Annexes

Annex 1 Definitions

Problem drug user

Any person who experiences social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption and/or dependence as a consequence of his/her own use of drugs or chemical substances. — ACMD 1982

The following, defined by the Department of Health, are used in England and Wales as well as in Scotland.

New patient/client

Any person who is attending the service for (a) the first time ever or (b) it has been at least six months since the last attendance at the service.

Drug

A drug is defined to be any drug of misuse, including solvents and tranquillisers, excluding tobacco. Alcohol is reported only if it is based on a secondary drug. Drugs which are prescribed by a doctor to be used as an alternative to the drug(s) of addiction are also specifically included.

Main drug

The drug which causes the patient/client the most problems at the time of contact; or the prescribed drug where it has been prescribed as part of a treatment package for addiction. This may not be the drug used most frequently or in the largest quantities.

Annex 2 List of services contributing to the Database in 1998/99

Annex 3 Specimen forms SMR22 and SMR23 (revised April 1995)

Annex 4 Deriving the area of residence

Information about health board and council area of residence of patients/clients is not recorded on forms. This information has to be derived using the following information, which is recorded: ward, and postal district.

Derivation is not straightforward, however, because of a number of possible problems, including :

• some wards, city/towns and postal districts (albeit a minority) may be bisected by either or both a health board and local authority boundary (or boundaries), and
• some ward, city/town and postal district information may be incomplete or missing. (ISD is working to address accuracy and completeness of recording as part of an overall drive to improve data quality).

The following provides an account of the method adopted to derive the health board and council area of residence of the patients/clients attending services.

Step 1 : Creation of ISD residence file

This file assigns a health board and/or council area of residence to those postal districts which are either (1) entirely within the boundaries of the board/authority, or, (2) for those postal district which are bisected by a boundary or boundaries, where the population within that postal district is very much on one side of the boundary. The file is created by :

• using the reference file obtained from the General Register Office for Scotland which contains full postcode assigned to health board and council area, aggregating to postal district level and, where possible, assigning appropriate health board and council areas.
• where it is not possible to unambiguously assign a health board or council area of residence, use the above GRO file aggregated to postal sector level and examine the population distribution within the area. Postal districts can then be mapped to the health board or council area with the largest population (at least an 80: 20 split). b

This accounts for most postal districts although some cannot be allocated using the above method.

Step 2 : Derivation of health board and council area of residence

• For those records with complete postal district information use the above ISD residence file to assign health board and council area of residence, where this is possible.
• For those complete postal districts which are not included in the ISD residence file i.e. those which cannot be unambiguously allocated (listed below), use the ward and city/town information, if recorded. The relevant area of residence is determined by reference to a range of Ordnance Survey maps.
  Health board: DD10, FK10, G52, G65, G72.
  Council area: AB9, AB12, AB21, AB23, DD5, DD10, G33, G46, G52, G65, G69, G71, G80, G82, G83, KA2, KA6, PH12.
• For the remaining records where the postal district is either incomplete or missing, health board and local authority areas of residence may be assigned by using the ward and city/town information, where recorded (as before). For those where ward and city/town information cannot be used, but where there is an incomplete postal district, it is possible to assign an area of residence to a particular health board and/or local authority area where most of the postal district lies. These are listed below :
  Health board: AB, DD, DG, EH, FK, G, HS, IV, KA, KY, ML, PA, PH, TD and ZE.
  Council area: DG, IV, KW, PA, PH, TD and ZE.
• Any remaining records are assigned to a health board and/or council area of residence by using, the health board and/or council area of treatment as a proxy for area of residence.

This method of derivation has been automated as part of a routine system.

Annex 5 Understanding the data

It is emphasised that the information held on the Database relates to new patients/clients. The definition of ‘new’ is (a) the person is attending the particular service for the first time ever, or (b) the person has attended before but not within the previous six months. Thus, the statistics do not reflect the total number of drug misusers seen by services during any period.

Further, the database does not collect information on the non-client work in which most specialist projects are involved, nor measures the number of contacts or amount of time spent with clients. The data is usually recorded at or around the time of the initial face to face contact and no measure of outcome is included. It would therefore be inappropriate to use the data for any overall performance evaluation of individual drug services.

By means of matching on certain criteria (initials, date of birth and sex) an adjustment is made for the double counting of individuals who may have attended more than one service during the period. With the exception of tables 1-3 (which are based on contacts) all the tables are based on these adjusted figures. The veracity of any “matches” identified cannot be guaranteed; it is likely that some individuals may have been wrongly matched and, conversely, some true matches may have been missed. Full names and addresses are not recorded on the forms returned to the Information & Statistics Division (ISD).

Misuse of alcohol may be reported to the database in circumstances only when it is secondary to some other drug of misuse. This is reflected in the relatively small incidence of alcohol misuse reported in Table 21.

In Scotland, data collection formally began in August 1990 with the Information & Statistics Division of the NHS in Scotland assigned responsibility for the Database. Similar systems were set up in England and Wales at the same time.