Reducing harm from drugs and alcohol
Counsellor Mitchie Alexander Cabinet member for Communities, Equalities, Public Health & Adult Social Care.
Brighton & Hove has high rates of drug deaths, I see daily the harms associated with drug and alcohol use and the impact on individuals and their friends, families, and communities.
Drug and alcohol use can increase inequalities in health outcomes. It reduces the number of years we spend in good health. It exacerbates poor mental health. It can also lead to insecure housing, estrangement from family or friends, and employment issues.
As a city council intent on advancing health equity, reducing the harms of drug and alcohol are a priority area for focusing our resources.
This strategy is our multi-agency approach to reducing harms from drugs and alcohol use.
This strategy brings together many partners and organisations including:
We’ve come together with people with direct experiences of drug use and harms, to develop this strategy.
Our approach to reducing the harms from drugs and alcohol are 3-pronged.
We aim to:
I am writing this foreword, as the Brighton & Hove City Council member with responsibility for Public Health, but it could just have easily been any or all of our partners in the collaboration we have here in Brighton & Hove.
This strategy builds on the successful partnership working of the past 2 years.
In that time we have:
We will use this strategy and its objectives to inform detailed action plans across the system to continue improving the health and wellbeing outcomes for people affected by drug and alcohol harms across the city.
Councillor Mitchie Alexander
This strategy for Brighton & Hove, describes how the Brighton & Hove Combatting Drugs Partnership will deliver locally the ambitions in the national strategy ‘From Harm to Hope’. The strategy describes the longer-term vision to 2030 to reduce harms from drugs and alcohol for everyone who lives in, works in, or visits Brighton & Hove.
The Brighton & Hove strategy has been developed by the multi-agency Combatting Drugs Partnership, made up of leaders from different organisations across the city who have a key role in tackling drug and alcohol related harms. This includes representatives from the Council, Police, Probation service, NHS, treatment and recovery services, treatment providers, mental health providers, community and voluntary sector, and people with lived experience.
This strategy is a high-level document that sets out the Combatting Drugs Partnership’s vision for changing the culture around drug use and reducing harms from drugs and alcohol in the city. Although there is a focus on both drugs and alcohol, this reflects the alignment of drug and alcohol treatment services and the management of community safety. The strategy does not include an assessment of licensing policy.
Our vision is to make Brighton & Hove a place where everyone will be safe from the harms caused by drugs and alcohol.
Combating Drugs Partnership - key members:
The strategy should be read in conjunction with other key stakeholders’ strategies, please see appendix 4.
We will work collaboratively across the community safety teams, police and communities to disrupt local drug supply chains and alcohol and drug related crime to create safe and thriving communities.
We will enhance both the quality and the capacity of our drug and alcohol treatment and recovery service, to provide person-centred support to everyone who needs it, focusing on those at higher risk.
We will:
We will incorporate the following principles in everything we do:
Many people who experience harms directly or indirectly from drugs or alcohol use may be affected by stigma when seeking help or accessing services. This could be in the form of direct judgement from other people or health care providers, expectations of stigma, or self-stigma.
This strategy takes a compassionate and non-judgemental approach.
In Brighton & Hove many people sign up to our drug and alcohol services every year. However, drug and alcohol use still harms individuals, families and communities in our City.
The global availability of drugs is at a record high. The UK is now Europe’s largest market for heroin and is a target for Organised Crime Groups (OCGs). The drugs market continues to evolve and present new challenges in tackling the supply chain of drugs.
These challenges include the use of illegal online markets and the increasing availability of synthetic opioids, such as nitazenes and fentanyl.
In 2021 the Government launched a 10-year strategy ‘From Harm to Hope ‘. The strategy commits the Government to reduce crime and save lives by:
Addressing the harms from drugs and alcohol use is a complex issue. Often harmful drug and alcohol use is found alongside risk factors such as:
Such factors may be both the drivers and consequences of drug and alcohol use. They require a multi-agency approach to reduce harms from, change perceptions of, and address the availability of drugs in the city.
The Partnership will be responsible for overseeing the implementation of the strategy.
In Brighton & Hove we have an estimated 3,030 people who use opiate and or crack cocaine in 2019 to 2020 this is a significantly higher rate compared to the South East and England.
This breaks down as follows:
a significantly higher rate of alcohol specific mortality compared to England - 21.8 per 100,000 people - more than double the rate in England (5.2 per 100,000) in 2020 to 2022
In Brighton there were:
A 2023 Brighton & Hove City Council drug related harm survey and a community forum on drug harms found that drug dealing and drug taking are ranked as top concerns for our communities, and that:
Between January and March 2024 we heard from approximately 50 adults, who have experience of accessing drug and alcohol services. We heard from people of different ages, sexual orientation, gender identity, and disability. It is important to note that the people we spoke with may not be representative of the wider population of those with experience of drug or alcohol harm, and as such we cannot generalise these findings.
We did not reach as many people from Black and Racially Minoritised backgrounds as we had hoped and were not able to engage with children and young people. We will undertake further engagement with these groups as a priority. We have committed to continue to work with people with lived experience on the strategy and its implementation.
We heard many experiences, with some clear themes coming out of the discussion, and these have informed the development of the strategy. In particular strategic priority 2: to deliver a world-class treatment and recovery service, and strategic priority 3 addressing the causes and risk factors for drug use. These themes are summarised in appendix 3 which provides further information on the discussions.
The following are barriers to accessing support:
The following are divers to accessing support:
There are many factors that are known to increase the risk of harmful drug and alcohol use.
Housing insecurity and homelessness:
The reducing harms from drugs and alcohol strategy recognises the significant health inequalities faced by people with multiple compound needs and the principles of integrated working set out in the aims of the MCN transformation programme.
The global availability of drugs is higher than ever before. The threat from drugs continues to evolve, with the emergence of highly potent synthetic opioids and access to drugs via online illegal markets. Organised crime groups criminally exploit children, young people and other vulnerable groups to move and distribute drugs. Breaking drug supply chains will reduce availability of drugs and associated violence and exploitation.
Workstream 1 is focused on disrupting the supply chain of drugs. It will improve community safety and support people who commit crimes related to drug or alcohol use into treatment and support. This Workstream is co-led by Sussex Police and the Council’s Safer Communities team.
This priority is delivered collaboratively across a range of organisations including the police, probation services, and the local authority community safety team.
We want to:
Workstream 2 aims to improve service capacity and capability to support people with a substance use need into treatment and recovery. This workstream is co-led by the adult drug and alcohol treatment service CGL and the Council’s Public Health Team and comprises representation from the children and young people’s drug and alcohol treatment service (RU-OK), and the NHS, including primary care.
Children’s and adults’ drug and alcohol treatment and recovery services have benefited from substantial additional supplementary funding grants between 2022 and 2025. In 2024 to 25 this amounted to approximately £4.4 million. This funding is in place until March 31 2025. Currently, it is unclear what additional funding streams may come into place from April 2025. Current service capability and capacity has been significantly increased with these grants.
We want to:
Improving the capacity of drug and alcohol treatment services is essential to address historic disinvestment which has led to reduced capacity in the drug and alcohol treatment service. Alongside this we need to improve the skill mix and capability in the service, to meet the increasing complexity of casework. The supplementary funding has started to address this historic disinvestment and outcomes are beginning to improve.
Further enhancing services will continue to address these gaps, improving public health, safety, and productivity, and ultimately foster stronger, more resilient communities.
Workstream 3 is a longer-term objective to reduce the demand for drugs and alcohol.
There are 2 approaches to reducing the demand for drugs and alcohol:
This workstream area will focus on reducing demand for drugs and alcohol amongst children and adults, through attitudinal shifts, as well as addressing the risk factors. This priority is led by the Trust for Developing Communities and the Council’s Adolescent Services.
The use of drugs has grown over a decade, especially among young people, risking individual and community harms.
We want to:
We have a strong foundation for this strategy, based on existing partnerships, good collaboration across partners, and a commitment to reduce drug and alcohol related harm for our residents.
The Combatting Drugs Partnership provides the leadership to this programme and comprises professionals from across the council and multiple agencies including the NHS, providers, and the criminal justice system, as well as people who have lived experience of the harms of drugs and alcohol. A full list of contributors is available at appendix 1.
In late 2022, the Combatting Drugs Partnership approved the establishment of 3 sub-groups to take forward the 3 priorities as workstreams of the national strategy.
Over the period to April 2024 the 3 workstream sub groups have been reviewing existing strategies and plans (see appendix 4) that contribute to the combatting drugs programme, and how these translate into action.
This has enabled us to develop a comprehensive picture of existing objectives and targets, and benchmarked activity which inform this strategy’s ongoing and additional activity.
Our headline outcome measures reflect the national priorities.
Under these will sit detailed outcome measures to support the action planning and progress monitoring:
Detailed action plans will be developed to sit underneath each strategic priority. They will form the basis for an outcomes monitoring framework. The actions and targets will be SMART: specific, measurable, achievable, realistic and timely, and will be developed to meet short term, medium term and longer-term needs.
The priorities, strategic objectives and the outcomes monitoring framework will be regularly reviewed by the Combatting Drugs Partnership to ensure it continues to meet the needs of our population, to reflect any changes in national policy, and accommodate funding changes (the current supplementary substance misuse treatment and recovery grant (SSMTRG) ends in March 2025).
This strategy reflects the collaboration between partners in Brighton & Hove with the aim of reducing harms from drugs and alcohol.
The Combatting Drugs Partnership (CDP) provides the structure to the collaboration and comprises multiple organisations with their own specific organisations’ governance arrangements and oversight boards. The CDP is supported by a multi-agency steering group. The CDP Board receives regular updates from the 3 priority work steams and provides oversight to these workstreams.
The CDP expect to provide annual updates on progress to the National Joint Combatting Drugs Unit, and to the Brighton & Hove Health and Wellbeing Board.
The partners and stakeholders involved in the development of the strategy include members of the CDP, priority workstreams and people with lived experience comprising representation from:
There is a planned public consultation which will further refine the strategy.
BHCC undertook an extensive Equalities Impact Assessment.
In summary, the Equality Impact Assessment (EIA) assesses the impact that the Drugs and Alcohol Strategy for Brighton and Hove may have on diverse protected characteristics and different communities, based on our current knowledge and assessment.
A range of barriers to accessing services and support was identified.
Some of them are likely to affect all groups equally:
The drug and alcohol strategy describes the longer-term vision to 2030, to reduce harms from drugs and alcohol for everyone who lives in, works in, or visits Brighton & Hove. The Brighton & Hove strategy will be delivered in partnership by multiple organisations.
The strategy has been developed by the multi-agency Combatting Drugs Partnership, comprising leaders from different organisations across the city who have a key role in tackling drug and alcohol related harms. This includes representatives from the Council, Police, Probation service, NHS ICB, mental health providers, treatment and recovery services, community and voluntary sector and people with lived experience.
This strategy is a high-level document that sets out the Combatting Drugs Partnership’s vision for changing the culture around drug use and reducing harms from drugs and alcohol in the city. Although there is a focus on both drugs and alcohol, the alcohol elements reflect where there is alignment between drug and alcohol treatment and management. It does not include an assessment of licencing policy.
The EIA describes how partners and residents were consulted and reflects the engagement with:
At the time of writing the EIA further consultation is planned, including a public consultation via the Council Your Voice portal.
The EIA uses demographic data to understand better the impact of the strategy on specific population cohorts, with a view to ensuring that disproportionate impacts are mitigated.
The EIA considers:
Detailed action plans will be developed to sit underneath each strategic priority. They will form the basis for an outcomes monitoring framework. The priorities, strategic objectives and the outcomes monitoring framework will be regularly reviewed by the Combatting Drugs Partnership
The EIA goes on to describe how the data are collected, noting gaps where data collection should be improved. For example, for armed forces personnel impact assessment. The headline data show the following for each characteristic – please see the full EIA for comprehensive detail.
The 35 to 54 age range is disproportionately represented in drug deaths, and in children and young people there were disproportionate needs reflected for benzodiazepine use compared to England averages.
Children and young people are particularly vulnerable to exploitation relating to involvement with drugs including involvement in gangs or county lines. 13% of first-time entrants to the youth justice system aged 10 to 17 years have committed offences relating to drugs.
Children and young people affected by drugs and alcohol use in the family are also noted to have worse health, wellbeing and educational outcomes than other children. Many children and young people also have co-occurring vulnerabilities such as poor mental health or exposure to domestic violence.
The team conducted a series of workshops to engage with people with lived experience (PWLE) of involvement with drugs and alcohol and support services to better understand their needs. Approximately 50 adults participated, with representation across an age range of 16 to 74 years.
The strategy recognises however, that there was no similar engagement with children and young people via focus groups or workshops. Objectives relating to the needs of children and young people are identified within the strategy and will be engaged with going forwards with the implementation of the strategy.
The 2021 Census ONS data shows that nearly 1 in 5 residents (19%) are disabled as defined by the Equality Act. Among residents without a disability, 8% have a long term physical or mental health condition.
Of the 23 participants in the PWLE workshops for whom disability data was captured, 20 self-identified as having a disability or long-term condition. Themes from the workshops identified disability as a trigger influencing drug and alcohol use. Accessibility of services, including accessible spaces, was identified as a barrier for disabled users. Better mental health provision was identified as an area for improvement.
Further engagement with people with lived experience is planned via the Drug and Alcohol Lived Experience Programme, of which the needs of disabled people will be a focus.
Recognition of disability and unmet physical and mental health needs as risk factors for drug and alcohol use, and as barriers to accessing services, is reflected in the strategy.
Priorities relating to this include:
More than a quarter (26%) of residents of Brighton and Hove are from a Black and Racially Minoritised group (non-White UK British). Amongst users of drug and alcohol treatment services in 2021 to 2022, 11% were from Black and Racially Minoritised backgrounds.
Unfortunately, the people with lived experience (PWLE) workshops did not reach as many people from Black and Racially Minoritised backgrounds as hoped, even though these were prioritised. The strategy acknowledges this and commits to undertake further engagement with these groups as a priority. This reflects a focus within the strategy of improving access to and experience of services for underserved cohorts including people from Black and Racially Minoritised backgrounds.
Barriers in accessing drug and alcohol treatment and recovery services which should be considered in the implementation and delivery of services may include:
The development of the strategy did not explicitly consult on data relating to religion.
Based on 2021 ONS Census data:
Data on religious identity was captured as part of the PWLE workshops, with participation of a range of people who identified as having a particular religion or none.
It is not envisaged that the detailed action plans underpinning the strategy will cause any disproportionate impact relating to religion, belief, spirituality, faith or atheism. However, barriers to accessing drug and alcohol treatment and recovery services should be considered in service development and may include:
Data from the 2021 ONS Census shows that 51% of residents are female, and 49% are male.
To inform the development of the strategy, the Public Health team used data relating to Gender Identity and Sex from the Brighton & Hove Drugs and Alcohol Needs Assessment (2022). The data shows that 63% of all Service Users in 2021 to 2022 were male. However, women may find it harder to access drugs and alcohol treatment due to specific concerns such as fear of losing their children, or accessing often male-dominated environments due to disproportionate experiences of Domestic Abuse and Sexual Violence.
Inpatient episode rates of intentional self-poisoning are significantly higher for women in Brighton and Hove (62.8 per 100,000) compared to England (38.6 per 100,000).
Feedback identified the importance of all-female service and activity spaces to enable Service Users to feel safe and comfortable.
Recognition of specific vulnerabilities and barriers to access relating to Gender Identity and Sex is reflected in the strategy, which includes a focus on underserved cohorts and a priority area led by the women’s drug and alcohol treatment service, Oasis. Amongst the specific priorities is a focus on developing an integrated response for people with co-occurring substance use and other needs, including:
In 2021 a new question on gender identity was included in the Census. The 5 local authorities with the highest proportion of the population aged 16 years and over who identified as non-binary were all outside London. Brighton & Hove had the highest percentage (0.35%).
Data from the Safe and Well at School survey suggests 17% of pupils who did not or did not always identify with their gender registered at birth had tried drugs, compared to 12% of those who did. Of the 23 participants in the PWLE workshops for whom this information was captured, 7 participants identified as trans.
Feedback identified specific barriers for trans people in accessing drugs and alcohol support, in particular where accessing treatment may impact on gender reassignment treatment. It also highlighted the importance of specific trans-inclusive spaces to facilitate access to support, including diversity of staff and volunteers.
Recognition of the specific barriers and needs of trans and gender diverse people is reflected in the strategy, which includes a priority of improving access to and experience of services, especially from underserved cohorts including LGBTQIA+ people.
2021 Census data suggests the proportion of adults identifying with an LGB+ orientation (10.6%) in Brighton and Hove is 3 times higher than in the rest of the South East and England. The Brighton & Hove Drugs and Alcohol Needs Assessment (2022) estimates that in 2021-22 18% of Service Users were from the LGBT community.
Data from the SAWSS shows that pupils who are LGBTQIA+, unlabelled, or unsure of their sexuality are statistically significantly more likely to have tried drugs (15% compared to 12%).
Additionally, of the 23 participants in the PWLE workshops for whom this information was captured, 6 participants identified as gay, lesbian, bisexual or another sexual identity. Feedback included the value of group-specific safe spaces and sessions, including for LGBTQ+ groups.
Recognition of specific vulnerabilities and barriers to access relating to sexual orientation is reflected in the strategy.
Barriers in accessing drug and alcohol treatment and recovery services may include:
The development of the strategy was not explicitly informed by data relating to marriage or civil partnership status. It is not envisaged that the detailed action plans underpinning the strategy will cause any disproportionate impact relating to this.
To inform the development of the strategy, the Public Health team used data from the Brighton & Hove Drugs and Alcohol Needs Assessment (2022), which recognises the specific needs of and barriers to parents and families in accessing drug and alcohol services. This is reflected in the strategy, which includes a priority area led by the women’s drug and alcohol treatment service, Oasis.
Barriers in accessing drug and alcohol treatment and recovery services which should be considered and mitigated may include:
The development of the strategy was not explicitly informed by data relating to the armed forces or veterans. It is not envisaged that the detailed action plans underpinning the strategy will cause any disproportionate impact relating to this group. However, we note that this cohort may experience barriers to accessing treatment, such as stigma, PTSD, availability linked to duty requirements. We will explore potential barriers and ensure the action planning reflects these.
Further work is identified for this cohort.
ONS Census data (2021) suggests 1 in 5 residents of Brighton and Hove (54,343 people, 20%) were born outside of the UK. This is a higher proportion than seen in the South East (16%) and England (17%).
The strategy was not explicitly informed by data relating to this group. Engagement with certain groups has been limited, and there is a focus on collaboration with underserved cohorts as a priority. Carers Carer status was also recorded for participants in the PWLE workshops.
Of the 23 participants for whom this information was captured, 5 identified as parents or carers. Participants identified being an unpaid carer as a life stressor that is a risk factor in drug and alcohol use.
Being a young carer is also a risk factor for drug and alcohol use. The SAWSS reports that 22% of young carers are likely to have tried drugs (as against 12% of other pupils).
There are also challenges associated with being a carer for or supporting someone experiencing harmful substance use. This is reflected in the strategy, which includes priority areas to develop an integrated response for people with co-occurring substance use and other needs such as being a carer. It also aims to improve access to and experience of services for young carers.
We know that people who are care experienced are disproportionately represented in drug deaths in Brighton & Hove, and the strategy and work planning reflects this.
Data from the SAWSS shows that adopted children are statistically significantly more likely to have tried alcohol than children who are not (51% vs 43%), as well as being more likely to have tried drugs (31% vs 12%).
The strategy recognises that there was limited engagement with children and young people via focus groups or workshops, and this includes looked after children. There is a commitment to further engage with children and young people. The strategy also includes priority areas to ensure an integrated approach to improving the transition for care leavers into adult services.
To inform the development of the strategy, the Public Health team used data from the Brighton & Hove Drugs and Alcohol Needs Assessment (2022), which reflects the particular vulnerabilities and needs of survivors of Domestic and Sexual Abuse and Violence, particularly in accessing services in male-dominated environments. Domestic violence is also a risk factor for involvement with drugs and alcohol; in 2021 to 2022, 27% of young people in treatment were affected by domestic violence.
This is reflected in the strategy, which includes a focus on addressing the causes of harmful drug and alcohol use including domestic violence and abuse, and improving awareness of, and access into services for people with experience of domestic abuse. The Oasis service works with women experiencing domestic abuse.
The strategy was informed by data relating to socio-economic disadvantage from the Brighton & Hove Drugs and Alcohol Needs Assessment (2022) particularly as it relates to housing issues and homelessness and educational outcomes for children. 17% of the population live in the 20% most deprived areas in England, and 15% of under-16 year olds live in income deprived households. In the year ending September 2022 the unemployment rate in Brighton and Hove was 3.5%.
This is reflected in the focus within the strategy on addressing the risk factors associated with drug and alcohol use including poverty.
Barriers in accessing drug and alcohol treatment and recovery services may include:
There is a high rate of homelessness according to the Brighton & Hove Drugs and Alcohol Needs Assessment (2022). In 2021 to 2022 26% of people in drug treatment had housing difficulties.
Recognition of specific vulnerabilities and barriers to access relating to homelessness is reflected in the strategy, which includes a focus on addressing the causes of harmful drug and alcohol use including housing issues or homelessness.
The development of the strategy and action plans will be developed closely with partners working in relevant Housing and homelessness teams, and there is homelessness representation on the CDP steering group
A dedicated Rough Sleepers Drug and Alcohol Treatment Grant held by the adult treatment and recovery service CGL, which delivers support and treatment for people rough-sleeping or at risk of rough sleeping.
The development of the strategy was not explicitly informed by data relating to Human Rights. It is not envisaged that the detailed action plans underpinning the strategy will cause any disproportionate impact relating to this.
People with lived experience, vulnerable people, and people with co-occurring needs.
Complex intersections of disadvantage:
The EIA considered in addition:
The Combatting Drugs Partnership Board and the Drug and Alcohol programme board will oversee the monitoring of actions and recommendations that fall out of the Strategy including where the EIA has proposed mitigations these include:
Between January and March 2024, we undertook a series of events with people with lived experience of drug and alcohol use to listen to their experiences of trying to access drug and alcohol treatment services in Brighton & Hove.
We held 5 sessions for:
We heard the experiences of approximately 50 people of different ages, sexual orientation, gender identity, and disability. This helped us to understand the experiences of people in accessing treatment and the unique and complex intersectional issues which can be significant challenges to accessing treatment.
We did not reach as many people from BRM backgrounds as we had hoped and we will explore how best to expand our engagement to include people from a range of backgrounds to better represent the population in Brighton and Hove. We also need to ensure that we engage with young people accessing treatment in the future as we were not able to engage with this group in the timeframes available.
We are committed to continuing to collaborate with people with lived experience, not only in the development of the strategy but also in its implementation.
The themes arising from the discussions to date include:
Several risk factors were identified by participants that influenced their drug and or alcohol use:
Participants outlined a range of barriers to accessing services and support:
There were some recurring themes that participants talked about that were drivers to accessing help:
There were a range of factors that would help people to access and stay in treatment, and support the journey through recovery:
There were many aspects of people’s treatment and recovery that worked well:
Specific alcohol and drug-related objectives from strategies that include Brighton & Hove residents.
Key areas for action in the strategy related to drugs and alcohol use include:
This Sussex wide strategy includes a section for Brighton & Hove, including some key priorities:
The Community Safety Partnership’s overarching duty is to:
The strategy describes the Partnership’s plans for the next three years in relation to five priorities:
The strategic priorities include:
The revised Statement of Licensing Policy was published in 2021. Special policies remain in place to reduce the availability of alcohol within the city centre area or cumulative impact zone.
Current actions include:
Priority 5: Develop accommodation and support services to meet the needs of people with co-existing conditions & multiple and compound needs: