New guidance published by the National Institute for Health and Care Excellence (NICE) covers interventions in schools to prevent and reduce alcohol use among children and young people. Mia Hodgson looks at what the guidelines say and how they should be used.

The Problem of Youth Drinking

Recent data suggests that, while attitudes to drinking alcohol amongst younger people are changing, it is still a major health concern. Those consuming alcohol at an early age (especially in large quantities) put themselves at risk of illness, injury, violence, depression and damage to their development. Drinking at an early age is also associated with a higher likelihood of alcohol dependency.

The Chief Medical Officer advises parents and children that an alcohol-free childhood is the healthiest and best option. However, the statistics on alcohol show that:

  • 44% of 11- to 15-year olds have tried alcohol

  • 10% of 11- to 15-year olds have drunk alcohol in the past week

  • pupils who drank alcohol in the past week consumed an average (mean) of 9.6 units

  • girls (11%) are more likely than boys (7%) to report having been drunk in the past 4 weeks

  • girls are more likely to be admitted to hospital for alcohol-specific reasons than boys, and are admitted at younger ages.

The Department for Education states that youth drinking and alcohol consumption, while not solely responsible for poor performance at school, is a significant factor in the cycle of lower aspirations and poorer attainment in some pupils.

Alcohol Awareness Education in Schools

Taking the above statistics into consideration, the current recommended role of schools is to provide alcohol education to equip pupils with the knowledge to:

  • stay safe around alcohol

  • reduce the incidence of “binge drinking” and alcohol-related harm

  • build their resilience and life-skills

  • promote dialogue about alcohol between teenagers, parents and teachers

  • raise the age of onset of drinking (first whole drink) to at least the Chief Medical Officer’s guidance of age 15 in a supervised environment.

Public health policy is that this can be achieved through an education programme that increases pupils’ understanding of:

  • alcohol’s effects on the immature body and the social and physical risks associated with its misuse

  • the laws restricting the consumption of alcohol, and why these exist

  • alcohol units, guidelines and responsible drinking.

The role of PSHE

From 2020 health and wellbeing will be a compulsory part of personal, social, health and economic education (PSHE) programmes in all schools.

Relationships Education, Relationships and Sex Education (RSE) and Health Education, published this year by DfE, sets out statutory guidance. It states that by the end of secondary school pupils should know about the physical and psychological consequences of addiction, including alcohol dependency. They should also know what constitutes low risk alcohol consumption in adulthood.

Schools should develop a PHSE curriculum that includes:

  • classroom curriculum activities

  • pastoral support, school policies and other actions to support pupils in the wider school environment

  • activities that involve parents or carers, families and communities.

Furthermore, designating a PSHE lead who has taken the relevant CPD can support the provision of a confident alcohol education through cascading their knowledge to other members of staff and advising on:

  • planning time

  • age-appropriate materials and resources.

The PSHE Association supports the delivery of alcohol education that utilises:

  • a positive approach to help pupils to make informed, safe, healthy choices

  • active pupil participation through discussion

  • the avoidance of scare tactics.

NICE recommendations

Additional guidance is provided in the updated NICE guidelines.

NG135, Alcohol interventions in secondary and further education, includes recommendations on planning alcohol education and on using targeted interventions. The guidelines recognise that current practice is to use a whole school approach for alcohol education and recommend that this format continues.

NICE support the use of a spiral curriculum in the delivery of alcohol education. This can be defined as a course of study in which students will see the same topics throughout their school career, with each encounter increasing in complexity and reinforcing previous learning.

When planning alcohol education NICE state that schools should:

  • ensure it is appropriate for age and maturity and aims to minimise the risk of any unintended adverse consequences

  • tailor it to take account:

    • each pupil's learning needs and abilities

    • the group's knowledge and perceptions of alcohol and it’s use

  • consider that those aged 18 and over can legally buy alcohol.

As with all curriculum considerations, best practice requires the differentiation of content and delivery for pupils with special educational needs and disabilities (SEND) where necessary.

Those at high risk

Implementing targeted interventions (for example counselling or brief intervention) for pupils identified as being most at risk of alcohol misuse is also recommended by NICE. Interventions should be tailored to individuals’ needs and should avoid stigmatising the pupils involved.

Personalities more prone to alcohol use and addition include those who are:

  • sensation-seekers (risk takers)

  • impulsive (often linked to attention deficit disorders)

  • prone to anxiety or sensitivity or

  • prone to feelings of hopelessness with low self-esteem

In addition, children with learning disabilities are at more risk of abuse and grooming whilst looked after children (LAC) have a considerably higher risk of substance misuse.

NICE specify that the pupils themselves should consent to their involvement in the interventions offered to them. It may also be necessary to gain consent from parents and carers if appropriate.

When selecting pupils for a targeted intervention schools are advised to avoid treating them in a way that could:

  • encourage them to see themselves as likely to use alcohol or see it as normal behaviour or

  • have a negative impact on their self-esteem.

Schools are also recommended to avoid normalising unhealthy drinking behaviours when delivering targeted group interventions (for example by not mixing different age groups).

Interventions tailored to needs

Before employing any intervention, best practice suggests identifying the key groups’ specific risk factors, vulnerabilities and behavioural concerns. This can be achieved through analysis of:

  • the current whole school approach

    • curriculum subjects

    • policies on social, moral and spiritual wellbeing

    • cultural awareness.

  • formal sources of information provided by

    • a level of needs assessment

    • children’s services such as social care.

  • informal sources of information about pupils’ behaviour

    • reports from the local community about pupils drinking alcohol.

Alcohol and safeguarding

Substance misuse is a factor in a significant number of children in need and child protection cases. It may be during the delivery of alcohol education that concerns are raised over a child’s exposure to alcohol, either directly or indirectly. Therefore, all involved in alcohol education sessions should be aware of the school's safeguarding policy and process for handling disclosures.

Referrals for further support

NICE state that clear referral pathways should be identified for pupils who require additional support.

Further support relating to alcohol misuse can take the form of (but is not limited to):

  • in-school nursing and/or counselling

  • early help services

  • voluntary sector services

  • young people drug and alcohol services

  • youth workers.

Involve the pupil and their parents or carers, as appropriate, in any consultation and referral to external services.

Reviewing drug and alcohol policies

All schools should review their drug and alcohol policies with reference to the new PHSE and NICE guidance.

It is important to involve a member of the Senior Management Team in the review process. Schools might also consider involving:

  • school drugs coordinators

  • PSHE coordinators

  • teachers responsible for pastoral support/behaviour

  • a governor with special responsibility for this area

  • parent representatives

  • pupil representatives

A school drug and alcohol policy is an effective tool to safeguard the health and safety of pupils and others within a school. It should be written to provide a framework on developing, implementing and monitoring the alcohol education programme and to help children and young people to be confident in making healthy choices outside school.

Conclusion

This guidance reinforces best practice and should help schools provide an alcohol education that fits into the new era of PSHE. An additional review of the resources listed below should enable the implementation or refinement of an alcohol education that is appropriate to current trends in pupil behaviours.

Ensure your school does what it needs to in order to:

  • deliver high quality PSHE education that makes a clear contribution to pupils’ spiritual, moral, social and cultural development

  • tailor intervention strategies for those who are at high risk

  • demonstrate to Ofsted that the behaviour and safety of pupils is ‘good’ or ‘outstanding’ and they understand how to manage risks

  • fulfil the school’s statutory duty to promote all pupils’ wellbeing.

Further Information

NG135, Alcohol interventions in secondary and further education, can be downloaded from the NICE website.

Relationships Education, Relationships and Sex Education (RSE) and Health Education, available the DfE website.

Last reviewed 19 December 2019