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South Ayrshire ADP Needs Assessment Local Report (2010)
Page 1 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 2 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 3 of 66
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 4 of 66
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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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.
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 6 of 66
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 7 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 8 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 9 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 10 of 66
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 11 of 66
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 12 of 66
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 13 of 66
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).
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 14 of 66
� 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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 15 of 66
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 16 of 66
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
East Ayrshire CHP North Ayrshire CHP South Ayrshire CHP
� 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
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
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).
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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),
South Ayrshire ADP Needs Assessment Local Report (2010)
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
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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%).
South Ayrshire ADP Needs Assessment Local Report (2010)
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
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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.
South Ayrshire ADP Needs Assessment Local Report (2010)
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)
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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.
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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.
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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.
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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
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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.
Number of clients seen
Narcotics Anonymous do not keep records of attendance at meetings.
Financial information
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
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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.
Number of clients seen
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.
Financial information
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
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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.
Number of clients seen
It is not possible to separate out this information from the psychiatric SMR 04 returns.
Financial information
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.
Number of clients seen
Figures currently included in addiction services locality returns.
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Financial information
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
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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
Financial information
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.
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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
Financial information
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.
Number of clients 2008/09
Gender Referred Assessed Received a
service
Discharged
Male 2573 608 732 725
Financial information
Financial information was not available from this service due to perceived business
sensitivity as the service provider is a private company.
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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:-
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• 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.
Numbers of clients 2008/09
Gender Referred Assessed Received a
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%
Financial information
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.
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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.
Number of clients 2008/09
Gender Referred Assessed Received a
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%
Financial information
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.
Number of clients seen
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:-
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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%
Financial information
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
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The staff group comprises 10 staff members for Ayrshire and Arran:- 1 WTE
manager, 8 WTE practitioners and 1 WTE administrator.
Numbers of clients 2008/09
Referred Assessed Received a
service
Discharged
Male Female Male Female Male Female Male Female
South
Ayrshire
94 57 51 40 46 35 85 52
Financial information
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.
Number of clients 2008/09
Information specific to South Ayrshire could not be provided. 205 clients were
referred across Ayrshire and 84 were assessed as suitable for service.
Financial information
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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.
Number of clients 2009/10
Referred Assessed Received a
service
Discharged
Male Female Male Female Male Female Male Female
South
Ayrshire
6 7 6 7 5 6 1 0
Financial information
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
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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.
Financial information
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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
Number of clients 2008/09
Referred Assessed Received a
service
Discharged
Male Female Male Female Male Female Male Female
South
Ayrshire
2 3 2 3 4 11 1 3
Financial information
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
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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
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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
South Ayrshire ADP Needs Assessment Local Report (2010)
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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:
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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
South Ayrshire ADP Needs Assessment Local Report (2010)
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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
South Ayrshire ADP Needs Assessment Local Report (2010)
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Intervention Setting Mode of Delivery
Staffing Resource Target Client group
Effectiveness Cost effectiveness
12-Step facilitation therapy
No specific setting works better than others
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
No specific setting works better than others
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
South Ayrshire ADP Needs Assessment Local Report (2010)
Page 66 of 66
Intervention Setting Mode of Delivery
Staffing Resource Target Client group
Effectiveness Cost effectiveness
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