Substance Use

In contrast to alcohol use, self-reported drug use across England and Wales in the past year has remained stable. This is also the case in Bristol, where there has been a continuing pattern of stability in the use of opiates and crack cocaine. However, the city continues to have the highest proportion of people in England using both heroin and crack cocaine, and a high proportion of people injecting.

• There are an estimated 4709 opiate and crack cocaine users – or 15.43 people per 1,000 in Bristol. This is a small decline compared with recent years.
• A study by the University of Bristol in 2015 estimated that there were 2700 injecting drug users in the city.
• Polydrug use (use of a range of substances, including alcohol and benzodiazepines)  is common. The number of clients using a combination of heroin and crack nationally is 39%, but in Bristol this figure is much higher, estimated at  69%.

The Bristol Drugs Project (BDP) reports that during 2017/18 there were 4,160 people in treatment with Bristol ROADS (Recovery Orientated Alcohol and Drugs Service), including:

• Around 2650 people being treated for opiate use
• 706 people treated for non-opiate drug use
• 772 people in treatment for their alcohol use

742 people who inject drugs engaged only with BDP’s needle and syringe programme.

A complex issue

People use drugs and alcohol for many reasons. Where drug or alcohol use becomes chronic and problematic, it is often a response to other issues in a person’s life including:

• Mental health

Some people try to ‘self-medicate’ with drugs and/or alcohol in order to deal with symptoms of their poor mental health. Drug and alcohol use can also make mental health problems worse, and harder to treat. 70% of people who are in community substance misuse treatment services are likely to also have problematic mental health issues (see Public Health England).

• Physical health

Use of drugs and alcohol can have many adverse effects on physical health resulting in long-term conditions.These can, in turn, also have an impact on mental health.

• Relationships

Drug and alcohol problems can damage relationships between individuals, families and across a community. The subsequent isolation can lead to mental health problems and increased substance misuse.

• Involvement with the criminal justice system

A high proportion of people involved in the criminal justice system have a dual diagnosis of drug or alcohol dependence and adverse mental health issues.

Overall, alcohol and drug misuse can result in people being locked into patterns of dependence, isolation, poor physical and mental health, and offending behaviour. The consequences of this are deadly – a report by Public Health England found that in 2016, nationally there were 2383 deaths related to drug poisoning, and 24,000 people died from alcohol-related causes.

Drug related deaths in Bristol have significantly risen in recent years, primarily due to the rise in opioid overdose fatalities. In 2017/18 these are likely to reach an unwelcome all time high. Purity of heroin and crack cocaine in Bristol remains high and is likely to be a factor in the increase in drug related deaths.

Treating alcohol and substance misuse in isolation and not looking at all the issues going on in a person’s life means that interventions are unlikely to have a long-term impact.  At Golden Key, we are working with clients and services to find better ways of providing support so that people with complex needs have better outcomes.