Scotland's public health priorities

Priority 4: A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs

We need to reduce the harm caused by smoking, drinking and drugs in Scotland. Although there is no safe way to smoke, no safe level of drinking alcohol and no completely safe level of drug use, the number of people using these substances and the harm caused to both them and those around them can be minimised.

Our definition purposefully avoids the terms addiction, dependency or misuse and highlights that alcohol and tobacco are the major causes of substance use harm in Scotland. The majority of the harm experienced across Scotland is not due to addiction, dependency or illegal drug use, but rather due to smoking and the large number of people drinking alcohol above the recommended guidelines per week on a regular basis.

Substance use is a diverse topic and encompasses many issues. People’s use of substances will vary over their lifetime – most will incur little harm as a result. But some will experience personal issues, mental or physical health problems, or even death. Substance use by parents and carers can also have a huge adverse effect on children and young people’s health and wellbeing.

Why are alcohol, tobacco and other drugs important?

Difficult economic and social conditions can be a driver of harmful consumption, and substance use varies across communities. Collectively, the harm from these substances is contributing to a considerable proportion of the preventable ill health in Scotland. In a Scotland where we smoked, drank or used drugs less, we would all be healthier.

Substance use is an area where we can make positive and sustainable changes now to realise significant progress through the generations and address the persistent public health problems that face communities. Sadly, Scotland remains a relatively heavy user of alcohol, tobacco and other drugs compared to similar countries. The harm that arises from this is significant and disproportionately affects those living in deprived communities.

Additionally, we know that our existing care and treatment services are not reaching everyone who needs help, and that those who they do reach are not always treated successfully. For too many people, multiple disadvantage contributes to substance use, which in turn contributes to further disadvantage. Drug related deaths have increased dramatically in Scotland over the last five years and are now, roughly, two and a half times higher than in England and Wales.

How will we make a difference?

The public health approach needs to be as diverse as the people affected and focus on the root causes of harm. We need to understand what drives consumption; considering price, availability and marketing as well as the underlying structural determinants such as socio-economic circumstances and the regulatory and legislative context.

Currently, our younger generation will grow up in a country where they are less likely to be exposed to smoke or commercial influences to smoke and where excessive alcohol consumption may be less affordable due to minimum unit pricing and the ban on ‘buy one get one free’ alcohol promotions. Through national interventions such as these, we can move Scotland’s cultural norms over the long term. However, significant inequalities in terms of both use and impact still exist, with those living in our poorest communities more likely to experience harm caused by substance use.

Reflecting on how the whole system is tackling this issue, Local Government, alcohol and drug partnerships, integration authorities, Police Scotland, the Scottish Prison Service and community planning partnerships are all developing locally tailored approaches to the issues faced on the ground.

The Scottish Government has introduced legislative measures to reduce the harms associated with drinking and smoking and a bold ambition exists for a tobacco-free Scotland by 2034. The current national alcohol and drug strategies will be unified in 2018 to form a single strategy on treatment and recovery, focusing on more than just dependency.

However, new challenges and opportunities are emerging all the time in the area of substance use and our response needs to constantly evolve.

Community planning partnerships bring together the main partners in minimising the harm resulting from our relationship with alcohol, tobacco and drugs in Scotland. Across Scotland, recovery peer support networks and recovery colleges are growing in strength and providing access to peer support, personal and social development, and learning opportunities to help reduce dependency on harmful substances.

Local partners are working with communities to develop education programmes in schools and beyond, and to design health-promoting environments which support healthier choices and reduce harm.

All local authorities have the power and duty to protect and improve public health through the licensing of alcohol sales. Many areas are developing over-provision policies which complement action by local trading standards on underage tobacco sales as part of an approach to creating healthier communities.

In Scotland we have ^4.1 :

• 21% of adults smoking (target: 5%)
• 26% of adults drinking above the recommended (14 units / week)
• 6% of adults stated they had used illicit drugs in the last year.
• 6% of adults are both smoking and drinking over the recommended units.

It has been estimated that alcohol alone costs the Scottish economy £3.6 billion a year in health, social care, crime, productive capacity and wider costs. Only 7% (£268 million) of this is estimated to be incurred by the NHS. ^4.3

Half of Scots report being harmed as a result of someone else’s drinking. ^4.4

Smoking remains the most important preventable cause of ill-health and premature death in Scotland, around 10,000 deaths every year / around one fifth of all deaths.

In 2015, 1,150 people died in Scotland due to an alcohol-related cause, an average of 22 people per week.

There were 867 drug-related deaths in 2016, the largest number ever recorded in Scotland. 23% higher rate of drug related deaths than in 2015 and more than double the rate in 2006. ^4.2

10 years after the Smoking ban ^4.5 :

• A reduction in the rate of child asthma admissions of 18% per year compared to an increase of 5% per year in the years preceding it.
• 39% reduction in second-hand smoke exposure in 11-year-olds and in adult non-smokers.
• 17% reduction in heart attack admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of 3% per year in the decade before the ban.
• 86% reduction in second-hand smoke in bars. pence per unit

Estimated impact of the minimum price of 50p minimum price per unit of alcohol:

Alcohol related deaths would fall by about 120 per year by 2038

A fall in hospital admission of 2,000 per year by 2038. ^4.6

• Drinking, smoking and drug use are at an all-time low in surveys of 15 year old school children.
• 80% of 15 year olds do not take any substance (smoke, alcohol, other drugs) regularly.
• Less than 20% drank in the last week. ^4.7