the state of the nation report addicted britain december 2006 2 • the state of the nation report About the Addiction Working Group The Addiction Working Group’s composition draws on a wide range of expertise in the field of drugs and alcohol addic- tion – involvement does not imply membership of the Conservative Party. The Group will report in the middle of next year June 2007. It will then present the Conservative Party with a set of options and recommendations for policy change while acknowledging what government on its own can and cannot effect. Further details of the membership of the work- ing group are to be found in the final appendix. Kathy Gyngell (Chair) is a Research Fellow at the Centre for Policy Studies David Burrowes MP (Deputy Chair) is Member for Enfield Southgate since 5 May 2005 General Election Professor Chris Cook is a consultant psychiatrist specialising in alcohol misuse with Tees, Esk & Wear Valleys NHS Trust. David Partington is Director of the International Substance Abuse & Addiction Coalition, Camila Batmanghelidjh, ‘Woman of the Year’ 2006, founded and runs Kids Company Andy Horwood is Director of Doyle Training & Consultancy Ltd Shaun Bailey runs ‘My Generation’ a youth community initiative on the North Kensington estates. Russell White is a researcher with the Social Justice Policy Review Rebecca Smith is Parliamentary Assistant to David Burrowes addicted britain • 3 Contents Foreword, Iain Duncan Smith, Chairman of the Social Justice Policy Review 7 Foreword, Kathy Gyngell, Chairman of the Addiction Working Group 8 Acknowledgements 9 Executive Summary, Kathy Gyngell 10 Introducion 15 Chapter Summaries 17 PART ONE - THE SELF HARM SOCIETY Preface Chapter One: Alcohol and Drug Trends 20 1.1 The UK’s drinking behaviour since 1900 1.2 Alcohol consumption a historic high 1.3 Alcohol cheaper today than 25 years ago 1.4 Alcohol related death and disease double in 25 years 1.5 Problems greater in north than south 1.6 Who or what is responsible for the epidemic? • A changed social context and culture • A town centre licensed capacity increase • Young people - a new hedonism • Binge drinking socially accepted • Teenage girls are more likely to binge drink than boys • A 50% increased consumption by young women in ten years • A new culture of intoxication • Government “official insouciance” about the quantities of alcohol now consumed 1.7 Trends in drug use: growth and spread since 1950’s 1.8 Prescribed Drug Use Trends 1.9 Cannabis, Cocaine and Ecstasy: Growth between 1998 to 2004 1.10 Age-related Drug Use Trends Chapter Two: Alcohol and Drugs Prevalence 24 2.1 Alcohol disorder, hazardous drinking and dependence by gender 2.2 Alcohol disorder etc by age 2.3 Alcohol disorder by class 2.4 Official Sources - Finding out about drug use 2.5 Drug use - the significance of age and gender 2.6 Cannabis drug of choice for 16 -24 year olds 2.7 Cannabis drug of choice for all age groups 2.8 Amounts of Cannabis Consumed 2.9 Factors which ‘predict’ who uses drugs • Young male and single • Regional variation • Lower socio-economic status • Housing • Unemployment • Club Going • Being single, divorced, cohabiting 2.10 The Evidence Base – its limitations 4 • the state of the nation report Chapter Three: Prevalence of ‘problem’ drug users 29 3.1 Official estimates of ‘problem’ drug users 3.2 Other data sources and research: • Survey of Psychiatric Morbidity • Crack Cocaine Research • ‘Club Drug’ prevalence studies 3.3 ‘Problem user’ social profiles 3.4 High drug using population subgroups • Care leavers • Young Homeless • Arrestees • Young Offenders • Serious or Frequent Offenders and Truants • Prisoners 3.5 A problem ofevidence Chapter Four: Children, Alcohol and Drugs Prevalence 37 4.1 Child alcohol use trends: “More alcohol is going down fewer throats” 4.2 Children who start drinking young have a cumulatively higher pattern of consumption 4.3 Today’s ‘early starters’ drink more and girls are catching up with boys 4.4 Cannabis trends and school age children • Increase in the numbers of children requiring treatment 4.5 ‘Any’ Drug use Trends and School Age Children 4.6 Children’s Frequency and Amount of Drug Use – a Data Deficit 4.7 Risk factors for children - social correlates • Previous smoking and drinking • Early onset of cannabis use • Family disunity • Family disruption • Low levels of parental monitoring • ‘Fatherlessness’ • Low family affluence • Social deprivation • Poor and crowded housing • Truancy • Exclusion • Being in care 4.8 How to meet the Data Deficit • Identify and map those most at risk • Survey and monitor drug use of children in care • Study trends in children’s drug use through longitudinal surveying • Collect data about the ‘mean consumption’ • Extend the ‘Young People Drinking and Smoking Survey’ • Establish ‘remedial’ surveying for truants and excludees Appendix 1: Selected charts from Drugs Misuse Declared: Findings of the 2005/6 British Crime Survey, Home Office October 2006 Appendix 2: European Comparison Charts. addicted britain • 5 PART TWO - SHATTERED LIVES, COLLATERAL DAMAGE Preface and Witness Testimonies Chapter Five: The Costs and Consequences of Substance Misuse 52 5.1 Hidden Harms of Substance Misuse • Adverse Consequences for Children • Child Protection Failure exacerbates harms • Adverse Consequences for Parents and Siblings 5.2 Damaged life chances • Early Sexual Encounters • Truancy • Homelessness 5.3 Damaged Health • Alcohol Poisoning in children • Sexually Transmitted Disease risk • Fetal Alcohol Syndrome risk • Fetal ‘Drug Syndrome’ risk • Cirrhosis, Suicide, Assault and Injury risks 5.4 Damaged Communities and Crime – Some Personal Accounts Chapter Six: Cannabis Specific Risks 64 6.1 Suicide and Depression 6.2 Psychiatric disorders, schizophrenia or schizophrenia-like illnesses 6.3 Cognitive functioning and the educational performance of adolescents. 6.4 Cancer. 6.5 Driving impairment 6.6 Dependency 6.7 Fertility, pregnancy and neo natal problems Chapter Seven: Public Health and Crime Costs 68 7.1 Alcohol • The impact of chronic and acute alcohol disorders on the NHS • The impact of alcohol on other diseases – brain damage and cancer, including mouth and breast cancer • Alcohol and violent crime • Licensed premises and ‘hot spots’ of late night crime • Alcohol and drugs and homicides • The knife culture: drugs, alcohol and children? • Government spending on alcohol policies? 7.2 Drugs • Computation of health and crime costs • Arrestees research: drugs and crime levels • Drug possession and trafficking • Drug deaths • Blood born infections • Government spending on drugs policies 6 • the state of the nation report Chapter Eight: ‘Causes’ of the Drugs ‘Epidemic’ 72 8.1 Witness Views: • Former Addict and Ex-Offender • Residential Rehabilitation Unit Director • Magistrate • Doctor • Ex Offender (interview extract) • Residential Rehabilitation Unit Founder • Danny Kushlick, Transform Drug Policy Foundation 8.2 Foresight PART THREE – THE NATIONAL DRUGS STRATEGY: A WAY OUT OF ADDICTION? A Brief History Introduction to Briefing Papers Directions of Enquiry Alcohol Case Study ‘Empty Beds – A Crisis in Residential Referrals’ 82 Russell White Briefing Paper 1 – A Perspective on the National Drugs Strategy 85 Andy Horwood Briefing Paper 2 – UK Drugs Policy A Critical Overview Part One: Treatment Policy and the Drugs Harm Index 90 Russell White Briefing Paper 3 – A Perspective on the Commissioning of Drug Treatment Systems 103 Andy Horwood Briefing Paper 4 - Drug Treatment Services in England (excluding prisons): 109 An Analysis of Capacity, Provision and Efficiency Russell White Briefing Paper 5 – UK Drugs Policy A Critical Overview Part Two: 124 The Governments Supply Reduction Strategy Russell White Briefing Paper 6 - A perspective on Drug Interventions in the Criminal Justice System 140 Andy Horwood BIBLIOGRAPHY MEMBERSHIP OF THE ADDICTIONS WORKING GROUP addicted britain • 7 Foreword by Iain Duncan Smith This Report documents the nature and full extent of alcohol and drug addictions in the UK. 8.2 million people in the UK have and alcohol disorder and over 350,000 children live in households headed by drug addicted families. A worrying development is that children as young as 11 are drinking and taking drug. Over 45% of 14 to 15 year olds have consumed more than 5 drinks on a single occasion in the last thirty days. Government needs to invest money to improve drug rehabilitation for addicts rather than focusing its attention on short- term initiatives and political objectives. Addicts do not want replacement drugs but want a break from their cycle of addictions. The voluntary sector is carrying out great work in tackling drug addictions and support must be given for these organisations to carry out their work. My thanks to Kathy Gyngell, and his committee, all of whom have worked incredibly hard to produce a detailed account of the reality of addiction in Britain today. Rt Hoi Iain Duncan Smith MP 8 • the state of the nation report Foreword by Kathy Gyngell, Chairman of Addiction Working Group The task of assessing the scale and nature of the problem been informed by practical realities rather than by politi- of addiction in Britain today and of reviewing the gov- cal orthodoxies, received wisdom or overly philosophical ernment’s policies in this field is a daunting one. The debate. Having David Burrowes, one the brightest, most sources of evidence are multiple and new information committed and caring of the new intake of Conservative comes into the public domain on almost a daily basis. Yet Members of Parliament, as the Deputy Chair has been much relevant research has hardly been communicated and is invaluable. We owe much to Russell White, our beyond academic confines and the odd civil servant. researcher for much of the period, whose research initia- Despite this there remains much that we do not know tive, analysis and speed of delivery have been exemplary about drug using behaviour and its prevalence in the pop- and to Andy Horwood who has brought to bear his spe- ulation.