (substance use), improve general health and function, and increase the motivation and skills of patients and their families to manage threats of relapse. Even serious substance use disorders can be treated effectively, with recurrence rates equivalent to those of other chronic illnesses such as diabetes, asthma, or hypertension. With comprehensive continuing care, recovery is an achievable outcome: More than 25 million individuals with a previous substance use disorder are estimated to be in remission. Integrated treatment can dramatically improve patient health and quality of life, reduce fatalities, address health disparities, and reduce societal costs that result from unrecognized, unaddressed substance use disorders among patients in the general health care system. However, most existing substance use disorder treatment programs lack the needed training, personnel, and infrastructure to provide treatment for co-occurring physical and mental illnesses. Similarly, most physicians, nurses, and other health care professionals working in general health care settings have not received training in screening, diagnosing, or addressing substance use disorders.

Implications for Policy and Practice

Policy changes, particularly at the state level, are needed to better integrate care for substance use disorders with the rest of health care. States have substantial power to shape the nature of care within these programs. State licensing and financing policies should be designed to better incentivize programs that offer the full continuum of care (residential, outpatient, continuing care, and recovery supports); offer a full range of evidence-based behavioral treatments and medications; and maintain working affiliations with general and mental health care professionals to integrate care. Within general health care, federal and state grants and development programs should make eligibility contingent on integrating care for mental and substance use disorders or provide incentives for organizations that support this type of integration.

But integration of mental health and substance use disorder care into general health care will not be possible without a workforce that is competently cross-educated and trained in all these areas. Currently, only 8 percent of American medical schools offer a separate, required course on addiction medicine and 36 percent have an elective course; minimal or no professional education on substance use disorders is available for other health professionals. Federal and state policies should require or incentivize medical, nursing, dental, pharmacy, and other clinical professional schools to provide mandatory courses to properly equip young health care professionals to address substance misuse and related health consequences. Similarly, associations of clinical professionals should continue to provide continuing education and training courses for those already in practice.

4. Coordination and implementation of recent health reform and parity laws will help ensure increased access to services for people with substance use disorders

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the 2010 Affordable Care Act increased access to coverage for mental health and substance use disorder treatment services for more than 161 million Americans. Even so, just 10.4 percent of people with substance use disorders who need treatment are accessing care. These pieces of legislation, besides promoting equity, make good long-term economic sense: Research reviewed in Chapter 6 - Health Care Systems and Substance Use Disorders highlights the extraordinary costs to society from unaddressed substance misuse and from untreated or inappropriately treated substance use disorders-more than $422 billion annually (including more than $120 billion in health care costs). However, there remains great uncertainty on the part of affected individuals and their families, as well as among many health care professionals, about the nature and range of health care benefits and covered services available for prevention, early intervention, and treatment of substance use disorders.

Implications for Policy and Practice

Enhanced federal communication will help increase public understanding about individuals' rights to appropriate care and services for substance use disorders. This communication could help eliminate confusion among patients, providers, and insurers. But, more will be needed to extend the reach of treatment and thereby reduce the prevalence, severity, and costs associated with substance use disorders. Within health care organizations, active screening for substance misuse and substance use disorders combined with effective communication around the availability of treatment programs could do much to engage untreated individuals in care. Screening and treatment must incorporate brief interventions for mildly affected individuals as well as the full range of evidence-based behavioral therapies and medications for more severe disorders, and must be provided by a fully trained complement of health care professionals.

5. A large body of research has clarified the biological, psychological, and social underpinnings of substance misuse and related disorders and described effective prevention, treatment, and recovery support services. Future research is needed to guide the new public health approach to substance misuse and substance use disorders

Five decades ago, basic, pharmacological, epidemiological, clinical, and implementation research played important roles in informing a skeptical public about the harms of cigarette smoking and creating new and better prevention and treatment options. Similarly, research reviewed in this Report should eliminate many of the long-held, but incorrect, stereotypes about substance misuse and substance use disorders, such as that alcohol and drug problems are the product of faulty character or willful rejection of social norms.

Thanks to scientific research over the past two decades, we know far more about alcohol and drugs and their effects on health than we knew about the effects of smoking when the first Surgeon General's Report on Smoking and Health was released in 1964. For instance, we now know that repeated substance misuse carries the greatest threat of developing into a substance use disorder when substance use begins in adolescence. We also know that substance use disorders involve persistent changes in specific brain circuits that control the perceived value of a substance as well as reward, stress, and executive functions, like decision making and self-control.

However, although this body of knowledge provides a firm foundation for developing effective prevention, early intervention, treatment, and recovery strategies, achieving the vision of this Report will require redoubled research efforts. We still do not fully understand how the brain changes involved in substance use disorders occur, how individual biological and environmental risk factors contribute to those changes, or the extent to which these brain changes reverse after long periods of abstinence from alcohol or drug use.

Implications for Policy and Practice

Future research should build upon our existing knowledge base to inform the development of prevention and treatment strategies that more directly target brain circuit abnormalities that underlie substance use disorders; identify which prevention and treatment interventions are most effective for which patients (personalizing medicine); clarify how the brain and body regain function and recover after chronic drug exposure; and inform the development of evidence-based strategies for supporting recovery. Also critically needed are long-term prospective studies of youth (particularly those deemed most at risk) that will concurrently study changes in personal and environmental risks; the nature, amount, and frequency of substance use; and changes in brain structure and function.

To guide the important system-wide changes recommended in this Report, research to optimize strategies for broadly and sustainably implementing evidence-based prevention, treatment, and recovery interventions across the community is necessary. Within traditional substance use disorder treatment programs, research is needed on how to use new insurance benefits and financing models to enhance service delivery most effectively, how to form working alliances with general physical and mental health providers, and how to integrate new technologies and information systems to enhance care without compromising patient confidentiality.

Individuals and Families

Reach out, if you think you have a problem

In the past, many individuals and families have kept silent about substance-related issues because of shame, guilt, or fear of exposure or recrimination. Breaking the silence and isolation around such issues is crucial, so that individuals and families confronting substance misuse and its consequences know that they are not alone and can openly seek treatment. As with other chronic illnesses, the earlier treatment begins, the better the outcomes are likely to be.

Be supportive (not judgmental) if a loved one has a problem

Recognizing that substance use disorders are medical conditions and not moral failings can help remove negative attitudes and promote open and healthy discussion between individuals with substance use disorders and their loved ones, as well as with their health care professionals. Overcoming the powerful drive to continue substance use can be difficult, and making the lifestyle changes necessary for successful treatment-such as changing relationships, jobs, or living environments-can be daunting. Providing sensitivity and support can ease this transition.

This can be challenging for partners, parents, siblings, and other loved ones of people with substance use disorders; many of the behaviors associated with substance misuse can be damaging to relationships. Being compassionate and caring does not mean that you do not hold the person accountable for their actions. It means that you see the person's behaviors in the light of a medical illness. Love and support can be offered while maintaining the boundaries that are important for your health and the health of everyone around you.

Show support toward people in recovery

As a community, we typically show empathy when someone we know is ill, and we celebrate when people we know overcome an illness. Extending these kindnesses to people with substance use disorders and those in recovery can provide added encouragement to help them realize and maintain their recovery. It also will encourage others to seek out treatment when they need it.

Advocate for the changes needed in your community

As discussed throughout this Report, many challenges need to be addressed to support a public health-based approach to substance misuse and related disorders. Everyone can play an important role in advocating for their needs, the needs of their loved ones, and the needs of their community. It is important that all voices are heard as we come together to address these challenges.

Parents, talk to your children about alcohol and drugs

Parents have more influence over their children's behavior, including substance use, than they often think. For instance, according to one study, young adults who reported that their parents monitored their behavior and showed concern about them were less likely to report misusing substances. Talking to your children about alcohol and drug use is not always easy, but it is crucial. Become informed, from reliable sources, about substances to which your children could be exposed, and about substance use disorders, and talk openly with your children about the risks. Some tips to keep in mind:

Set clear expectations about alcohol and drug use, including real consequences for not following family rules;

Help your child deal with peer pressure;

Get to know your child's friends and their parents;

Talk to your child early and often; and

Support your school district's efforts to implement evidence-based prevention interventions and treatment and recovery support.

Educators and Academic Institutions

Implement evidence-based prevention interventions

Schools represent one of the most effective channels for influencing youth substance use. Many highly effective evidence-based programs are available that provide a strong return on investment, both in the well-being of the children they reach and in reducing long-term societal costs. Prevention programs for adolescents should target improving academic as well as social and emotional learning to address risk factors for substance misuse, such as early aggression, academic failure, and school dropout.

When combined with family-based and community programs that present consistent messages, these programs are even more powerful. Interventions that target youth who have already initiated use of alcohol or drugs should also be implemented to prevent escalation of use. Colleges, too, should implement EBIs to reduce student alcohol misuse.

Provide treatment and recovery supports

Many students lack regular access to the health care system. For students with substance use problems, schools-ranging from primary school through university-can provide an entry into treatment and support for ongoing recovery. School counselors and school health care programs can provide enrolled students with screening, brief counseling, and referral to more comprehensive treatment services. Schools can also help create a supportive environment that fosters recovery. Many institutions of higher learning incorporate collegiate recovery programs that can make a profound difference for young people trying to maintain recovery in an environment with high rates of substance misuse.

Teach accurate, up-to-date scientific information about alcohol and drugs and about substance use disorders as medical conditions

Teachers, professors, and school counselors play an obvious and central role as youth influencers, teaching students about the health consequences of substance use and misuse and about substance use disorders as medical conditions, as well as facilitating open dialogue. They can also play an active role in educating parents and community members on these topics and the role they can play in preventing youth substance use. For example, they can educate businesses near schools about the positive impact of strong enforcement of underage drinking laws and about the potential harms of synthetic drugs (such as K2 and bath salts), to discourage their sale. They can also promote non-shaming language that underscores the medical nature of addiction-for instance avoiding terms like "abuser" or "addict" when describing people with substance use disorders.

Enhance training of health care professionals

As substance use treatment becomes more integrated with the health care delivery system, there is a need for advanced education and training for providers in all health care roles and disciplines, including primary care doctors, nurses, specialty treatment providers, and prevention and recovery specialists. It is essential that professional schools of social work, psychology, public health, nursing, medicine, dentistry, and pharmacy incorporate curricula that reflect the current science of prevention, treatment, and recovery. Health care professionals must also be alert for the possibility of adverse drug reactions (e.g., co-prescribing of drugs with similar effects, drug overdoses), and co-occurring psychiatric conditions and infectious diseases, and should be trained on how to address these issues. These topics should also be covered in formal post-graduate training programs (e.g., physician residencies and psychology internships) as well as in board certification and continuing education requirements for professionals in these fields. Continuing education should include not only subject matter knowledge but the professional skills necessary to provide integrated care within cross-disciplinary health care teams that address substance-related health issues.

Health Care Professionals and Professional Associations

Address substance use-related health issues with the same sensitivity and care as any other chronic health condition

All health care professionals-including physicians, physician assistants, nurses, nurse practitioners, dentists, social workers, therapists, and pharmacists-can play a role in addressing substance misuse and substance use disorders, not only by directly providing health care services, but also by promoting prevention strategies and supporting the infrastructure changes needed to better integrate care for substance use disorders into general health care and other treatment settings.

Support high-quality care for substance use disorders

Professional associations can be instrumental in setting workforce guidelines, advocating for curriculum changes in professional schools, promoting professional continuing education training, and developing evidence-based guidelines that outline best practices for prevention, screening and assessment, brief interventions, diagnosis, and treatment of substance-related health issues. For example, to help address the current prescription opioid crisis and overdose epidemic, associations should raise awareness of the most recent guidelines for opioid prescribing and commend the use of PDMPs by providers. Associations also should raise awareness of the benefits of making naloxone more readily available without a prescription and providing legal protection to physician-prescribers and bystanders ("Good Samaritans") who administer naloxone when encountering an overdose situation.

Health Care Systems

Promote primary prevention

Health care systems can help prevent prescription drug misuse and related substance use disorders by holding staff accountable for safe prescribing of controlled substances, training staff on alternative ways of managing pain and anxiety, and increasing use of PDMPs by pharmacists, physicians, and other providers.

Promote use of evidence-based treatments

Substance use disorders cannot be effectively addressed without much wider adoption and implementation of scientifically tested and proven effective behavioral and pharmacological treatments. The full spectrum of evidence-based treatments should be available across all contexts of care, and treatment plans should be tailored to meet the specific needs of individual patients. Health care systems should take every step to educate health care professionals and the public about the value of MAT for alcohol and opioid use disorders, correcting misconceptions that have barred their wider adoption in the past.

Promote effective integration of prevention and treatment services

Effective integration of behavioral health and general health care is essential for identifying patients in need of treatment, engaging them in the appropriate level of care, and ensuring ongoing monitoring of patients with substance use disorders to reduce their risk of relapse. Implementation of systems to support this type of integration requires care and foresight and should include educating and training the relevant workforces; developing new workflows to support universal screening, appropriate follow-up, coordination of care across providers, and ongoing recovery management; and linking patients and families to available support services. Quality measurement and improvement processes should also be incorporated to ensure that the services provided are effectively addressing the needs of the patient population and improving outcomes.

Work with payors to develop and implement comprehensive billing models

Consideration of how payors can develop and implement comprehensive billing models is crucial to enabling health care systems to sustainably implement integrated services to address substance use disorders. Coverage policies will need to be updated to support implementation of prevention measures, screening, brief counseling, and recovery support services within the general health care system, and to support coordination of care between specialty substance use disorder treatment programs, mental health organizations, and the general health care system.

Implement health information technologies to promote efficiency and high-quality care

Health information technology-ranging from electronic health records to patient registries, computer-based educational systems, and mobile applications-has the power to increase efficiency, improve clinical decision making, supplement patient services, extend the reach of the workforce, improve quality measurement, and support a "learning health care system." Health care systems should explore how these and other technologies can be used to support substance use disorder prevention, treatment, and recovery.

Communities

Build awareness of substance use as a public health problem

Civic and advocacy groups, neighborhood associations, and community-based organizations can all play a major role in communication, education, and advocacy efforts that seek to address substance use-related health issues. These organizations provide community leadership and communicate urgent and emerging issues to specific audiences and constituencies. Communication vehicles such as newsletters, blogs, op-ed articles, and storytelling can be used to raise awareness and underscore the importance of placing substance use-related health issues in a public health framework. Community groups and organizations can host community forums, town hall meetings, listening sessions, and education and awareness days. These events foster public discourse, create venues in which diverse voices can be heard, and provide opportunities to educate the community. In addition, they can promote an awareness of the medical nature of addiction, to encourage acceptance of opioid treatment programs and other substance use disorder treatment services embedded in the community. Communities also can sponsor prevention and recovery campaigns, health fairs, marches, and rallies that emphasize wellness activities that bring attention to substance use-related health issues.

Invest in evidence-based prevention interventions and recovery supports

Prevention research has developed effective community-based prevention programs that reduce substance use and delinquent behavior among youth. Although the process of getting these programs implemented in communities has been slow, resources are available to help individual communities identify the risk factors for future substance use among youth that are most prevalent within their community and choose evidence-based prevention strategies to address them. Research shows that for each dollar invested in research-based prevention programs, up to $10 is saved in treatment for alcohol or other substance misuse-related costs.

Implement interventions to reduce harms associated with alcohol and drug misuse

An essential part of a comprehensive public health approach to addressing substance misuse is wider use of strategies to reduce individual and societal harms, such as overdoses, motor vehicle crashes, and the spread of infectious diseases. Communities across the country are implementing programs to distribute naloxone to first responders, opioid users, and potential bystanders, preventing thousands of deaths. Others have implemented needle/syringe exchange programs, successfully reducing the spread of HIV and Hepatitis C without seeing an increase in injection drug use. These and other evidence-based strategies can have a profound impact on the overall health and well-being of the community.

Private Sector: Industry and Commerce

Promote only responsible, safe use of legal substances, by adults

Companies that manufacture and sell alcohol and legal drugs, as well as products related to use of these substances, can demonstrate social responsibility by taking measures to discourage and prevent the misuse of their products. Companies can take steps to ensure that the public is aware of the risks associated with substance use, including the use of medications with addictive potential alone and in combination with alcohol or other drugs.

Support youth substance use prevention

Manufacturers and sellers of alcohol, legal drugs, and related products have a role in reducing and preventing youth substance use. They can discourage the sale and promotion of alcohol and other substances to minors and support evidence based programs to prevent and reduce youth substance use.

Continue to collaborate with the federal initiative to reduce prescription opioid- and heroin-related overdose, death, and dependence

Pharmaceutical companies and pharmacies can continue to collaborate with the U.S. Department of Health and Human Services to identify and implement evidence-informed solutions to the current opioid crisis. This collaboration may include examining and revising product labeling, funding continuing medical education for providers on the appropriate use of opioid medications, developing abuse-deterrent formulations of opioids, prioritizing development of non-opioid alternatives for pain relief, and conducting studies to determine the appropriate dosing of opioids in children and safe prescribing practices for both children and adults.

Federal, State, Local, and Tribal Governments

Provide leadership, guidance, and vision in supporting a science-based approach to addressing substance use-related health issues

Coordinated federal, state, local, and tribal efforts are needed to promote a public health approach to addressing substance use, misuse, and related disorders. As discussed throughout this Report, widespread cultural and systemic issues need to be addressed to reduce the prevalence of substance misuse and related public health consequences. Government agencies have a major role to play in:

Improving public education and awareness;

Conducting research and evaluations;

Monitoring public health trends;

Providing incentives, funding, and assistance to promote implementation of effective prevention, treatment, and recovery practices, policies, and programs;

Addressing legislative and regulatory barriers;

Improving coordination between health care, criminal justice, and social service organizations; and

Fostering collaborative initiatives with the private sector.

For example, federal and state agencies can implement policies to integrate current best practices-such as the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain or mandatory use of PDMPs-among federal and state supported service providers.

Improve coordination between social service systems and the health care system to address the social and environmental factors that contribute to the risk for substance use disorders

Social service systems serve individuals, families, and communities in a variety of capacities, often in tandem with the health care system. Social workers can play a significant role in helping patients with substance use disorders with the wrap-around services that are vital for successful treatment, including finding stable housing, obtaining job training or employment opportunities, and accessing recovery supports and other resources available in the community. In addition, they can coordinate care across providers, offer support for families, and help implement prevention programs. Child and family welfare systems also should implement trauma-informed, recovery-oriented, and public health approaches for parents who are misusing substances, while maintaining a strong focus on the safety and welfare of children.

Implement criminal justice reforms to transition to a less punitive and more health-focused approach

The criminal justice and juvenile justice systems can play pivotal roles in addressing substance use-related health issues across the community. These systems are engaged with a population at high-risk for substance use disorders and often at a teachable moment-when individuals are more open to prevention messaging or to accepting the need for treatment. Less punitive, health-focused initiatives can have a critical impact on long-term outcomes. Sheriff's offices, police departments, and county jails should work closely with citizens' groups, prevention initiatives, treatment agencies, and recovery community organizations to create alternatives to arrest and lockup for nonviolent and substance use-related offenses. For example, drug courts have been a very successful model for diverting people with substance use disorders away from incarceration and into treatment. It is essential that these programs promote the delivery of evidence-based treatment services, including MAT.

Many prisoners have access to regular health care services only when they are incarcerated. Significant research supports the value of integrating prevention and treatment into criminal justice settings. In addition, community re-entry is a particularly high-risk time for relapse and overdose. Criminal justice systems can reduce these risks and reduce recidivism by coordinating with community health settings to ensure that patients with substance use disorders have continuing access to care upon release.

Facilitate research on Schedule I substances

Some researchers indicate that the process for conducting studies on Schedule I substances, such as marijuana, can be burdensome and act as disincentives. It is clear that more research is needed to understand how use of these substances affect the brain and body in order to help inform effective treatments for overdose, withdrawal management, and addiction, as well as explore potential therapeutic uses. To help ease administrative burdens, federal agencies should continue to enhance efforts and partnerships to facilitate research. Some of these efforts have already borne positive outcomes. For example, a recent policy change will foster research by expanding the number of U.S. Drug Enforcement Administration (DEA) registered marijuana growers. Making marijuana available from new sources could both speed the pace of research and afford medication developers and researchers more options for formulating marijuana-derived investigational products.

Researchers

Conduct research that focuses on implementable, sustainable solutions to address high-priority substance use issues

Scientific research should be informed by ongoing public health needs. This includes research on the basic genetic and epigenetic contributors to substance use disorders and the environmental and social factors that influence risk; basic neuroscience research on substance use-related effects and brain recovery; studies adapting existing prevention programs to different populations and audiences; and trials of new and improved treatment approaches. Focused research is also needed to help address the significant research-to-practice gap in the implementation of evidence-based prevention and treatment interventions. Closing the gap between research discovery and clinical and community practice is both a complex challenge and an absolute necessity if we are to ensure that all populations benefit from the nation's investments in scientific discoveries. Research is needed to better understand the barriers to successful and sustainable implementation of evidence-based interventions and to develop implementation strategies that effectively overcome these barriers.

Researchers should collaborate with health care professionals, payors, educators, people in treatment and recovery, community coalitions, and others to ensure that real-world barriers, such as workforce issues and billing limitations, are taken into consideration. These collaborations should also help researchers prioritize efforts to address critical ongoing barriers to effective prevention and treatment of substance use disorders.

Consider how scientific research can inform public policy

Effective communication is critical for ensuring that the policies and programs that are implemented reflect the state of the science and have the greatest chance for improving outcomes. Scientific findings are often misrepresented in public policy debates. Scientific experts have a significant role to play in ensuring that the science is accurately represented in policies and program.

Promote rigorous evaluation of programs and policies

Many programs and policies are often implemented without a sufficient evidence base or with limited fidelity to the evidence base; this may have unintended consequences when they are broadly implemented. Rigorous evaluation is needed to determine whether programs and policies are having their intended effect and to guide necessary changes when they are not.

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VISION FOR THE FUTURE: A PUBLIC HEALTH APPROACH

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Embedding prevention, treatment, and recovery services into the larger health care system will increase access to care, improve quality of services, and produce improved outcomes for countless Americans.

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NHS Smoking, drinking and drug use among young people in England 

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NHS Smoking, drinking and drug use among young people in England 

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https://digital.nhs.uk/data-and-information/areas-of-interest/public-health/smoking-drinking-and-drug-use-among-young-people-in-england

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This survey helps central and local government to better understand young people's behaviours and to develop policies, plan services and new initiatives and to monitor and evaluate their impact.

About the survey

One of the ways the survey findings are used is to shape services and regulation that help to support and protect young people, including recent laws banning smoking in cars and plain packaging on cigarette boxes.

The SDD publication Series

Why we do this survey

Smoking, drinking and drug use amongst young people are key public health concerns. This survey provides vital information, which is used by central and local government to better understand these behaviours and to develop policies, plan services and new initiatives, and to monitor and evaluate their impact.

As well as being used across government departments (such as the Department of Health and Social Care, the Home Office and Department for Education) and local authorities, the data is also used by a wide variety of other organisations, including NHS England, other NHS bodies, charities and voluntary organisations. Academic institutions also use the data for research purposes.

Managing the survey

The 2016, 2018, 2021 and 2023 surveys are being carried out by Ipsos (global market research and public opinion specialist) on behalf of NHS Digital. In 2020 the survey did not go ahead due to the coronavirus (COVID-19) pandemic.

Fieldwork for the 2023 survey will be carried out from September to December of 2023. The survey report is scheduled for autumn 2024.

Survey review

Before each survey, the methodology and information provided to participating schools and pupils is reviewed and approved by an ethics board at the National Children's Bureau (NCB).

Participants

Participants are aged between 11 and 15. For each survey, around 1 in 7 secondary schools in England is randomly chosen to take part. Nearly every type of school with pupils in years 7 to 11 is eligible for selection, and only very small schools and special schools are excluded.

What the survey involves

The survey fieldwork takes place during the autumn term and only requires a small time commitment from schools taking part. Pupils are given a self-completion questionnaire to complete in exam conditions, which takes about 40 minutes. Each stage of the short process - from agreeing to take part to the survey being completed - is organised and supported by experienced Ipsos staff.

Data collected

The survey includes information on:

prevalence of smoking, drinking and drug taking among school children

use of e-cigarettes and emerging drugs

types of alcohol and drugs taken

how often pupils smoke, drink and take drugs

where pupils obtain cigarettes, alcoholic drinks and drugs

pupils' attitudes to these behaviours

predictors of the likelihood of smoking, drinking and drug use among school

from 2018, the survey also collects some information about well-being, and the relationship to risky behaviours

What we do with the answers

The survey is completely confidential and the information is anonymous. We don't ask pupils to put their names on the questionnaire and it is not possible to identify a pupil from the published results.

Findings from the main survey are published in a report and tables which are freely available on our website. An anonymised copy of the dataset is available on the UK Data Service (UKDS) for the purposes of not-for-profit research. Access is restricted to registered users of the UKDS within UK higher education or further education, central and local government, NHS, research companies and charities.

Other researchers outside of these categories can apply to NHS Digital for permission to use the dataset. However, the purpose must be for not for profit research that would benefit the UK health and social care system or patients.

Unfortunately, due to other priorities and responding to the COVID-19 pandemic the SDD 2018 dataset is not yet available. We hope to make this available to access via UKDS in summer 2023.

Survey datasets

The anonymised Smoking Drinking and Drug Use among young people survey datasets can be accessed via the UK Data Service. Strict measures are in place regarding who can access the data and users will need to agree to the licence conditions about use. Researchers interested in accessing the datasets will need to register with UK Data Service in the first instance.

For more information about the additional restrictions applied to each survey year dataset please visit the DARS Population Health Surveys.

Bulletins

Make sure you are receiving our latest information about SDD by subscribing to our bulletins. Manage your preferences on our bulletins subscription page.

Last edited: 29 December 2022 3:18 pm

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Smoking, drinking and drug use among young people in England - NHS Digital

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Smoking, drinking and drug use amongst young people are key public health concerns. This survey provides information, which is used to better understand these behaviours and develop policies, plan services and new initiatives. The data is also used by a wide variety of other organisations.

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Westminster Drug Project offer services for young people in the boroughs of Brent, Redbridge, and Barking & Dagenham

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Westminster Drug Project offer services for young people in the boroughs of Brent, Redbridge, and Barking & Dagenham

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https://www.wdp.org.uk/brent-elev8

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At ELEV8, we support young people (up to age 25) who want help with their drug and/or alcohol use, or are struggling with their mental health.

If you or the young person you're worried about lives or goes to school/college in Brent, get in touch for support and advice from one of our team.
View our service leaflet to see the full list of support available
Contact us

Tel: 0300 303 4547

Instagram: https://www.instagram.com/elev8brent/

Address: 97 Cobbold Road, London NW10 9SU

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Free and confidential help for young people in Brent At ELEV8, we support young people (up to age 25) who want help with their drug and/or alcohol use, or are struggling with their mental health. If you or the young person you’re worried about lives or goes to school/college in Brent, get in touch for support and advice from one of our team.

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Drug and alcohol education programme of study,  guidance and lesson plans for primary and secondary schools

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Cover the statutory Health Education requirements with our Drugs and Alcohol lesson plans. Includes lessons on vaping and e-cigarettes.

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Useful data about prevalence and issues in your local region

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Useful data about prevalence and issues in your local region

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https://fingertips.phe.org.uk/profile/child-health-profiles

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A technical anomaly has been identified for 2022 to 2023 data which meant that a rounding issue has resulted in an error of one decimal place in the value and confidence intervals which are displayed in Fingertips. The indicators affected were the six child development indicators, the five health visiting indicators and the breastfeeding at 6 to 8 weeks indicator. This error has now been corrected.
15 November 2023
An error identified with the data for financial year 2018 to 2019 child development indicators published in Fingertips was corrected on Tuesday 5 December 2023. The error affects England versions. It does not affect the data published on GOV.UK. The error is to the counts and rates for:
7 November 2023
The indicators covering the following topics have been updated with the most recent data:

persistent absentees in primary and secondary schools

average attainment 8 score of children in care

school pupils with special educational needs (SEN)

free school meals uptake

children's public health 0 to 5 years indicators for: breastfeeding at 6 to 8 weeks, health visiting services and child development at 2 to 2 and a half years

Following user feedback, key stage 1 and 2 indicators have been discontinued. The data remains available from the Department for Education.

The following indicators have been updated with the most recent data:

Inequalities for live births and stillbirths have been added to the inequalities tab for England only.

Note: revision to teenage mothers 2021 to 2022 data

The England total and data for ethnicity at England level have been revised for the teenage mothers indicator for 2021 to 2022 data to include a small number of people who had an unknown residence recorded. There have been no changes to local or regional values.

Note: i mpact of updated mid-year population estimates on Fingertips indicators
7 March 2023
The 2023 Child Health Profile snapshot reports are now available .

These indicators have also been updated in the interactive child and maternal health profiles for local authorities.

The following indicators have been updated with the most recent data:

Infant mortality rate

Children in care immunisations

Average attainment 8 score

Children in care

Teenage mothers

Baby's first feed breast milk: new method

A&E attendances (0-4 years): new method

Hospital admissions caused by unintended and deliberate injuries in children (0 to 14 years)

Hospital admissions caused by unintended and deliberate injuries in young people (15 to 24 years)

Hospital admissions for asthma (under 19 years)

Hospital admissions for mental health conditions (under 18 years)

Hospital admissions as a result of self-harm (10 to 24 years, 10 to 14 years, 15 to 19 years, 20 to 24 years)

School pupils with social, emotional and mental health needs (2022)

Note: Impact of updated mid-year population estimates on Fingertips indicators

See latest news on the Fingertips home page for details.
7 February 2023
The following indicators have been updated with the most recent data:

Child and Maternal Health profile indicator review: November - January 2023

The Office for Health Improvement and Disparities (OHID) is reviewing the list of indicators within the Fingertips Child and Maternal Health profile. As part of the review process, we have created a short survey to help understand the needs of stakeholders. The survey is anonymous and should take no more than 15 minutes to complete. The survey can be found at https://forms.office.com/r/LK8LhSYVMC, and will remain open until the end of January 2023.
December 2022
The following indicators have been updated with the most recent data:

Persistent absentees - primary school

Persistent absentees - secondary school

Key stage 1 pupils meeting the expected standard in writing

Key stage 1 pupils meeting the expected standard in reading

Key stage 1 pupils meeting the expected standard in maths

Key stage 1 pupils meeting the expected standard in science

Average attainment 8 score of children in care

November 2022
The following indicators have been updated with the most recent data:

Breastfeeding prevalence at 6-8 weeks after birth - LA

Proportion of New Birth Visits (NBVs) completed within 14 days - LA

Proportion of infants receiving a 6 to 8 week review - LA

Proportion of children receiving a 12-month review - LA

Proportion of children who received a 2-2½ year review - LA

Proportion of children aged 2-2½ yrs receiving ASQ-3 as part of the Healthy Child Programme or integrated review - LA

Percentage of children at or above expected level of development in all five areas of development 2-2.5 years - LA

Percentage of children at or above expected level of development in communication skills at 2-2½ years - LA

Percentage of children at or above expected level of development in gross motor skills at 2-2½ years - LA

Percentage of children at or above expected level of development in fine motor skills at 2-2½ years - LA

Percentage of children at or above expected level of development in problem solving skills at 2-2½ years - LA

Percentage of children at or above expected level of development in personal-social skills at 2-2½ years - LA

August 2022
Since publication in November 2020, Leicestershire Council has identified errors in the data it submitted to OHID (formerly Public Health England) for 2019 to 2020 data for the Proportion of New Birth Visits (NBVs) completed within 14 days indicator (Early Years topic). This error has caused a statistically significant change in the health visiting data for 2019 to 2020, and so OHID has updated and reissued the data in OHID's Fingertips tool. Data has been corrected for Leicestershire, the East Midlands region, and England.
June 2022
New sections containing indicators relating to the high impact areas for the early years, maternity and young people have been added. These replace the high impact areas HTML reports.
May 2022
The following indicators have been updated with the most recent data:
March 2022
The following indicators have been updated with the most recent data:

Following consultation with users, the snapshot reports for local authorities which include commentary and additional interpretation will next be updated in 2023.
February 2022
Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.
December 2021
The high impact area summaries for Early years and Young people have been updated for England, regions and local authority level.
November 2021
The following indicators have been updated with the most recent data:
September 2021
Proportion of New Birth Visits (NBVs) completed within 14 days (Early years topic): Since publication in November 2020, Lewisham Council has identified errors in the new birth visits within 14 days data it submitted to Public Health England (PHE) for 2019 to 2020 data. This error has caused a statistically significant change in the health visiting data for 2019 to 2020 for Lewisham, and so PHE has updated and reissued the 2019/20 data for Lewisham, London region and England.
July 2021
The high impact area summaries for Early years and Young people have been updated for England, regions and local authority level.
June 2021
New high impact area summaries for Maternity have also been produced for England, regions and local authority level.
May 2021
The following indicators have been updated with the most recent data:

Several indicators related to injuries have also been updated in the Unintentional injuries in and around the home and Unintentional injuries on the roads reports for each local authority.
March 2021
The 2021 Child Health Profile PDF snapshot reports are now available here.

These indicators have also been updated in the interactive child and maternal health profiles for local authorities. Equivalent indicators for CCGs and other supplementary indicators have also been updated.

The children in low income families indicator has been replaced by two new indicators:

Children in relative low income families

Children in absolute low income families

The family homelessness indicator has been replaced by a new indicator:

Homelessness - households with dependent children owed a duty under the Homelessness Reduction Act

The following indicators have been updated with the most recent data:
November 2020
The following indicators have been updated with the most recent data:

General fertility rate

Multiple births

Stillbirth rate

Neonatal deaths

Post-neonatal mortality rate

Neonatal mortality and stillbirth rate

Low birth weight of all babies

Very low birth weight of all babies

Average attainment 8 score of children in care

Persistent absentees - Primary school

Persistent absentees - Secondary school

Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.

The high impact area summaries for Early years and Young people have also been updated for England, regions and local authority level.
September 2020
New indicators for smoking, obesity, early access to maternity services, folic acid supplement use and alcohol and drug misuse in early pregnancy based on data from the Maternity Services Dataset version 1.5 have been added to the Pregnancy and Birth domain. Data is presented at a national level, with most indicators also available at regional level and for upper tier local authorities, clinical commissioning groups and local maternity systems. The indicators include information about inequalities.
May 2020
The high impact area summaries for Early years and Young people have been updated for England, regions and local authority level.

Following a user feedback exercise, we have now discontinued indicators for elective hospital admissions and some indicators for emergency hospital admissions and A&E attendances. Full details are in Child health profiles: summary of feedback exercise and PHE response.

The following indicators have been updated with the most recent data:

Note: An error was identified for indicators based on hospital episode statistics (HES) data which gave misleading results for areas within the South East region and East Sussex. Affected areas have been suppressed or flagged to be treated with caution. Full details can be found in the caveats section of the descriptive metadata for each affected indicator.
March 2020
The 2020 Child Health Profiles are now available here.

Note: An error was identified for indicators based on hospital episode statistics (HES) data which gave misleading results for areas within the South East region and East Sussex. Affected areas have been suppressed or flagged to be treated with caution. Full details can be found in the caveats section of the descriptive metadata for each affected indicator.

Child Health Profile indicators which have been updated with the most recent data:

The following indicators have been updated in the unintentional injuries domain:
February 2020
Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.
December 2019
National Child Measurement Programme (NCMP) indicators have been updated to 2018/19 for local authorities, regions and England.
November 2019
Several indicators have been updated with the most recent data:

Proportion of infants receiving a 6-8 week review

Proportion of children receiving a 12-month review

Proportion of children who received a 2-2½ year review

Proportion of children aged 2-2½yrs receiving ASQ-3 as part of the Healthy Child Programme or integrated review

Percentage of children at or above expected level of development in gross motor skills at 2-2½ years

Percentage of children at or above expected level of development in fine motor skills at 2-2½ years

Percentage of children at or above expected level of development in problem solving skills at 2-2½ years

Neonatal mortality and stillbirth rate

Key stage 1 pupils meeting the expected standard in reading

Key stage 1 pupils meeting the expected standard in writing

Key stage 1 pupils meeting the expected standard in maths

Key stage 1 pupils meeting the expected standard in science

Key stage 2 pupils meeting the expected standard in reading, writing and maths

Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.

Breastfeeding prevalence at 6-8 weeks after birth has been updated for 2017/18 due to an error in data submitted by Redbridge Council which has caused a statistically significant change in the England figure.
October 2019
New high impact area summaries for Early years and Young people released at England, regions and local authority level.
August 2019
An error in trend information for infant mortality has been identified affecting a small number of the pdf child health profiles first published in March. Corrected profiles have been published for:

This only affects the pdf downloads. No changes to Fingertips data have been made due to this.

Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.
June 2019
A new report relating to speech, language and communication is available from the Reports tab or from the link in the introduction.
April 2019
A new indicator has been added to the Early years and School-age children: Primary domains:

Percentage of children achieving at least an expected level of development across all learning goals in communication and language - LA

Data is available split by inequalities (sex, free school meal status) at TTLA, Regional and England level, for academic years 2012/13 to 2017/18
March 2019
The 2019 Child Health Profiles are now available here.

Child Health Profile indicators which have been updated with the most recent data:
February 2019
Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.
January 2019
Several indicators have been updated with the most recent data:
December 2018
Indicators relating to School age children and Young people have been updated with the most recent data, including:

Persistent absentees in Primary and Secondary schools - LA

Key stage 1 pupils meeting the expected level in reading, writing, maths and science - LA

Key stage 2 pupils meeting the expected level in reading, writing, maths - LA

Homeless young people aged 16-24 - LA

November 2018
New reports relating to unintentional injuries around the home and on the roads are available from the Reports tab or from the links in the introduction.

Indicators from the Public Health Outcomes Framework have been updated this month, a full list of indicators with new data is available.
October 2018
A small error has been corrected to the England value for Hospital admissions as a result of self-harm (10-24 years), and to the England values for the three sub-indicators relating to children and young people aged 10-14 years, 15-19 years and 20-24 years. PDF versions of the child health profile have been reissued for a small number of areas where this makes a difference to the significance shown on page 4 of the profile; for all other areas, a final page has been inserted as notification of the issue.
September 2018
New functionality added to Child and Maternal Health profiles with a drop down list added to allow navigation between all Fingertips profiles related to the subject. Minor changes made to profile layouts should make finding data easier, if you do have any queries please use the "Contact Us" link above.

Indicators relating to Early years have been updated with the most recent data, including:

Other indicators which have been updated with the most recent data:

First time entrants to the youth justice system - LA

Year 6: Prevalence of overweight(including obese) - CCG

School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs - LA

Pupils with special educational needs (SEN): % of school pupils with special educational needs - LA

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Office for Health Improvement and Disparities (OHID)

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Data and reports related to pregnancy, birth, maternity and the health of children and young people,

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Resources for under 21s, parents, carers and professionals

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Get help and support with these apps, websites and helplines. They cover drinking, drugs, relationships, health and wellbeing.

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Developing a Policy for substance misuse

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Developing a Policy for substance misuse

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Resources Downloadable versions of our resources are available here for you to view or download. Please note that we are currently unable to post out resources and will let you know when the situation changes. Do download resources and print them, and feel free to share with others.

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Find out everything you need to know about drugs, their effects and the law. Talk to Frank for facts, support and advice on drugs and alcohol today. | FRANK

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Get Support Online

Our team provides free, confidential advice on a range of issues, including drug or alcohol worries and mental health - whether they affect you directly or a friend or relative. And if we don't have the answers to all of your questions, we will be able to signpost you to somebody who will. Our online chat service is currently available between 9am and 3pm Monday-Friday (excluding Bank Holidays). Please note: Reach Out is not a crisis service. If you are in an urgent situation or emergency, such as a suspected overdose, call 999. If you are in crisis, contact the Samaritans.

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Our team provides free, confidential advice on a range of issues, including drug or alcohol worries and mental health - whether they affect you directly or a friend or relative. And if we don't have the answers to all of your questions, we will be able to signpost you to somebody who will.

# data[].attributes.headline
Support for schools - The Daniel Spargo-Mabbs foundation offers evidence-based guidance, support and resources which could be helpful, particularly for secondary schools: 

# data[].attributes.subject
Support for schools - The Daniel Spargo-Mabbs foundation offers evidence-based guidance, support and resources which could be helpful, particularly for secondary schools: 

# data[].attributes.attachment_link.title
What is good drug education? " Daniel Spargo-Mabbs Foundation

# data[].attributes.attachment_link.description
What is good drug and alcohol education? Why doing drug education - and doing it well - matters Why good drug education is vital for all young people Alcohol and other drugs are an increasingly unavoidable part of the world most young people inhabit, whether online, in real life or both, and schools are key ...

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Free Gaming & Gambling Safeguardiung Workshops (Online)

# data[].attributes.subject
Free Gaming & Gambling Safeguardiung Workshops (Online)

# data[].attributes.body
Ygam offer fully funded online workshops on Gaming & Gambling harms. You receive access to over 1000 resources, City & Guilds CPD certificate and communication with an Education Manager.

Contact training@ygam.org for any questions.

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Book training TRAINING & RESOURCES Through our portfolio of education programmes, we provide free training and resources for teachers, youth workers, practitioners, universities, faith leaders and health professionals. All of our resources, training and education programmes have been independently scrutinised, challenged, evaluated and quality marked by a wide range of organisations.

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Guidance for school leaders and staff on managing drugs, drug-related incidents within schools and pastoral support for pupils.

Applies to England

Documents

Details

This guidance, produced jointly with the Association of Chief Police Officers ( ACPO), is for:

school leaders

school staff

governing bodies

local authorities

It applies to:

local-authority-maintained schools

academies and free schools

pupil referral units

non-maintained special schools

independent schools

sixth-form colleges

It may also be useful for:

further education and community settings

parents

school nurses and other health professionals who help with drug issues

police and local agencies working with individual schools to prevent drug misuse among pupils

This guidance:

answers some of the most common questions raised by school staff about drugs

explains the relevant powers and duties schools have in relation to:

powers to search for and confiscate drugs

working with the police

working with parents

includes information to help and support pupils

Pupil referral units provide education for vulnerable children unable to attend a mainstream school.

Thank you for your feedback

Report a problem with this page

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Guidance for school leaders and staff on managing drugs, drug-related incidents within schools and pastoral support for pupils.