Drug and alcohol services for young people cut by £26m in six yearsBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n817 (Published 28 March 2021) Cite this as: BMJ 2021;372:n817
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We read with interest the report by Kmietowicz highlighting a significant reduction in the budget for drug and alcohol services in young people between 2013 and 2020. This is of particular relevance given the specific effect of the coronavirus pandemic on drinking in young people and the need to ensure that any additional funding is targeted appropriately.
The pandemic has been associated with an increase in alcohol consumption but young people are almost twice as likely to be drinking more compared to older individuals. This is likely to be due to specific pandemic related pressures on young people, including employment (young people have faced the largest drop in paid work and highest rates of furlough) and social isolation (51% of 16-24 year olds reported feeling lonely compared with 24% of 55-64 year olds). This may be linked to one in five 16-39 year olds developing depression in 2020 and an increase in the suicide rate in those under-18 during 2020, which highlights the need for an integrated approach encompassing drugs, alcohol and mental health.
We therefore agree with Kmietowicz that additional funding is needed to provide appropriate support for young persons, both for those with pre-existing alcohol problems and also for prevention. However, there is also a need for funding to be targeted, ensuring that interventions for this specific age-group are both effective and can be implemented in clinical practice. Mental health treatment varies in efficacy between young people and older adults. Specifically NICE recommends family therapy and cognitive-behavioural therapy for young people with alcohol misuse disorders. Additional approaches might include 12-step therapies, including the most commonly recognised “Alcoholics Anonymous”. These free community-based groups have been shown to be cost-effective and successful in young people. On the other hand, the use of “motivational interviewing” has been reported to have a minimal clinical effect. There are also challenges in implementation due to limited capacity and stigma associated with mental health disorders. Confusion about the clinical and public health utility of 12-step therapies was recognised in NHS doctors despite a recent Cochrane review highlighting their effectiveness.
One promising consequence of the pandemic has been an increase in digital alcohol services. Potential advantages include increased availability and accessibility which are particularly relevant to young people who may have limited access to transport or experience frequent change of location. Delivering interventions via social media may also have role, as has been applied successfully for HIV prevention in young people. However, caution is required when designing such services to ensure that those with low digital literacy or lack of digital access have alternative pathways to care.
In summary, the pandemic has worsened problem drinking in young people and there is a need not only for increased funding of services, but also for the identification and targeting of effective interventions with sufficient infrastructure and training to ensure their rapid implementation.
1 Kmietowicz Z. Drug and alcohol services for young people cut by £26m in six years. BMJ (Clinical research ed) 2021;372:n817. doi:10.1136/bmj.n817
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Competing interests: No competing interests