Initial interventions

Chapter 3.3


Prevention is a critical element in reducing the number of individuals turning to drugs.

The Christie Commission highlighted the positive impacts of prevention interventions in 2011. It estimated that 40% of spending on public services is on interventions that could have been avoided by prioritising a preventive approach (25). Despite this, no meaningful shift to a preventive approach in drugs policy and interventions has been

Prevention means changing the structural drivers of problem drug use. These include poverty and multiple deprivations, adverse childhood experiences, trauma and mental ill health. seen.

Targeting interventions on the environmental, structural and personal factors that can make individuals more likely to experience problem drug use may prove beneficial. This approach may also tackle other social harms and negative outcomes, reflecting a holistic approach to wellbeing, care and support that is core to this report.

Our remit was to focus on interventions that can impact directly on the drug-death crisis in Scotland. We have therefore not undertaken in-depth work on prevention. We nevertheless have some suggestions for further work.

What needs to change

A sustained shift is required to tackle structural inequality and poverty as root causes of drug dependency, with clear actions to increase prevention.

Action 31. The Scottish Government must prioritise tackling the root causes of drug dependency, embedding this focus into work across Government to address poverty and structural inequality.

The traditional “just say no” approach to education is unlikely to prevent young people from taking drugs. The Scottish Government’s report What Works in Drug Education and Prevention? (26) highlights that there is more robust evidence to show what is ineffective in drug education than what is effective.

Drug education nevertheless can have some impact on delaying young people using drugs and promoting harm reduction.

Evidence suggests “testimonial education” isn’t effective and can be counterproductive. Instead, programmes that target multiple risk behaviours, help build self-esteem and develop life skills are more likely to be effective. The wider school ethos and approach, with pupils having positive relationships with peers and teachers, can also be an important preventive factor.

Action 32. Education Scotland should develop a new education programme for drugs based on findings in “What works in Drug Education and Prevention?”

Early intervention

We recognise that a drug-free world is not realistic. Some people will always use substances. People therefore need to be able to do so as safely as possible. They should be supported to make informed decisions about their drug use and be able to access holistic support if their use becomes problematic.

What needs to change

High-quality and evidence-based information on drugs and harm reduction must be available consistently across the country, especially for young people (who may choose to use drugs for the first time) and older people (who are at high risk of drug harms).

Information should be available where people who may use drugs go – places like night clubs, youth centres, schools, colleges and universities, community centres, job centres and doctors’ surgeries. Digitally availability is a must – this is explored further in Chapter 4.

People who use drugs come into contact with a wide variety of public services that may have no direct connection to their drug use. These touch points need to be seen as opportunities for intervention. Consideration should be given to how to maximise existing touch points. The Scottish Ambulance Service (SAS), for instance, often has reach into communities where people do not go to their GP and may be able to offer people an early intervention or referral.

There are clear times in a person’s life – for example, when entering the justice system, becoming homeless, or a young person leaving secure accommodation – that should be considered as key points for intervention.

Relationships are core to any intervention and to any system. The reality is that no matter what is in a written policy, human connections will have an impact and often make the difference in creating effective change.

Action 33. Within the next year, the Scottish Government should undertake and publish a mapping exercise of touchpoints outwith the drug and alcohol sector, with the ultimate aim of making every contact count. The Government should then ensure that at these touch points, people are aware of the services available and are able to engage effectively with referral pathways into treatment and support.

We know that many people with problematic drug use have experienced trauma, often repeatedly. A trauma-informed workforce (across all areas of the public sector) is crucial to ensure those who have experienced trauma are able to access and engage in services.

All public sector and publicly funded workers should be supported to achieve the trauma-informed practice level of NHS Education for Scotland’s (NES) National Trauma Training Programme (27). Those working directly with people who use drugs should have a higher level of training, becoming trauma-skilled practitioners.

Action 34. The Scottish Government, chief officers and ADPs should ensure that every worker who is public-facing or who works in a publicly funded service completes trauma training appropriate to their role, as set out in the NES Knowledge and Skills Framework for Psychological Trauma (28) and the Scottish Psychological Trauma Training Programme (29).

Consideration should also be given to the environment in which services are provided to people who use drugs.

Psychologically-informed environments are designed to take the psychological and emotional needs of people with trauma experiences into account. Service providers should ensure that the space in which they work makes people feel safe and promotes positive relationships.

Action 35. ADPs and Healthcare Improvement Scotland (or the Care Inspectorate) should ensure that all drug services are delivered in psychologically- and trauma-informed environments.


Information for non-specialised services

Tackling the drug death crisis is everybody’s business. Workers in services outside the drug sector need to know how to help people who want to change or stop their drug use.

What needs to change

We heard that service provision across the country is inconsistent. Consistency across the country in treatment access and options is crucial.

This does not mean that every area has to have exactly the same services, delivered by the same organisations. It does mean that everyone must have access to the treatment they need.

People in need should be able to access treatment from anywhere in the system. Services and workers outwith the drugs sector therefore need to know how to refer people into more specialised services.

ADPs should establish and maintain referral pathways for all services. They should be reviewed regularly to ensure effectiveness and be accessible through a single national platform (see Chapter 4).

Action 36. Local ADPs should keep a single, up-to-date, publicly available record of services in their area. It should clearly identify referral pathways and feed into a national platform from which information on any local area can be found.