Substance use

What is substance use? 

Substance use is an umbrella term that refers to the use of drugs and or alcohol use, including: 

• physical dependence  
• psychological dependence  
• recreational use 

Substance use is the preferred terminology rather than 'substance misuse' or 'substance abuse' to help reduce stigma and negative bias when discussing addiction. This is based on feedback from industry professionals and people with lived experience. 

Professor Dame Carol Black Review - Effective Treatment and Recovery Systems 

Professor Dame Carol Black completed a 2-phase review in 2021 called Substance Use Treatment and Recovery Systems. The review states that there are 5 elements needed to be in place for individuals to have the greatest chance of achieving recovery from addiction, and to reduce the risk of negative health and social outcomes. 

'From Harm to Hope' - 10 Year National Drug Strategy to cut crime and save lives 

The UK government published the national strategy in 2021 following the two-phase Professor Dame Carol Black Review and Autumn spending review. The strategy aims to: 

• break drug supply chains 
• deliver a world class treatment and recovery system 
• achieve a generational shift in demand for drugs 

 'World Class Treatment and Recovery System' targets and ambitions 

The targets and ambitions are: 

• 20% increase of people in treatment for substance use 
• improved quality of services - reduced caseloads, trauma informed care, integrated care, improved capacity, workforce development, recovery and harm reduction activities 
• Continuity of Care - 75% of prison leavers accessing community treatment within 3 weeks of leaving 
• more people accessing residential rehabilitation 
• increased professional staff mix - mental health, psychology, social workers, and nursing staff 
• reduced drug and alcohol related deaths 

Substance Use Quality Commissioning Standards  

In 2022, the UK government published new Quality Commissioning Standards (QCS) for Substance Use Treatment and Recovery Services. The standards aim to guide processes, partnerships and systems for effective commissioning and delivery of drug and alcohol treatment services.  

This includes 65 quality statements, split across 11 standards, which are grouped into the following 4 key themes: 

• Partnerships and Governance 
• Commissioning Cycle 
• Whole and Integrated System Approaches 
• High Quality Treatment Systems 

Impact of substance abuse

Substance use has a considerable impact on individuals, families and communities, contributing to a range of physical, mental and social harms. Local authorities and wider partners have a role to play in reducing the harm related to drugs and alcohol. 

Due to stigma within society, there is a shift towards treating substance use as a long-term relapsing chronic health condition and using non-stigmatising language or approaches.

Health inequalities in substance use are both a cause and a consequence of deprivation, with those in most deprived areas experiencing the highest levels of harm. 

In England the rate of drug-related deaths for 2021 to 2023 was 5.5 per 100,000 deaths and 7.3 per 100,00 deaths for Stockton-on-Tees, equalling 40 people in Stockton-on-Tees dying from drug use.

The societal costs for illicit drug-related harm including health harms are estimated to be £10.7 billion in England. 

In terms of return on investment, it is reported that for every £1 invested into drug treatment, there is a £4 social return.

Key risk factors for substance use

The top 3 risk factors for developing substance use related harms later in life are:

• persistent, multiple factors of disadvantage - substance use is used as a coping mechanism in response to stress or pain
• Adverse Childhood Experiences (ACE's) -. disrupting neurodevelopment, creating coping mechanisms like self-medication, fostering mental health issues such as anxiety and depression, and increasing vulnerability to further trauma, because substances are used to escape distress, numb painful emotions, or as a form of self-harm, leading to a cyclical relationship where addiction can increase the likelihood of further trauma
• parental substance use - if a parent uses substances this creates a higher-risk environment where children may be more susceptible to developing their own substance use disorders

Other risk factors, and therefore inversely, protective factors, related to substance use, which can increase individuals' chance of experiencing health inequalities and poor health outcomes are:

• people who attend nightclubs and festivals
• domestic abuse
• sexually exploited or sexually assaulted
• involved in sex work
• homelessness
• LGBTQ+
• not in employment
• children and young people, looked after, and or carers
• children and young people in contact with young offenders but not in secure environments
• poor mental health

Emerging trends: Ketamine, Nitazenes, illicit vapes and chemsex

Ketamine

Nationally, there has been a notable rise in ketamine use since 2020 with a notable rise in the presentation of users at treatment services and associated long-term health conditions impacting NHS services. Prevalence is highest amongst the 16 to 29 age group. In Stockton-on-Tees the numbers remain very low, with most users in treatment being male and under 50.

Nitazenes

Significant reductions in the global heroin supply have impacted drug-taking trends, with a shift towards non-opiates, crack and tablet use reported within the sector and communities. This change in supply has also influenced the rise in availability of Nitazenes, which have increasingly been linked to fatal overdoses since their emergence in the UK in 2020, with more than 400 recorded overdoses since June 2023. They are usually mixed with other substances and mainly mis-sold as other drugs. Young people who buy pills and powers online and older people who normally use street heroin are most at risk.

Illicit vapes 

The level of smoking in those who use substances is significantly higher than the general population however little is known about the level of vaping and using illicit drugs in vapes. Evidence has suggested there is an increasing number of young people using vapes that contain THC and spice and incidents locally have arisen.

Chemsex

Chemsex is the term used when people (usually men who have sex with men or MSM) are having sex, which involves one or more of 3 specific substances (chems) in any combination. Crystal methamphetamine, gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL) and mephedrone are the drugs commonly used. Aside from the risks of taking illicit drugs, the combination of drug use and sex can increase the risk of HIV, hepatitis B and C and other sexually transmitted infections (STIs) increases.

National guidance published in 2015 highlights the public health risk of chemsex and provides prompts for services to understand the needs of the local MSM population and commission appropriate services to meet the needs of those who engage in Chemsex. 

It is important for the wider system to remain aware, flexible and responsive to changes in drug-taking supply, trends or harms, working together to mitigate the impact on local communities.

Together, a group of services provide clear priorities for preventing and tackling health and social harms related to substance use going forward. They are:

• The 2021 National Drug Strategy
• 2022 Substance Use Quality Commissioning Standards
• 2025 Health Needs Assessment
• service reviews
• stakeholder consultations

Although current support services are performing comparatively well in Stockton-on-Tees, supported by an increase in National Drug Strategy funding, the sector faces challenges relating to:

• a changing drugs market
• supply and trends
• growing complexity
• risks
• stigma
• health inequalities

Another challenge the sector is facing is health harms associated with substance use particularly for communities experiencing prolonged use, several identified risk factors or co-morbidities, or severe and multiple disadvantage.

This JSNA highlights opportunities to reduce harm, address inequalities and improve outcomes for those using and or experiencing harm due to substances. Taking forward recommendations will require a coordinated approach to ensure that support is accessible, effective and responding to current needs.

Stockton Recovery Service summary

Stockton Recovery Service is currently delivered by Change Grow Live (CGL) and Recovery Connections and includes a multi-disciplinary team of:

• recovery coordinators or coaches
• nurses
• mental health professionals
• social workers
• group workers
• specialist and targeted roles

Over 30% of the team have direct lived experience of substance use (and more with familial lived experience), which is recognised as good practice for effectively building relationships, engaging communities and supporting people into recovery.

The service provides a range of substance use treatment and recovery support options to both adults and young people including support for opiates, non-opiates and alcohol (including poly-use) through a mix of medical and Psychosocial Interventions (PSI), Harm Reduction approaches and access to residential rehabilitation. 

The service also plays a key role in preventing and learning from overdoses and drug related deaths, facilitating wider workforce development, dispensing Naloxone to partners and the community, and tackling stigma whilst promoting visible recovery. 

The number of adults in treatment for drugs in 2024 was 1315, which includes 170 for non-opiates and alcohol, 230 for non-opiates, and 915 for opiates. Most new presentations to treatment are aged 30 to-49, male, white, heterosexual and do not report a disability. Those who enter treatment for opiates are also least likely to be in stable employment and most likely to have an urgent housing need.

The service has dramatically reduced average waiting times from referral to assessment and increased the proportion of clients successfully accessing treatment following referral, by introducing a full-time walk-in offer with same day prescribing in 2024. Stockton Recovery Service has also made significant progress against the 'From Harm to Hope' ambitions outlined including becoming a regional lead in some target areas. 

Stakeholder Engagement 2025

In 2025, 4 focus groups and 4 surveys were completed with stakeholders to gather feedback around awareness, needs, challenges and support for substance use.

Responses were grouped into the 4 themes.

Awareness and education

There were concerns about young peoples' lack of awareness regarding drug and alcohol effects due to insufficient education. Communication campaigns, training and better promotion of support services are being suggested to improve overall knowledge and awareness.

Wider determinants of health

Issues like deprivation, social inequality, the COVID-19 pandemic, homelessness, and unemployment were associated with the potential of increasing substance use. Substance use was also identified as being something that was often used as a coping mechanism for trauma and mental health issues.

Views on drug use

There are varied views on drugs, with some seeing it as a risk for offending and others as pain relief. The availability of drugs in Stockton-on-Tees was a concern. We need to recognise that there is a need to prioritise saving lives and providing help over crime reduction.

Unmet needs

There is a gap in mental health provision, housing, family support and specific services for ethnic communities and female-only groups. Improvements included better promotion, more outreach, integrated services and dedicated spaces for young people. A holistic approach with collaborative working was also emphasised.

Consultation with Partners - Local Priorities (2023)

In January 2023 Public Health held a consultation event, with over 30 local partners from across the system and people with lived experience. Discussions were focused around 4 themes (Adults, CYP, Healthcare, Recovery and or Communities), with 10 priority areas identified based on local needs, gaps and insights:

• improved physical healthcare offer and access to healthcare services
• improved integration with mental health services, and delivery of trauma-informed services
• improved integration with housing, probation, community safety, licensing, safeguarding and or social care, domestic abuse services, local businesses and VCSE sector, to help address complex needs and or multiple disadvantage
• improved integration with children's services, schools and or colleges and VCSE Youth Sector
• targeted support for young adults, care leavers, night-time economy and 16 to 25 year old transitional support
• continued development of whole-family, multi-agency, harm reduction and overdose prevention approaches
• improved outreach and out-of-hours provision, including recovery support
• targeted work around tackling stigma and promoting visible recovery
• improved marketing, promotion and communication of available services, including new Drug Strategy funded interventions
• ongoing engagement with people with lived experience to inform further service developments

Recommendations

The Substance Use Health Needs Assessment completed in 2025 provided over 50 specific recommendations for addressing local need, grouped into 3 themes. The 3 themes have been condensed into 11 overarching recommendations.

Prevention

The recommendations are:

• reduce alcohol-related harm
• improve access and awareness
• strengthen, prevention and harm reduction
• engage communities and partners

Access to treatment and recovery

The recommendations are: 

• integrate and personalise support
• expand access and outreach
• strengthen health interventions

Intelligence and system improvement

The recommendations are:

• strengthen intelligence and data use
• improve access and integration
• promote inclusion and reduce stigma
• advance research and innovation

1. Government response to the independent review of drugs by Dame Carol Black.
2. From harm to hope: A 10-year drug plan to cut crime and save lives.
3. Commissioning quality standard: alcohol and drug treatment and recovery guidance.