The road to recovery: a new approach to tackling Scotland's drug problem

Chapter 2: Preventing Drug Use

The Scottish Government believes that preventing drug use is more effective than treating established drug problems. Achieving the Scottish Government's overall Purpose and strategic objectives will have a significant impact on the factors associated with problem drug use. It is essential that we recognise the impact of actions that a wide range of policies will have. However, we must realise that people will always consider using drugs, and it is crucial that no-one in Scotland today takes drugs out of ignorance of the consequences. The provision of accurate information to the public is vital, as is effective communication with young people in, and outwith, the school environment.

This Chapter sets out:

• definitions of experimental, regular and problem drug use, and the underlying factors associated with them;
• how the Government is addressing these wider factors, particularly through an economic strategy that will reduce poverty and revitalise our poorest communities, and transforming the way that public services interact with families and young people;
• the Government's approach to the provision of factual information on drugs to the public, including families;
• how the Government believes substance misuse education in schools will be improved; and
• the importance of other sources of substance misuse education for young people.

FACTORS ASSOCIATED WITH DRUG USE

35. The seminal publication by the UK's Advisory Council on the Misuse of Drugs ( ACMD), Pathways to Problems (2006), presents a compelling analysis of why people take illegal drugs and what factors can lead people to regular or problem use.

36. There are clearly a wide range of complex factors involved. Many young people experiment and take drugs - including tobacco, alcohol and cannabis - for a variety of reasons, without progressing further. These young people come from all social backgrounds and all parts of the country. The most important factors determining whether people experiment appear to be early years experiences, family relationships and circumstances, and parental attitudes and behaviours. There also appears to be strong links between truancy and other forms of delinquency, as well as certain pre-existing behavioural problems such as Attention Deficit Hyperactivity-Disorder ( ADHD).

37. From the late teens onwards, the progression from experimentation to regular and then problem drug use appears to be strongly linked to socio-economic disadvantage, particularly in communities where problem drug use has become an "inescapable feature of life" and apparently acceptable and normal. Not all people in deprived areas will develop a drug problem, but those with the most limited prospects in society appear to be most at risk, and less likely to overcome a drug problem once it has become established. Indeed, studies have shown that there is a clear link between problem use of heroin and crack cocaine and deprivation; evidence that a drug user in a deprived area is less likely to get care and treatment; and that deprived areas with high unemployment levels can foster an environment where drug dealing flourishes as a way of making money. ¹⁹ The association between deprivation, drugs and health inequalities is also clear. ²⁰ A study of drug use hospital admissions in 2003-04 showed that the admission rate in the most deprived quintile was 17 times higher than in the least. ²¹

There are at least three broad categories of people who use drugs.

Experimenters - people who try legal and illegal drugs, including alcohol, tobacco, cannabis and psychostimulants. They are unlikely to be in touch with drug services, except for those providing information. They will come from a mixed social and demographic group.

Regular users - individuals who are typically using legal and illegal drugs regularly. As with experimenters, they will be from a mixed social and demographic profile. They may have had some contact with drug information services, but are unlikely to have used any other drug service.

Problem Drug Users - this is the category of people who will be experiencing or causing social, psychological, physical, medical or legal problems because of their drug use. They are likely to be in touch with drug treatment services, although many will not.

38. Some analysis of these factors might help explain why Scotland appears to have a worse drug problem than other countries in the UK or indeed in Europe. In particular, Scotland has highly concentrated pockets of intense deprivation, with multiple social problems. ²² Illegal drug markets have consumed whole communities, with the widespread availability of illegal drugs and a range of barriers to recovery, such as a lack of opportunities for employment or access to essential services.

39. Drugs are therefore both a symptom and cause of the health inequalities that face Scottish society. Deprivation and chronic stress lead to a lack of resilience to cope with life events and circumstances, and to people feeling out of control and threatened. This is more likely to lead to problem drug use, which in turn has a detrimental effect on the health and well-being of individuals and societies.

40. Problem drug use can therefore be seen as a symptom of the failure of other policies to bring about a wealthier and fairer society. As part of making Scotland a more successful country, with opportunities for all to flourish, the Government is implementing a range of reforms that will directly address some of the underlying reasons behind Scotland's problem drug use.

How the Scottish Government is addressing the underlying factors associated with drug use

41. First, as set out in Chapter 1, the Government's Economic Strategy ( GES) sets new ambitious targets for increasing sustainable economic growth. This will be achieved by improving learning, skills and well-being; the creation of a supportive business environment; development of infrastructure; more effective government; greater equity - and through a closer and more effective partnership between central and local government.

42. Crucially, in the context of problem drug use, the GES accords a strategic priority to achieving more balanced growth across Scotland and providing enhanced life chances and incentives to those in our most deprived communities. Targeted action to achieve these goals will release potential to contribute to Scotland's economic growth and success. These are set out in the Government's discussion paper on tackling poverty, deprivation and inequality.

43. Secondly, the Government and COSLA recently published a joint policy statement on early years and early intervention. ²³ This recognises the importance of establishing early intervention as the key to achieving a range of social policy objectives and stresses the need for a transformational change in the way that public services interact with families and young people. Over the coming months, the Government, COSLA and other partners will be developing an early years framework. This will focus on building parenting and family capacity, creating communities that support the positive development of children, delivering integrated services that meet children's holistic needs and developing a workforce to deliver this.

44. Thirdly, the principle of early intervention will be covered in the Ministerial Task Force on Health Inequalities report due shortly. The Task Force has addressed a range of underlying causes of inequalities in the health of those people identified above. They will recommend practical action, based on an understanding of the role of deprivation and stress in poor health. They will also indicate how a range of public services need to respond to their clients, to prevent further negative effects on their health and well-being.

45. Fourthly, the Government is committed to making our communities safer and stronger. As well as general initiatives such as increasing the number of police officers, the Government and the Police are working closely to tackle organised crime, including through the SCDEA's project to understand better the patterns of organised criminal activity in Scotland (see Chapter 4).

46. Finally, the Government understands the need for young people in our communities to have access to facilities that promote constructive and positive behaviours while supporting them in realising their full potential. The Scottish Government is currently drawing up a new Youth Framework that will consider these issues in the round. In the meantime, it is worth noting the success of the Government's Cashback project that is using around £8m of funds from the Proceeds of Crime Act ( POCA) to benefit young people in those communities hardest hit by crime, and which most lack facilities and opportunities.

47. The key outcomes associated with these policies should create more opportunities for all of Scotland to flourish and participate fully in the economic and social life of the nation. This will raise aspirations, particularly for young people, so that problem drug use is no longer seen as an inescapable fact of life. It will also revitalise our poorest communities, disrupt drug markets, encourage investment and remove barriers to recovery.

How the Scottish Government is addressing the proximate factors associated with drug use

48. As recognised by Pathways to Problems, there is also a complex series of proximate factors associated with problem drug use. There can be a wide range of factors or 'triggers' that lead people to problem drug use - either for the first time, or to relapse. People often report wanting to self-medicate, or block out some personal trauma (including, often, the legacy of abuse). Many of these will be related to the fundamental factors set out above.

49. The Government is active in setting policy in a number of key areas that often have a bearing on whether people become problem drug users. These include the Government's new plan for improving population mental health; ²⁴ and the Government's approach to tackling and preventing homelessness which is focused on improving the rights of homeless people to accommodation and encouraging a joined up service response that identifies and addresses their individual needs in a holistic way. ²⁵ The Government will also shortly publish its long-term approach to tackling alcohol misuse, making it clear that alcohol and drugs misuse cannot be considered in isolation. ²⁶

INFORMATION AND EDUCATION

50. Although Government policies can do much to address the factors associated with drug use, it is inevitable that people - across all societies - will always consider the use of drugs. However, it is our view that no-one in Scotland today should take drugs in ignorance of the consequences. It is essential that there is a range of credible and accurate factual information available to allow people to make informed decisions.

51. Consequently, the Government is committed to continued funding of statutory and non-governmental drugs information campaigns. Know the Score is a public information campaign which is effective in increasing knowledge and promoting positive lifestyles and avoidance of drug use. As well as informing potential drug users themselves, Know the Score offers a wealth of information for families and friends (from whom there is often the most demand). Specific campaigns and generic information are provided through the website, a 24-hour helpline and a suite of materials available to the public which have been developed in consultation with the target audience. Further targeted development in support of this strategy will continue to benefit from this approach.

52. Also essential is the provision of accurate information for parents and other adult family members such as grandparents. Having this information allows adults in families to communicate with their children and grandchildren in an informed way. It allows adults to discuss the risks of drug taking credibly, while understanding the perspective and concerns of young people. It can also better prepare adults to spot the signs that young people are using drugs and allow them to discuss options for treatment or help. A well-informed dialogue about drugs within the family can be a significant factor in influencing decisions about drug use or assisting recovery. The Government's proposals for improving the parenting skills of young parents in the Early Years Framework will also assist in this area.

Young People and Drug Use

53. Young people will always be a particular target for those who deal drugs. Although the prevalence of drug use among 15 year olds and 13 year olds declined between 2004 and 2006, high numbers of school children in Scotland continue to report using drugs. The most recent survey found that around a quarter of all 15 year olds (23%) and 7% of all 13 year olds reported that they had used drugs in the last year. In addition, 48% of 15 year olds said it was 'very easy' or 'fairly easy' to obtain drugs (compared, encouragingly, with 58% in 2004) and 53% of 15 year olds said that they had been offered drugs (compared with 63% in 2004). ²⁷

54. There is, however, no room for complacency. The Government is determined that young people should receive credible information and education, so that they can make informed choices. A key part of that is maximising the positive impact that schools can make.

CURRICULUM FOR EXCELLENCE AND HEALTH PROMOTING SCHOOLS

55. Schools can make a significant contribution to the aims underlying this strategy, through specific learning programmes but also through opportunities for wider learning and support that they bring to their students, that help tackle issues of poverty and deprivation.

56. Our aspiration for all our young people, as reflected in the Scottish Government's national outcomes, is that they are successful learners, confident individuals, responsible citizens and effective contributors. The Government is currently reforming education in Scotland from 3 to 18 year olds through the Curriculum for Excellence programme. The aim of Curriculum for Excellence is to help prepare all young people in Scotland to take their place in a modern society and economy. It will provide a framework for all young people in Scotland to gain the knowledge they need, skills for learning and skills for life, including the promotion of active and healthy lifestyles and skills for work.

57. The Curriculum for Excellence is about making a difference to children and young people, developing values and attitudes as well as knowledge and understanding. Thus, schools have an important role to play in developing in young people qualities of resilience and adaptability so that they are able to make informed choices to enhance their own and their families' health and well-being. Schools also have an important role to play in promoting the social responsibility of young people for their school and the school as it sits within the wider community.

58. There is also now a legislative duty on Scottish Ministers and local authorities under the Schools (Health Promotion and Nutrition) (Scotland) Act 2007 to ensure that schools are health promoting. A health promoting school will provide activities, environment and facilities which promote the physical, social, mental and emotional health and well-being of pupils. Internal self-evaluation by schools and local authorities on meeting the duty to be health promoting will be complemented by external evaluation through Her Majesty's Inspectorate of Education's inspection regime.

59. Draft learning outcomes for health and well-being under the Curriculum for Excellence will be released shortly together with Guidance on the 2007 Act. Taken together these documents will describe the expectations for promoting the health and well-being of children in school. Learning through the draft health and well-being outcomes will enable children and young people to make informed decisions in order to:

• improve their mental, emotional, social and physical well-being;
• experience positive aspects of healthy living and activity for themselves;
• apply their mental, emotional and social skills to pursue a healthy lifestyle; and
• establish a pattern of health and well-being which will be sustained into adult life and the next generation.

60. For the first time, through Curriculum for Excellence, all those within the school's community, no matter how extensive or narrow their contact with children and young people, share the responsibility to contribute to the new health and well-being framework so that the relevant aspects are developed, reinforced and supported. Furthermore, Curriculum for Excellence promotes a partnership approach involving colleges, universities, employers, the voluntary sector and other agencies to enrich the learning experience for all young people: it applies to all practitioners delivering teaching and learning in a broad range of contexts.

61. The ethos of placing the child at the centre is vital and the Government will also shortly publish a new framework for learning and teaching under Curriculum for Excellence which will reinforce this and emphasise the importance of planning a curriculum which is based on the needs and achievements of the young person. Schools need to acknowledge explicitly the wider social and environmental factors that determine children's well-being and ability to learn, through influencing their attitudes, values and behaviours. The new framework for learning and teaching will also make clear that beyond 15 years of age when they work towards qualifications, young people should continue to have opportunities to develop an active and healthy lifestyle.

Substance Misuse Education Within A Curriculum for Excellence

62. Substance misuse education in schools is often the first line of prevention against drug use, providing opportunities to pass on accurate, up-to-date facts, explore attitudes and, crucially, foster the skills needed to make positive decisions. It is not just about classroom teaching, but encompasses all policies, practices, programmes, initiatives and events in the school connected with the prevention and reduction of drug-related harm. The evidence is clear that no one approach to prevention and education is effective, and that one-off interventions will have limited value. Furthermore, we know that the culture, relationships and opportunities in schools contribute to young people's social and academic outcomes, and that these are relevant to a whole range of behaviours including drug use. ²⁸

63. Teachers will always be in the front-line for delivery in schools, and their ownership is fundamental to the effectiveness of the education received by young people. However, as for any other area of the curriculum, teachers are not expected to deliver substance misuse education alone. Research evidence indicates that messages can be most effective if delivered in partnership with a range of agencies. Integrating inputs from different sources is likely to be best, ensuring quality teaching as well as accurate, credible information and messages. ²⁹

64. In practice, delivery by classroom teachers is often supplemented by police, youth work, nurses and a wide range of other NHS health professionals as well as ADATs. In short: there is a wide range of potential fields from which visitors might be drawn. These inputs can add significant value to the educational experiences received by young people, but we need to ensure that their contributions to education are maximised. To ensure effective teaching and learning, regard must be had to the skills and capacities of all involved, with appropriate training and support to equip them to deliver effective substance misuse education.

65. Peer education might also play an important role in supporting young people. For example, in the Borders, senior school pupils provide alcohol and drugs awareness programmes for senior primary pupils through the ' UP2U' programme.

66. While there is good practice in substance misuse education in schools there is room for improvement. The Government has recently established a steering group to advise it on developing more effective substance misuse education in Scottish schools. Membership includes experts from education, drug agencies, NHS Health Scotland, the police and officials from across the Scottish Government. The group is due to publish an interim report early in 2009 and will produce advice, guidance and proposals aimed at helping schools and authorities to achieve the improvements sought through Curriculum for Excellence and the 2007 Act so that:

• appropriate teaching materials are available and are being used most effectively;
• comprehensive, evidence-based approaches to substance misuse education are integrated into wider health education and promotion in the school;
• education is planned in partnership with inputs from Health, the police and the community;
• delivery is by appropriately trained practitioners, for effective pedagogy (e.g., with interaction to develop skills);
• there is student-centred, culturally appropriate and relevant education, targeted to needs and context;
• training, networking, delivery and evaluation by practitioners is co-ordinated; and
• there is appropriate engagement with parents.

67. The draft Health and Well-being outcomes developed within Curriculum for Excellence will be trialled in schools from May until the end of December and will provide a further opportunity for new approaches and best practice to be developed for substance misuse education. The steering group will take account of the trialling in developing its proposals for improvement activities.

68. There are considerable opportunities for drugs education to be applied in other curriculum areas. Curriculum for Excellence will provide new opportunities for schools to plan challenging interdisciplinary studies, where the different experiences and outcomes in the whole curriculum can be grouped together to reinforce and emphasise messages about substance misuse as part of a whole-school strategy. This will ensure that they have sustained impact. For example, using the expressive arts as a medium for learning can present issues such as decision making skills and peer pressure in a more accessible way through role play. There are clear connections in the biology element of the science curriculum where the impact of drugs (both legal and illegal) on the functions of the body can be analysed. There are also links between the social studies and aspects relating to citizenship. The steering group will consider proposals for work to identify and disseminate best practice in this area to support Curriculum for Excellence.

Promoting Inclusion

69. There are strong links between problematic substance misuse and low educational attainment; truancy or exclusion from school; involvement in criminal activity or anti-social behavior; and abuse and neglect. Promoting inclusion at key transitional stages in a young person's life, e.g. between primary and secondary school, or leaving school has been shown to help boost resilience.

70. The most recent guidance on attendance at school, published in December 2007, offers advice on the promotion of attendance and management of absence from school, including truancy. The guidance indicates that school staff should be aware of signs for concern, of which non-attendance may be the initial trigger of investigation. The guidance includes indicators of the effects of substance misuse, potential impact on learning and encourages a multi-agency approach to prevention, information sharing and efforts to respond to young people in difficulty.

71. Furthermore, the ethos within which Curriculum for Excellence is implemented places the child at the centre of the process, and schools need to acknowledge explicitly the wider social and environmental factors that determine children's well-being and ability to learn, through influencing their attitudes, values and behaviours. In addition, there is to be a focus on continuity and progression through school to post-school, aimed at retaining young people in learning after the age of 16.

Supporting Children and Young People in Schools

72. Schools play an important part in supporting pupils affected by drug use. In difficult circumstances, the support offered in school can make a real difference. Support in schools must meet the needs of all children and young people, whatever the choices and experiences they face.

73. There are ten standards for personal support in Scottish schools, which include access to support. Schools need to ensure all children and young people, and their parents, feel confident that the school will support them by:

• providing access to staff by children and parents who want support; and
• co-ordinating support between agencies and schools, wherever learning takes place.

Substance Misuse Education Outwith School Settings

74. Schools have a role to play in educating young people about substance use, but they cannot do it on their own. There is a wide range of cultural and environmental factors that contribute to young people's involvement with drugs. Parents, and others in the wider community such as youth workers, have a role to play in educating children and young people about drugs. In addition, young people can and do educate one another, increasingly exchanging information through the use of social networking websites.

75. A National Development Officer for Schools and Youth Work has recently been appointed for two years. The aim of this post is to forge close links and better communication between schools and the youth work sector; seek out examples of how schools and youth workers can work effectively together to achieve positive outcomes for young people and share good practice; and make schools more aware of how a youth work approach can work effectively in achieving positive outcomes for young people, particularly those young people who need more choices and more chances.

CONCLUSION

76. This Chapter recognises the impact that a wide range of policies, such as the Government's Economic Strategy and Early Years Framework and mental health will have on reducing future demand for drugs. The Scottish Government will continue to support the use of credible and accurate information for the public and for young people, in and outwith, the school environment. Chapter 3 sets out our vision to support people, who have developed problem drug use, based on promoting recovery.