Young people experiencing harms from alcohol and drugs: literature and evidence review

1. Background and Overview

1.1 Overview

The level of harms from alcohol and drugs in Scotland are high in comparison to the rest of the UK and Europe, and cause avoidable damage to people’s lives, families and communities.

The country is in the midst of a drug death crisis. The 1,339 drug-related deaths reported in 2020 was the highest number ever recorded in Scotland for the sixth consecutive year, was around five times higher than across the rest of the UK, and was higher than any other European country^[1]. This crisis is also reflected in rising drug-related hospital admissions and harms. Alcohol-related harms also remain high in Scotland, with 1,190 alcohol-specific deaths in 2020^[2] and over 35,000 hospital stays in 2019/20^[3].

While these trends have been driven primarily by older (although still young) age-groups, it is important to note that alcohol and drug-related problems often emerge at a younger age. Over 70% of those accessing Tier 3 and 4 treatment services^[4] for problem drug use in 2015/16 started using drugs under the age of 25, with a median age of 15^[5]. Three-quarters (75%) of those who died from drug-related causes in 2015/16 had been using drugs for 10 years or more, and 43% for 20 years or more^[6]. Further, the data presented throughout this report also shows worrying signs of increasing alcohol and drug-related harms among those of younger ages. Taking action on the determinants of problematic alcohol and drug use among younger people is therefore vital to prevent the emergence of another cohort of individuals vulnerable to these avoidable harms as they grow older.

1.2 Policy Background

Preventing harms from alcohol and drugs among children and younger people is a broad agenda which cuts across many Ministerial portfolios. Reducing the harms caused by drugs and alcohol (alongside tobacco), forms one of the Scottish Government’s six Public Health Priorities, outlined in 2018^[7]. This work is in line with the Scottish Government drug and alcohol strategies published in 2018;

• Rights, Respect and Recovery^[8], which sets out Scotland’s strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths;
• Alcohol Framework 2018: Preventing Harm^[9], which provides an updated framework setting out Scotland’s national prevention aims on alcohol, endorsing the World Health Organisation’s Safer initiative of five evidence-based strategies that governments should prioritise to tackle alcohol-related harm^[10].

Both of these strategies place a central focus on actions aimed at protecting young people from short and longer-term harms from drugs and alcohol. This project has been explicitly developed to support Action 4 from the Rights, Respect and RecoveryAction Plan[11];

‘We will develop a comprehensive approach to early intervention among young people who are at risk, through deprivation, inequality or other factors, of developing problem alcohol and drug use.

Further, on 20th January 2021, the First Minister made a statement^[12] to parliament which set out a National Mission to reduce drug deaths through improvements to treatment, recovery and other support services.

Preventing harms among children and young people from alcohol and drugs also contributes to a wide range of the national outcomes set out in the National Performance Framework. This is most directly relevant in the areas of ‘children and young people’ (that we ‘grow up loved, safe and respected so that we realise our full potential’) and ‘health’ (that ‘we are healthy and active’), but also holds clear relevance for outcomes across Communities, Education, Human Rights and Poverty.

Preventing harms from alcohol and drugs among children is also central to the Getting it Right of Every Child (GIRFEC) approach and its eight indicators of wellbeing^[13]. These indicators aim to ensure that every child and young person is; safe, healthy, achieving, nurtured, active, respected, responsible and included (SHANARRI), with this work primarily relevant to keeping children safe, healthy, achieving and responsible.

1.3 Aims

In supporting Action 4 of the RRR framework, this report aims to:

1. Provide an up-to-date overview of the latest data pertaining to younger people (<25 years) experiencing harms from drugs and alcohol use.

2. Draw on the Scottish, UK and international literature to give a greater understanding of the nature and extent of the health and social harms being experienced by younger people through hazardous or harmful alcohol and/or problem drug use, both in the short and longer term.

3. Explore the risk factors underpinning these harms, and the population groups most vulnerable to them, and;

4. Deepen our understanding of the range, nature and suitability of existing treatment and recovery services for younger people experiencing harms from alcohol and drug use in Scotland.

While parental problematic alcohol and drug use forms a considerable issue in Scotland – and provides a risk factor for the development of problematic alcohol and drug use in their children – this report places primary focus on hazardous/harmful alcohol and problem drug use as undertaken by children and younger people.

1.4 Methodological Approach

The report draws on a rapid review of the existing literature and evidence base relevant to children and younger people experiencing harms from alcohol and drug use. Given the broad scope of such a project, the relatively brief time frame within which the report was compiled did not allow for a fully comprehensive or systematic review of the relevant literature. A focus was placed on key data sources relevant to children and young people in the Scottish context. The multifaceted nature of this review also meant that the use of a strict set of methodological criteria or filters would have been difficult across the range of factors studied.

1.5 Structure of report

Following this introduction, Chapter 2 provides the latest data the prevalence of alcohol and drug use and associated harms experienced by younger people in Scotland. Chapter 3 then explores the risk factors for harms from alcohol and drugs in this population and identifies a number of younger populations vulnerable to alcohol and drug harms. Chapter 4 examines the existing treatment and recovery services available to younger people across Scotland, explores barriers to their uptake and examines evidence of the kind of services work among this population. Chapter 5 summarises the key points of the report, and draws out recommendations for policy and further research.