Recommendations

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 Delivering drug misuse prevention activities as part of existing services

1.1.1 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.

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

1.2 Assessment

1.2.1 At routine appointments and opportunistic contacts with statutory and other services, such as those listed in recommendation 1.1.1, 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.

1.2.2 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 practice standards for young people with substance misuse problems.

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

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

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

1.3 Children and young people assessed as vulnerable to drug misuse

1.3.1 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 section 1.4) may be a more appropriate approach.

1.3.2 Ensure any skills training is:

  • commissioned as part of existing services (see recommendation 1.1.1)

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

  • delivered by people competent to provide skills training.

1.3.3 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.

1.3.4 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.

1.3.5 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.

1.3.6 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.

1.4 Adults assessed as vulnerable to drug misuse

1.4.1 Offer adults who are assessed as vulnerable to drug misuse (see section 1.2) 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).

    This information should be provided at the same time as the assessment.

1.4.2 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 and individual approaches to behaviour change and patient experience in adult NHS services.

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

1.5 People at risk of using drugs

1.5.1 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).

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

1.5.3 Consider providing information on:

  • drugs and their effects (for example, on NHS Choices)

  • local services and where to find further advice and support

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

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

Terms used in this guideline

This section defines terms that have been used in a specific way for this guideline. For general definitions, please see the glossary.

Care leavers

People aged 25 or under who have been looked after by a local authority for at least 13 weeks since age 14, and who were looked after by the local authority at school leaving age or after that date.

Children and young people who are looked after

Children and young people looked after by the state for whom the Children Act 1989 applies. The term includes children and young people who are subject to a care order or temporarily classed as looked after on a planned basis for short breaks or respite care. The term also includes those in residential care, foster care or boarding school, or with birth parents, other family or carers. It includes children and young people in placements out of the child or young person's home area. Children and young people who are in young offender or other secure institutions are not included in this definition, because this group is outside the scope of the guideline.

Drugs

Drugs described in the Misuse of Drugs Act 1971 and the Psychoactive Substances Act 2016, as well as new psychoactive substances (often described as 'legal highs'), solvents, volatile substances, image- and performance-enhancing drugs, prescription-only medicines and over-the-counter medicines.

Drug misuse

Dependence on, or regular excessive consumption of, psychoactive substances, leading to physical, mental or social problems. This term does not include occasional or experimental drug use in adults.

Groups at risk

Groups at risk of drug misuse, including:

  • people who have mental health problems

  • people who are being sexually exploited or sexually assaulted

  • people involved in commercial sex work

  • people who are lesbian, gay, bisexual or transgender

  • people not in employment, education or training (including children and young people who are excluded from school or who truant regularly)

  • children and young people whose carers or families use drugs

  • children and young people who are looked after or care leavers

  • children and young people who are in contact with young offender teams but not in secure environments (prisons and young offender institutions)

  • people who are considered homeless

  • people who attend nightclubs and festivals

  • people who are known to use drugs occasionally or recreationally.

Prevention

Preventing or delaying drug use, preventing people who are already using some drugs from using other drugs, and preventing people who already experiment or use drugs occasionally from using drugs regularly and excessively.

Treatment

The clinical management of drug misuse or dependence. This could comprise, for example, pharmacotherapy, psychosocial therapy or a combination of these.

Vulnerable to drug misuse

People in groups at risk who may be particularly vulnerable to drug misuse. This may include people:

  • in multiple groups at risk

  • whose personal circumstances put them at increased risk

  • who may already be using drugs on an occasional basis

  • who may already be regularly excessively consuming another substance, such as alcohol.

Young people

People aged 10 to 18. This term also includes people aged up to 25 who have special educational needs or a disability (consistent with the Children and Families Act 2014).

  • Public Health England
  • National Institute for Health and Care Excellence (NICE)