Drug misuse prevention: targeted interventions

Deliver drug misuse prevention activities for people in groups at risk through a range of existing statutory, voluntary or private services, including:

• health services, such as primary care services, community-based health services, mental health services, sexual and reproductive health services, drug and alcohol services, and school nursing and health visiting services

• specialist services for people in groups at risk

• community-based criminal justice services, including adult, youth and family justice services

• accident and emergency services.

Ensure activities targeting groups at risk are consistent with any population-level (universal) activities aimed at preventing drug misuse.

At routine appointments and opportunistic contacts with statutory and other services, such as those listed in recommendation 1.1.1 in the section on delivering drug misuse prevention activities as part of existing services, assess whether someone is vulnerable to drug misuse. Examples of routine appointments and opportunistic contacts include:

• health assessments for children and young people who are looked after or care leavers, including initial assessments, any reviews and contacts

• appointments with GPs, nurses, school nurses or health visitors

• attendances at emergency departments as a result of alcohol or drug use

• contacts with the community-based criminal justice system.

Use a consistent, locally agreed approach to assessment that is respectful, non-judgemental and proportionate to the person's presenting vulnerabilities. For an example for young people, see the Royal College of Psychiatrists practice standards for young people with substance misuse problems.

Discuss the person's circumstances, taking account of their age and developmental stage. The initial discussion could include:

• their physical and mental health and their personal, social, educational or employment circumstances (which may trigger a more in-depth assessment)

• any drug use (including the type used and how often).
  
  If the person is already misusing drugs, see NICE's guidelines on psychosocial interventions and opioid detoxification for drug misuse in people aged 16 years and older, needle and syringe programmes, and alcohol-use disorders: diagnosis and management of physical complications.

Think about the immediate safety of the person being assessed and any people under their care, and whether any action is needed.

Discuss with the person what their priorities are and take into account how these might affect next steps or referral to other services.

Consider skills training for children and young people who are assessed as vulnerable to drug misuse. If skills training is delivered to children and young people, ensure that their carers or families also receive skills training. For older children and young people, think about whether providing information (see recommendations in the section on adults assessed as vulnerable to drug misuse) may be a more appropriate approach.

Ensure any skills training is:

• commissioned as part of existing services (see recommendation 1.1.1 in the section on delivering drug misuse prevention activities as part of existing services)

• delivered as part of activities designed to increase resilience and reduce risk

• delivered by people competent to provide skills training.

If skills training is offered to children and young people and their carers or families, ensure it helps children and young people develop a range of personal and social skills, such as:

• listening

• conflict resolution

• refusal

• identifying and managing stress

• making decisions

• coping with criticism

• dealing with feelings of exclusion

• making healthy behaviour choices.
  
  Ensure that personal and social skills training for children and young people who are looked after and care leavers puts particular emphasis on how to deal with feelings of exclusion.

If skills training is offered to children and young people and their carers and families, ensure that it helps carers and families develop a range of skills, such as:

• communication

• developing and maintaining healthy relationships

• conflict resolution

• problem solving.
  
  Ensure that skills training for foster carers includes using behaviour reinforcement strategies alongside the other skills listed.

Take into account the age, developmental stage, presenting vulnerabilities, cultural context, religion, ethnicity and any other specific needs or preferences of the child or young person when deciding:

• whether to offer training sessions to children and young people and their carers or families together, or whether to offer separate sessions

• the content of the skills training

• whether to provide individual or group-based sessions

• the number of sessions needed (a minimum of 2 sessions should be offered)

• where to hold the sessions

• how long each session should last.
  
  For more information, see the Department of Health's quality criteria for young people friendly services.

Discuss and agree a plan for follow-up at the skills training sessions, to assess whether additional skills training or referral to specialist services is needed.

Offer adults who are assessed as vulnerable to drug misuse (see the section on assessment) the following:

• clear information on drugs and their effects

• advice and feedback on any existing drug use

• information on local services and where to find further advice and support (see recommendation 1.5.3 in the section on people at risk of using drugs).
  
  This information should be provided at the same time as the assessment.

Offer information and advice both verbally and in writing. Provide advice in a non-judgemental way and tailor it to the person's preferences, needs and level of understanding about their health. Ensure that information and advice is delivered in line with NICE's guidelines on general approaches to behaviour change, individual approaches to behaviour change and patient experience in adult NHS services.

Discuss and agree a plan for follow-up at the assessment, to determine whether additional information or referral to specialist services is needed.

Consider providing information about drug use in settings that groups who use drugs or are at risk of using drugs may attend. These settings could include:

• nightclubs or festivals

• wider health services, such as sexual and reproductive health services or primary care

• supported accommodation or hostels for people without permanent accommodation

• gyms (to target people who are taking, or considering taking, image- and performance-enhancing drugs).

Consider providing information in different formats, including web-based information (such as digital and social media) and printed information (such as leaflets).

Consider providing information on:

• drugs and their effects (for example, the NHS webpage on drug addiction)

• local services and where to find further advice and support

• online self-assessment and feedback to help people assess their own drug use.

Ensure that information provided is in line with NICE guidelines on general approaches to behaviour change, individual approaches to behaviour change and patient experience in adult NHS services.