Detoxification and other support available in residential rehabilitation settings
This report presents findings from a survey of residential rehabilitation providers in Scotland. It seeks to establish the current provision of detoxification across residential rehabilitation facilities and explores how these services operate and are governed.
Key findings
This report presents findings from a survey of residential rehabilitation providers in Scotland. It seeks to establish the current provision of detoxification across residential rehabilitation facilities and explores how these services operate and are governed, as well as the range of pre-, through- and after-care support available to individuals alongside their residential rehabilitation treatment.
The survey was conducted between 5 September and 14 October 2025 and received responses from all residential rehabilitation facilities the Scottish Government is aware of (n = 28).
Detoxification
Half of the facilities (n = 14) offer a detoxification service[1].
Detoxification is offered for a range of substance use profiles, the most common of which are for the use of opiates (92%), prescription-only painkillers (85%), and alcohol and benzodiazepines (both 77%).
Facilities are broadly evenly split between those that offer rehabilitation treatment to clients who will remain on medication assisted treatment (46%) and those that do not (54%). Injectable or long-acting buprenorphine and methadone were the most commonly reported medications reported by those facilities that do.
A range of clinical professions are reported to be involved in the detoxification service provided, with general practitioners (69%), pharmacists (69%) and mental health nurses (62%) being most commonly selected from a list of response options.
A range of prescribing procedures are reported. These are most commonly performed by a clinician directly employed by the residential rehabilitation provider (69%), followed by a clinician acting in a private (i.e. non-NHS) capacity contracted to the prescriber (31%) or by community-based prescribers (23%). Additionally, 3 facilities (23%) access a client’s GP or other medical history before prescribing (2 of which rely on clinicians directly employed by the residential rehabilitation provider while the other uses a combination of privately contracted clinicians and community-based prescribers).
All facilities monitor detoxification or assisted withdrawal. Facilities are broadly split between those where this is carried out by clinical staff (54%) and those where it is done by non-clinical staff trained in the application of withdrawal rating scales. Among the six facilities without clinical staff on-site, 50% reported arrangements involving off-site clinical staff.
Most facilities (85%) use a standardised withdrawal assessment tool. This includes the Clinical Opiate Withdrawal Scale (COWS), the Clinical Institute Withdrawal Assessment for alcohol and benzodiazepines (CIWA, CIWA-Ar, CIWA-B). Some also report using their own proprietary tool.
All facilities that offer a detoxification service operate within a regulatory framework, with most being registered with the Care Inspectorate (71%).[2] All also have governance arrangements in place for their detoxification service, either in the form of external regulation or inspection (e.g. by the Care Inspectorate or Healthcare Improvement Scotland) (62%), being managed directly by an NHS health board (23%) or overseen by an internal clinical governance group (23%). One facility’s detoxification service is governed by a private general practitioner. All facilities have a written policy in place for managing early discharge from the service.
Other forms of treatment or support offered
Most of the 28 facilities surveyed (79%) offer some form of pre-care support, other than detoxification or assisted withdrawal. Facilities described a broad range of pre-admission support designed to psychologically or practically prepare clients for residential rehabilitation treatment and facilitate their transition into the programme. Some facilities also noted offering some form of support or engagement with a client’s family members. A person-centred approach is evident in both the type of support offered and how it is delivered.
A majority (61%) reported carrying out mental health or cognitive assessments prior to admission.[3] A range of clinical staff are involved in these, with general practitioners (53%), psychiatrists (53%) and mental health nurses (47%) being more commonly selected from a list of response options. Psychologists were much less commonly reported to be involved (12%).
Almost all facilities (86%) reported offering other support options during a client’s stay, alongside any residential rehabilitation or detoxification provided. The majority report offering family support (82%) and mental health support (71%). It was less common for facilities to offer medication assisted treatment prescribing (32%).
All but one facility (96%) reported offering some form of after-care support in preparation for or following a client’s discharge from the service. The only one that did not offer this directly is able to make referrals to community-based services. The most commonly offered types of support are peer support (82%), housing support (68%) and employability support (57%), with facilities using the open text responses to provide further detail. Once again, a person-centred approach is evident in both the type of support offered and how it is delivered, which extends to flexible timeframes.