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Tackling alcohol misuse in children

Louise Naughton
Nursing in Practice

Primary healthcare professionals are being warned not to succumb to negative attitudes and dismiss alcohol and drug abuse among children as antisocial behaviour

Alarming figures were recently released from the Welsh Government showing that at least 1,200 children under the influence of alcohol have been admitted to A&E departments each year for the past three years across Wales. Some such children are believed to be as young as four.

Hundreds more patients under 16 were seen by A&E staff in Wales after taking drugs as a result of accidental swallowing of tablets, medication overdose or substance abuse.

Moreover, the same source shows over 120 children under the age of 12 in Wales were referred for specialist help for drugs and alcohol problems during 2008-09.

It is clear that such growing - and worrying - numbers are not restricted to Wales. While rates of drug use have fallen among young people in England during the last decade, an estimated 13 children a day are admitted to hospital as a result of drinking alcohol in England, and 24,000 young people access specialist support for substance misuse - 90% because of cannabis or alcohol.1,2

The government acknowledged in its 2010 Drugs Strategy report, Reducing Demand, Restricting Supply, Building Recovery, that it is important for young people's services to be configured and resourced to respond to their particular needs so that they can be offered the right support as early as possible.3

"One of the major problems for young people today is that the drink and drug culture is all around them," says Jane Allen, a Senior Support Worker at drug and alcohol rehabilitation unit Affinity Lodge.

"It is accessible, available and almost expected. Children are pressurised by their peers to be involved."

Chris Cloke, Head of Child Protection Awareness at the National Society for the Prevention of Cruelty to Children (NSPCC), believes that alcohol and/or drug abuse in children may be a byproduct of neglect and abuse. It is thought that a young child displaying signs of alcohol or drug abuse could be a sign of parental neglect and an indication of a chaotic family life, but older children may use alcohol and drugs to cope with more sinister problems, says Cloke.

In a survey conducted in the 1990s, some 1,000 child abuse survivors told the NSPCC they previously used drugs and alcohol as a way of blocking out experiences of abuse. Cloke says this habit continues today: "We would urge nursing and primary healthcare staff to take the time to think about why a child might misuse alcohol and drugs.

"GPs and nurses can always turn to the NSPCC helpline if they want to talk their suspicions through and we can help them in their decision moving forward."

While healthcare professionals are becoming more aware of the 'toxic trio' of abuse - drugs and alcohol, domestic violence and mental health abuse - a change in attitude is required.
Older children and teenagers have long been battling against becoming stereotyped as engaging in antisocial behaviour, and the recent riots in cities across England have only served to alienate this generation further. NSPCC research has shown primary healthcare professionals do not escape falling victim to labelling children as 'delinquents' because they drink or consume drugs, and are as much affected by the 'trial by media' children have endured as the general public.

"There is always a risk of healthcare professionals thinking delinquent behaviour is linked to alcohol and drug abuse," says Cloke.

"Such negative attitudes could mask very real child
protection issues."

Children are also turning to ChildLine instead of primary healthcare staff to get advice and help for their alcohol and drug problems. The NSPCC's most recent figures show 3,000 children called ChildLine in the year 2008/09 to report concern over their own drinking or drug intake. Cloke says these children may have found it difficult to be heard or taken seriously by their GPs or nurses as they are often not seen as a priority.

The Welsh Government's A&E statistics, coupled with the level of calls coming through to ChildLine, indicate more needs to be done to prevent alcohol and drug abuse among children.

The NSPCC's top line message for parents is to consider the implications of their own behaviour and the example it sets to their children. While Cloke says it is not the case that the majority of parents or carers are "constantly out of their mind" on alcohol or drugs, they will have periods of lucidity. It is the task of primary healthcare professionals to help educate parents through set programmes or one-to-one advice and counselling sessions.

In December 2010, the Home Office announced its commitment to pump £125m into a new drugs prevention and rehabilitation strategy in England and Wales. In addition, a £60m contribution has been made by the Department of Health.

'It is vital we do all we can to prevent people using drugs in the first place," said Anne Milton, Public Health Minister, on the launch of the 2010 Drug Strategy report.

"Those who do must have access to the services they need to help them re-build their lives and contribute productively to society Recovery is at the heart of our approach. This money will mean we can put the right services in place to enable those who are drug dependent to find the right recovery path."

Many young people face increased risks of developing problems with drugs or alcohol, notes the report. Vulnerable groups, such as those who are truanting or excluded from school, young offenders and those at risk of involvement in crime and anti-social behaviour, those with mental ill health, or those whose parents misuse drugs or alcohol - need targeted support to prevent drug or alcohol misuse or early intervention when problems first arise.

In a bid to combat drug abuse in all ages, the UK government is currently in the throes of developing a 'vision' for Public Health England (PHE) - the new public health system. The aim is to create strong, effective action at the local level, led by local Directors of Public Health.

PHE is expected to come into shadow form from April 2012 and be fully operational with its own budget from April 2013.
Directors of Public Health will see the commissioning and oversight of drug and alcohol treatment services as a core part of their work. They will be expected to play a key local leadership role around delivering public health outcomes and work with local partnerships - including Police and Crime Commissioners (PCCs), employment and housing services, and prison and probation services - to increase the ambition for recovery.

In keeping with the government's local focus, September 2010 saw a teacher's stop-and-search powers increased. Under the Education Reform Bill, which is currently sat with the Lords Committee, such powers are set to be beefed up further to include more scope under which pupils can be searched for illegal substances.

"It is encouraging to see that young people seem to becoming less tolerant of drinking, smoking and taking drugs but there is no room for complacency," said a spokesperson from the Department of Education.

"Dangerous drug use, alcohol misuse and smoking are still major problems that need to be tackled. We are currently reviewing drug and alcohol education as part of the PSHE review. We are determined to continue these downward trends."

It is all too easy to label a child with alcohol or drug problems as delinquents and troublemakers. GPs and nurses have an obligation to fight this way of thinking and decide on a case-by-case basis why a child might be engaging in such behaviour.

Many children are desperately crying out for help and it is up to primary healthcare professionals to wake up from their slumber and listen.

1.     Rogers P. National enforcement priorities
for local authority regulatory services. London: The Stationery Office; 2007.
2.    Hibell B, Guttormson U, Ahlstrom S. The 2007 ESPAD Report. Substance Use among Students in 35 European Countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs; 2009.
3.    Department of Health. Drug strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life. London: DH; 2010.

Welsh Government