Scottish Social Attitudes Survey 2021/22: Public Attitudes Towards People with Problem Drug Use

Chapter 1 – Introduction

This report presents findings from the 2021/22 Scottish Social Attitudes Survey (SSA) conducted between the 21^st of October 2021 and the 27^th of March 2022. It focuses on attitudes of the members of the public towards people with problem drug use, as well as providing some degree of context across attitudes toward other areas of substance use, where relevant. Specifically, this report sets out to explore the following questions:

• To what extent do people think that problem drug use are individual issues or societal issues in terms of their causes and who should be responsible for helping people with these problems?
• How compassionate and understanding are people in Scotland towards those with problem drug use?
• To what extent do people believe that recovery from problem drug use is possible and how do they perceive individuals who are seeking recovery or in recovery^[4]?
• Do people perceive drug use as a criminal matter, namely should those possessing small amounts of specific drugs be prosecuted?

Some of these questions are comparable to those asked in previous Scottish Social Attitudes surveys on attitudes in Scotland towards people with problem drug use (2001 and 2009). Where relevant, views from 2021/22 have been compared with those in previous years to gauge change over time.

Policy background

Problem drug use in Scotland has been of particular concern in recent years with the susbtantial increase in drug-related deaths; which has more than quadroupled over the past 20 years^[5]. In 2020, the number of people who died of drug-related causes in Scotland peaked at 1,339 but saw a slight decrease to 1,330 in 2021. This was the first time in eight years that the rate had seen a decrease rather than an increase on the previous year, but it is still amongst the highest rate in Europe and was around three times the rate of that in the UK as a whole^[6].

This trend is mirrored by a rise in self-reported drug use^[7] among adults in Scotland which saw an increase from 7% in 2017/18 to 10% in 2018/20^[8]. Figures from 2018/20 highlight that cannabis was the most commonly used illegal drug (7.9%), followed by cocaine (3%) and then ecstasy (1.6%). The most recent estimates for the percentage of the Scottish population with problem drug use using illegal opiates and/or benzodiazepines was in 2014/15 and was 1.6%, which is a decrease on the estimate of 1.7% in 2009, the year SSA last covered this topic^[9]. Estimates of current problem drug use (opiates and benzodiazepines) are not available so we cannot conclude if the prevalence rate has continued to decrease in 2021.

UK Government and the Scottish Government, since it was formed in 1999, have taken a variety of approaches to tackle the epidemic, including education, harm reduction, treatment and rehabilitation, media campaigns, and legal punishment^[10].

UK Government current policy on drug use has focused on problem drug use as a criminal justice issue. However, since 2016, there has been a shift in the Scottish Government's approach, instead designating problem drug use as a public health concern, recognising a failure of previous approaches to tackle the issue of drug use and dependence over the past 50 years^[11]. Evidence shows that drug use increases the risk of blood born viruses, bacterial infections, homelessness, unemployment, family breakdown, overdose-induced fatality, and mental ill-health^[12]. In addtion, it has been shown that mass media operations to discourage drug use have generally failed to reduce drug use and harms and have conributed to the stigma associated with problem drug use^[13]. Current evidence also suggests that criminalising people who possess drugs for personal use does not reduce the prevalence of drug use or drug-related harm in society^[14].

At the time of SSA's last drug-stigma related module in 2009, Scotland had launched a new policy 'The Road to Recovery'^[15] the previous year, which had aimed to refocus all drug treatment and rehabilitation services on recovery and committed to improving education on drugs for children, young people, families and communities^[16]. It also sought to prevent drug use by targeting the supply and availability of illegal drugs and extended drug treatment orders to lower tariff offenders^[17].

In 2018, the Scottish Government published a new drug-related strategy 'Rights, Respect and Recovery'^[18] that adopted a public health approach to reducing drug-related harm in Scotland^[19]. This strategy sought to provide support to those experiencing problem drug use through focusing on prevention, tackling health inequalities, supporting individuals and families experiencing drug-related harm, and an improved public health approach in justice settings.

In January 2021, in response to Scotland's 2020 drug death rate, the Scottish Government announced a new 'National Mission to reduce drug related deaths and harms'^[20], which was supported by an additional £50 million of funding, with aims covering access to treatments, harm reduction strategies, improved frontline services, residential rehabilitation, linking social deprivation policies, supporting families, communities and those with multiple and complex needs, bringing in lived and living experience and reducing stigma^[21].

While Scotland has adopted a public health approach to reducing drug-related deaths and harms, penalties for taking or carrying drugs remain under the jurisdiction of the UK Government. Those found to be carrying class A drugs such as heroin for personal use could receive a sentence of up to 7 years in prison, while those found in possession of class B drugs such as cannabis could receive up to 5 years^[22]. The possession of class C drugs, such as benzodiazepines, for personal use could result in a prison sentence of up to 2 years^[23].

An inquiry by the UK Parliament in 2019 learned that stigma plays a role in preventing people who use drugs from getting treatment or encourages them to drop out of treatment, leading to a perpetuation of problem drug use^[24]. Research carried out by YouGov in 2016 into public attitudes in Scotland towards people with problem drug use found strong feelings of sympathy and care among the public with the majority of respondents agreeing that drug dependence was an illness, that people with drug problems were 'demonised in the media' and that we have a responsibility to care for people with problem drug use. However, there were still high levels of fear over living near someone with a drug dependence issue and having people obtaining treatment for drug dependence in their neighbourhood^[25].

Stigma is considered a policy priority for the Scottish Government as it is seen as a barrier to health improvement agendas. It is recognised that stigma comes in many guises, including self-stigmatisation and workforce stigma but the evidence for this to date is mixed and it is not clear to what extent people in Scotland currently hold stigmatising attitudes toward problem drug use. The aim of these questions within SSA 2021/22 was to explore current public attitudes around stigma towards people with problem drug use. This survey also provided an opportunity to compare attitudes over time, with certain questions having been asked in previous years of SSA.

Methods

The Scottish Social Attitudes Survey

The Scottish Social Attitudes (SSA) survey has been run annually by the Scottish Centre for Social Research (ScotCen) since 1999. This report presents findings from the Scottish Government module of questions concerning the public's attitudes towards people with problem drug use.

As in previous years, a random sample of all those aged 16 and over living anywhere in Scotland (including the Highlands and Islands) were interviewed. Fieldwork for SSA 2021/22 began on 21^st October 2021 and ceased on 27^th March 2022. As there were comparable questions asked in previous years of SSA, the views from 2021/22 have been compared with those from 2009 to explore any changes in attitudes over time. As detailed in the technical report, because of the pandemic SSA had to be conducted differently in 2021/22. Whereas previously it had been administered face-to-face by interviewers who knocked on randomly selected respondents' doors, this time it was completed by telephone by a sample of respondents who were, at random, invited to do so by post. It should therefore be taken into account that changes in attitudes may be, at least in part, due to changes to the survey methodology. However, the sampling approach has remained comparable with previous years and the 2021/22 data have been weighted to try and ensure that this risk has been minimised. Furthermore, it is not expected that the changes in methodology would have had a notable impact on the results for these particular measures – as may be the case for other measures included in the 2021/22 survey and reported elsewhere.

Letter invitations to take part were issued to 21,775 addresses, of which 1,349 households opted-in and 1,043 provided at least one interview. A maximum of two adults per household were invited to take part in the survey. A total of 1,130 interviews were achieved in total. Assuming 10% of addresses were vacant, derelict or ineligible for other reasons^[26], these figures equate to an opt-in rate of 7% and a response rate among opted-in households of 77%. Data are weighted in order to correct for non-response bias and differential selection probabilities due to deliberate over-sampling of rural areas and those living in the most deprived areas, and to ensure that they reflect the age-sex profile of the Scottish population. Technical details about the survey are published in a separate SSA 2021-22 Public attitudes towards people with problem drug use - Technical Report^[27].

Question design

A set of questions were developed in order to capture public attitudes towards people with problem drug use alongside questions on attitudes toward individuals with problem alcohol and tobacco use and obesity^[28].

The questions on problem drug use were aimed to address the key questions described at the start of this chapter. This module included eight questions on problem drug use repeated from previous survey years in 2009 (and in some cases 2001) to allow us to explore how attitudes have changed over time^[29]. It also included four new questions in 2021/22 aimed at capturing stigma towards problem drug use including public perceptions of the level of societal and individual influence over this problem. Two questions were asked for the purpose of sub-group analysis of the attitudes, in addition to standard demographic questions, on the respondents' own past drug use and whether they know someone who has ever used drugs.

In order to inform the development of the final set of questions, all of the potential new questions were cognitively tested and/or piloted between July and September 2021. The pilot included 15 questions on attitudes towards people with problem drug use. The final 14 questions on problem drug use were agreed based on the findings of the pilot. For the full set of questions refer to the Technical Report for SSA 2021-22 Public Attitudes Towards People with Problem Drug Use²⁷.

The aim of the cognitive testing was to ask a sample of respondents (14 people) a sub-set of the full survey questions being proposed, including 6 questions on views on people with problem drug use. This was followed by asking respondents a selection of probes to check whether they were interpreting the questions and associated answer options consistently. Adaptations were made to several questions as a result of the cognitive testing.

The aim of the survey pilot was to ask some of the questions being proposed for the main survey of a sufficient sample to establish whether the questions were understood in the context of the survey, whether respondents raised any issues with any of the questions and to look at the distribution of answers. The pilot sample consisted of 83 respondents out of a sample of 167 selected randomly from ScotCen panel members living in Scotland^[30].

Analysis

Most of the statistics presented in this report show the percentage of respondents who selected particular answer options. All percentages cited in this report are based on the weighted data and are rounded to the nearest whole number. A percentage may be quoted in the text for a single category that aggregates two or more of the percentages shown in a table. The percentage for the single category may, because of rounding, differ by one percentage point from the sum of the percentages in the table. Differences between figures shown in the tables are calculated using unrounded figures and may differ from the rounded figures shown in the text.

All differences described in the text (between different groups of people or between different points in time) are statistically significant at the 95% level or above, unless otherwise specified. This means that the probability of having found a difference of at least this size, if there was no actual difference in the population, is 5% or less. The term 'significant' is used in this report to refer to statistical significance; this is not intended to imply substantive importance. Further details of significance testing and analysis are included in the separate technical report and full data tables are available as 'supporting files' to this publication.

This report presents comparative data for previous years where available for each question. SSA 2021-22 Public attitudes towards people with problem drug use - Annex tables provides the full tables for each of these chapters (2-4) cross-tabulated by the background analysis variables^[31] as well as the comparative overall figures where available for previous years. These can be referred to alongside the relevant chapters in this report. Whilst the annex tables follow the order/numbering of the chapters the annex table numbers do not directly match the tables within the report as the tables provide a full breakdown of each of the questions asked in relation to Scotland's handling of the pandemic cross-tabulated by each of the sub-groups.