1 INTRODUCTION
1.1 Setting the Scene
1.1.1 There are an estimated 52,000 heroin and benzodiazepine misusers in Scotland, with the highest prevalence in inner cities, particularly Glasgow and Dundee. This represents around 1 % of the population in Scotland. The numbers of drug misusers coming into treatment are increasing year on year, about two thirds of them reporting heroin use. A growth in the use of cocaine and crack cocaine is also being detected across Scotland, although this remains low compared to some other parts of the UK. Thirteen percent of people entering treatment with an illicit drug use problem also report an alcohol misuse problem.
1.1.2 Excessive alcohol consumption is a more widespread problem. The Scottish Health Survey 2003 recorded that 27% of men and 14% of women are estimated to be drinking more than the safe weekly limits. Recommended Daily Limits are also being exceeded. The Survey recorded that of those who had drunk alcohol in the past week, 63% of men and 57% of women had drunk more than the recommended limit on their heaviest drinking day.
1.1.3 Among young people, 57% of 13 year olds and 84% of 15 year olds reported that they had drunk alcohol. Of these, around 15% of 13 year olds and 34% of 15 year olds reported that they had been drunk more than 4 times. Discharges from general hospitals of patients with alcohol related conditions increased by 16% over 8 years to 39,061 in 2005-6.
1.1.4 The misuse of drugs and alcohol in Scotland has serious implications, not just for the health and life chances of the individuals directly involved, but also for their families and wider communities. It brings additional costs for the health service and local authorities as well as for police and the criminal justice system.
1.1.5 To address these problems, the Scottish Executive has developed national policies on education and prevention treatment, rehabilitation and supply. The role of ADATs is to bring together the right partners at a local level to help deliver the national targets and meet identified local needs and priorities.
1.2 The Challenge for ADATs
1.2.1 ADATs were amongst the earliest partnership initiatives formed to drive forward a programme of action which transcended several statutory agencies responsibilities and required statutory, voluntary and private sector providers to collaborate in order to make a difference.
1.2.2 ADATs are charged with seeking solutions to some of the most challenging and complex problems that affect communities, families and individuals. Substance misuse is a societal problem with real life complexities and uncertainties that do not respect the service boundaries of statutory bodies. The challenge for ADATs is to provide a multi-faceted collective response, involving complex inter-relationships which are joined up at strategic and operational levels. We have addressed the challenge for ADATs under three key headings:
These are the factors that need to be present to ensure that a complex interweaving of responsibilities can be integrated into an action centred and outcome focused programme of work. These essential components form the environment in which the ADAT operates.
For ADATs to ensure that they focus their attention appropriately and effectively, they must have a clear and shared understanding of local needs and the strategic and operational measures that are required to meet those needs. This requires a planning and implementation process which both successfully delivers the ADAT's activity and continuously reviews its impact.
The difference that an ADAT makes is the impact of the collective endeavour of all the partners. In other words, have the actions of the ADAT resulted in services tailored to local need and which are responsive to the views of service users and carers as well as the wider community. This can be measured by the extent to which there is local awareness of the ADAT itself as well as the services available to tackle substance misuse.
1.2.3 These three key headings provide the structure for our report and we have devised a diagram to illustrate this. We have called this the ADAT Wheel, which is illustrated below.
1.3 Methodology
1.3.1 The Stocktake of Alcohol and Drug Action Teams commenced in October 2006 and the full multi-agency ADAT Stocktake Team ( AST) was in place from the beginning of November. The Stocktake was a crosscutting exercise carried out jointly for the Health and Justice Departments of the Scottish Executive to assess the performance of ADATs and examine their capability to deliver Ministerial priorities on drugs and alcohol. The full Terms of Reference are at Annex A.
1.3.2 The Stocktake was chaired by Sandy Cameron, also Chair of the Parole Board, and the Stocktake Team comprised an official from the Scottish Executive, a Community Planning Manager, a Police Inspector and two business consultants with collective Health Board experience as Chief Executive, Chair and Member. The Team's experience also includes executive and non-executive experience within the voluntary sector. A list of the membership is at Annex B. Analytical and research input was provided by the Analytical Services Divisions in the Health and Justice Departments of the Scottish Executive and the Information Services Division of the NHS.
1.3.3 The fieldwork was intensive and involved visiting every one of the 22 ADAT areas (23 ADATs) in Scotland and interviewing Chairs, staff, ADAT partners and, where possible, service users and carers. In preparation for this, the Team drew up a standard framework of questions to steer the interviews. The framework of questions was closely linked to the remit for the Stocktake and was agreed with Scottish Executive officials.
1.3.4 In preparation for each visit, Team Members reviewed an information pack for each ADAT. Included in this pack was the Corporate Action Plan ( CAP), feedback given to the ADAT on the CAP by Scottish Executive, local statistical information, the local drug and alcohol strategy where available, local publicity material and any other available material that would be helpful to the Stocktake Team. Generally, two members of the Team undertook each visit.
1.3.5 In addition, the Team met a number of key national organisations and individuals as well as officials in Scotland, England and Wales. These are listed in Annex C. Altogether over 300 interviews were conducted between November and the end of April. The Team also read or consulted numerous relevant publications, many of which are listed in Annex D. The Team commissioned a survey conducted by Alcohol Focus Scotland of the views of alcohol service users and it drew on the views of service users commissioned as part of the review of methadone treatment. A survey was also undertaken of other local partnerships to identify the level of contact they report they have with ADATs.
1.3.6 This report is the conclusion of the work described above and the recommendations contained therein are based firmly on the evidence gathered.