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Tobacco, Alcohol and Drugs: A combined harm reduction approach

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Cllr Lorna Fielker

Deputy Leader
Cabinet Member Adults, Housing and Health
Southampton City Council

Cllr Lorna discusses Southampton’s initiatives to reduce harm caused by tobacco, alcohol and drugs.

Good health and wellbeing transforms our lives. Sadly, many people still have preventable illnesses and die before time. Harm from tobacco, alcohol, and drug (TAD) use is common, it does not only impact on individual people, it also effects those around them and communities. Despite TAD often being used at the same time by the same people, with the same agencies involved with reducing harm and supporting people who use them using similar approaches, local authorities have generally taken a siloed approach by developing separate strategies and work strands.

Southampton City Council have taken a different approach. Our innovative  Tobacco, Alcohol and Drugs Strategy (2023-2028) brings together tobacco, alcohol and drugs and takes a whole-council approach. This will help us take every opportunity to reduce harm and improve health, wellbeing, and the city as a whole.

Developing the strategy last year, we found that only Guernsey and Australia had combined strategies and that most other strategies have priorities related to population subgroups or primary/secondary/tertiary prevention, rather than explicitly being cross-council.  In contrast Southampton’s strategy has five work programmes split across the council directorates. The programmes will result in a step-change in local experience and outcomes.

Our Children & Learning programme has a key focus to prevent children and young people from starting using tobacco and e-cigarettes, alcohol under-age or at higher risk levels, or drugs. We also will work to reduce the harm, to children and young people, caused by ‘parental’ drug and alcohol dependence. Health and Adult Social Care will concentrate on the identification of more people with higher-risk use and to strengthen local services which will help people with tobacco, alcohol and/or drug use, to stop or reduce their use, or at least be safer while using.

Our Place directorate is directing its attention to Southampton having more public places that are free from tobacco, alcohol, or drug use, particularly those that children and young people are exposed to and to support employers to promote health and reduce harm from tobacco, alcohol, and drugs.

Communities, Culture and Homes will work with local partners such as the Safe City Partnership, Hampshire Constabulary, and the Voluntary Sector to reduce illicit or illegal supply of tobacco, alcohol, and drugs, keep people safe from harm and make the most of opportunities to strengthen communities and housing in a health promoting way.

This work is underpinned by support from the corporate directorate who are leading on embedding a health in all contracts and commissioning approach, supporting workforce wellbeing, including a new workforce drug and alcohol policy which prioritises support with safety, as well as providing guidance on advertising, and seeking to ensure that our work does not link to the tobacco industry, including pension investment.

A fundamental principle of this strategy is to be non-judgemental and compassionate. We strive to encourage people to seek support by reducing stigma. The use of tobacco, alcohol and/or drugs often starts in childhood or as young adults, before we can fully understand or judge the immediate and long-term risks, and when we may be more influenced by the significant people in our lives and marketing. For example, one of the main risk factors for young people smoking is that they live with an adult who smokes. Tobacco, alcohol, and drugs can seem like they make us feel better which can be very compelling, particularly when we are stressed, tired, shy, or lonely. But biologically, they can make us feel worse through cravings, low mood and/ or anxiety. Withdrawal symptoms, including the way they affect our brain, can make it difficult to stop using them.

For many people with tobacco, alcohol and drug dependence and higher-risk use, their use is not a choice. It is a symptom of other problems, such as mental ill health, abuse, grief, loss, and other trauma. These same difficulties can also make it very difficult to limit, reduce or stop using, without help, and sometimes even with help. Many people who smoke or who have alcohol or drug related issues are ashamed of their use or the associated problems. It can take courage to seek help and any judgement would further put people off.

Compassion and self-compassion are effective in improving engagement in services and outcomes. This strategy is hopeful. This strategy unites colleagues across the council and shows them what they can do. It also shows residents, visitors, and other stakeholders in the city what we are striving to achieve and the role they can play to help each other to be happy, hopeful, and healthy.

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