Preventing Harm, Promoting Recovery: Scotland's Alcohol & Drugs Strategic Plan 2026 – 2035

Treatment & Care

Outcome: People affected by alcohol and drugs receive high quality treatment and care services.

Ensuring access to high-quality treatment and care is essential for recovery. Recovery is not always linear, and people may access a range of medical, psychological, social and peer-led community-based supports on their journey. Services must therefore be flexible, traumainformed, and responsive to individual goals. The Charter of Rights will continue to inform service design and delivery, ensuring that treatment and recovery pathways uphold the principles of participation, accountability, and empowerment.

Our key priorities for treatment and care include:

• Establishing an overarching system for improved quality of services

• Ensuring equal focus on alcohol and drug treatment
• Responding to changing trends
• Reducing barriers to residential services
• Supporting wider communities of care

Establishing an overarching system for improved quality of services

The introduction of MAT standards in 2021 and the increased focus on residential rehabilitation as a choice of treatment have marked a step change in how treatment is delivered, forming an important foundation for continuous quality improvement. It is important to build on this approach to create a holistic, integrated system of care – one that offers the right range of services, supported by robust metrics to monitor progress and effective scrutiny to drive improvement.

A rights-based system of care: Scotland’s alcohol and drug treatment services must be firmly grounded in a human rights-based approach as articulated in the Charter of Rights. This means ensuring that dignity, respect, equality and participation are at the heart of service design and delivery.

Services that meet local need: The National Service Specification aims to support equitable delivery of alcohol and drug services across Scotland – including those commissioned to be delivered by third sector partners. The Specification outlines the types of services everyone should be able to access at all stages of their journey no matter where they live. It is designed to support planners, commissioners, and providers in delivering services that meet the AAAQ framework – ensuring that services offered are person-centred and impactful. The Specification outlines the core components that all local strategies and delivery plans should include, while recognising that each area will tailor these to its specific needs and circumstances. For example, service provision in remote and rural communities may require different delivery arrangements than those used in urban settings. The development of the Specification has been guided by consultation with people directly involved in providing, designing, commissioning and using services. It is intended to be iterative and responsive to changing patterns and evolving best practice, such as digital innovations to enhance service delivery, accessibility and efficiency.

Pathways to access the right support at the right time: A lack of clarity on pathways into and through recovery services has been cited as a contributing factor in the decline in the number of people accessing specialist services.^[88] While there is now clear information on pathways for residential rehabilitation services, this needs to expand to cover all treatment routes and substance types, including recognising the important role that recovery communities and mutual aid can play in helping to promote and sustain recovery.

Standards for all drugs and alcohol treatment: Significant progress has been made to support people to access appropriate treatment. The MAT standards provide a set of 10 evidencebased standards to enable the consistent delivery of safe, accessible, high-quality treatment for people on MAT, primarily opioid agonist therapy (OAT). The MAT standards are in their final stage of implementation, with more to be done to ensure they are consistently implemented, especially within justice settings.^[89] These are complemented by the Standards for Young People Accessing Treatment or Support for Alcohol or Drugs published in 2025, which help address the specific needs of young people.

The changing drug landscape, alongside the need for a demonstrable focus on alcohol treatment, means that while implementing the MAT standards remains important, our approach must continue to evolve to meet current and future needs. We intend to expand on the principles and approach of the MAT standards, the standards for young people, and the health and social care standards, by establishing standards of support for all drugs and alcohol treatment. These will ensure the same level of focus on access, choice and support for everyone, regardless of the substance they are affected by. Publication of new standards is scheduled for 2027/28.

Monitoring delivery and external scrutiny for assurance: Robust local accountability mechanisms are essential to ensure that standards are met, upheld, and continuously improved. This is a key element of a human rights-based approach. The revised Partnership Delivery Framework clarifies how accountability should operate in local areas, and the introduction of overarching standards will assist local decision makers in assessing service performance.

The Drug and Alcohol Information System (DAISy) is Scotland’s national digital database for recording specialist treatment data for alcohol and drug use.^[90] It will continue to evolve as the primary tool for tracking service performance and outcomes alongside other bespoke monitoring tools, such as those in place for tracking residential rehabilitation client level data.

External scrutiny is vital to ensure quality, safety, and public confidence in alcohol and drug services. Some elements of treatment already benefit from this oversight - for example, residential services should be registered and inspected by either the Care Inspectorate or HIS. By introducing overarching standards and expanding external scrutiny through regulation and inspection, we aim to extend this assurance framework to all alcohol and drug services.

HIS are well placed to explore the role of scrutiny and assurance within the proposed overarching standards through their Quality Management System approach. This brings together assurance, improvement, engagement and evidence, offering a practical framework for governance, commissioning and learning systems.

Commitment: We will work to establish an overarching system for improved quality of services through:

• Supporting successful take up of the National Service Specification.
• Improving treatment pathways in alcohol and drug services and connections to primary, acute and specialist settings.
• Continuing to embed the MAT standards.
• Working with stakeholders to develop standards of support for all drugs and alcohol treatment.
• Continuing to develop and improve DAISy to become the primary monitoring and reporting tool for treatment services.
• Working with HIS, Care Inspectorate and other partners to prepare for external scrutiny against the standards.

Ensuring equal focus on alcohol and drug treatment

In order to address the high levels of alcohol harms, it is important to balance the focus between alcohol and drugs within treatment and care services. While the National Mission focused on drugs, it also increased support for alcohol treatment, including through workforce development, the Charter of Rights, the expansion of residential rehabilitation placements and ongoing work to support children and families. However, specific challenges associated with alcohol treatment require specific focus. In its 2024 review of alcohol and drug services, Audit Scotland recommended that more focus and funding is directed towards alcohol services, while continuing to focus on drug services. The UK wide Clinical Guidelines for Alcohol published in 2025 set out a comprehensive framework for alcohol treatment.

There are a greater number of referrals to specialist treatment services for alcohol than for drugs each year, and this pattern is reflected in the higher number of alcohol-related hospital admissions.^[91][92] Each year, there are around 30,000 admissions to hospital for conditions which are wholly attributable to alcohol ^[93] and there is a clear expectation that hospital services provide alcohol-specific support to this cohort. A range of stakeholders have recommended that more hospitals in Scotland adopt the formal Alcohol Care Team approach introduced in England to ensure appropriate expertise is in place to provide assessment, liver disease screening, psychosocial support, abstinence advice and onward referral to specialist services.

Commitment: We will increase focus on alcohol services and care in community and specialist treatment services through:

• Promoting the use of Clinical Guidelines for Alcohol Treatment which cover the full range of treatments.
• Commissioning a national needs assessment for alcohol treatment and care services.
• Working with health boards to improve multi-agency alcohol-specific support for people in acute settings and considering an expansion of the formal Alcohol Care Team model.
• Ensuring longer-term support and care is in place in acute settings, such as for alcohol related brain damage.

Responding to changing trends

In recent years, we have seen rapidly changing patterns of psychoactive drugs in Scotland, including ongoing polydrug use, the emergence of potent synthetic substances, and increasing diversity and use of street benzodiazepines.^[94] This is alongside an overall trend towards cocaine’s increasing role in drug harms ^[95] and a significant spike in ketamine harms – particularly among young people.^[96] These shifts highlight the need for responsive and adaptive services, including tailored psychosocial support, which may be the only treatment option available at present for some substances.

The absence of clinical consensus on benzodiazepine treatment requires continued collaboration with clinical advisory partners to explore safe and effective options. Additionally, given the current absence of evidence-based pharmacological treatments for stimulant use, research and development of improved treatment pathways for problem use of stimulants, including cocaine, is essential.^[97][98] A short-life working group convened by PHS in 2025 has helped to strengthen the knowledge base and support improvements in harm reduction and treatment in response to increased cocaine use.

Opioids continue to be a major contributor to drug-related mortality, being implicated in approximately 80% of drug deaths in 2024.^[99] Evidence shows an average 70% reduction in drug related deaths for people on OAT, compared to people not on OAT.^[100] This reinforces the importance of continued support for OAT as an evidence-based treatment for opioid dependence, and to continue to expand access to alternatives to methadone, such as longacting buprenorphine, where clinically appropriate.

Commitment: We will adapt to changing trends through:

• Continuing to learn from surveillance on alcohol and drug trends and supporting services to adapt to new and emerging threats.
• Continuing to support OAT as a protective treatment for opiate dependency.
• Supporting ADPs to develop and publicise treatment and care options for benzodiazepines, cocaine, and other non-opiates.
• Supporting research into treatment options for problem use of benzodiazepines, cocaine, synthetic opioids and other emerging substances of concern.

Reducing barriers to residential services

An additional £100 million was made available to enhance access to residential rehabilitation as part of the National Mission. This funding has supported the development of eight new or expanded facilities (including specialist services) and placements are estimated to have roughly doubled between 2019/20 and 2024/25.^[101] Scotland now has a nation-wide monitoring system in place, including client level outcome data.^[102]

Despite increased availability of residential rehabilitation, access to detox remains a major barrier. Many people need detox, stabilisation or crisis support before entering residential rehabilitation. By strengthening access to these services, we expect to release capacity across the system - enabling the existing residential estate to be used more efficiently, by more people. While some rehabilitation providers offer in-house detox which eases transitions, wider availability is limited and contributes to longer wait times.^[103] The period between detox and residential rehabilitation is acknowledged to be high risk, so eliminating this gap is critical.

Crisis and stabilisation services are a crucial, but currently underdeveloped, component of Scotland’s treatment system, particularly for those who are not currently ready for, or planning to move on to, abstinence-based rehabilitation. National coverage of crisis and stabilisation services, including crisis beds under a residential harm reduction model, was recommended by the Drug Deaths Taskforce. Other residential services – such as care for people with alcohol related brain damage and Managed Alcohol Programmes – are also within scope for a future residential harm reduction model.

Crisis care can also occur in non-residential services, and we will continue to work with providers and acute and unscheduled care to support people in accessing the right type of care when they need it.

Commitment: We will reduce barriers for those seeking residential services through:

• Maintaining the target of 1,000 publicly funded residential rehabilitation placements per year as a minimum for Scottish residents, and keeping this under review to ensure it aligns with need and system capacity.1
• Increasing access to residential detox services and improving direct pathways from detox to residential rehabilitation and beyond to community based care.
• Conducting a feasibility study to explore ways to expand access to other services such as stabilisation, crisis care, and long-term support for specialist conditions such as alcohol related brain damage.

1 A residential rehabilitation placement that is, at least in part, funded by: a health board, an ADP, a local authority, Prison-to- 22 Rehab or other Scottish Government funds, housing benefit (including placements funded through the Dual Housing Support Fund), a public sector employer or a third sector organisation funded by a public body. This last category includes placements funded by third sector residential rehabilitation centres themselves. Publicly funded placements can include an element of private funding.

Supporting wider communities of care

We recognise that non-medicalised and community-based support play a vital role in supporting recovery. Achieving recovery is not the responsibility of a single service - it relies on a network of supports across health, housing, employment, and justice. Strong communities are public health assets and the foundation of recovery and this is why families, recovery communities and existing peer-led mutual aid must continue to be supported, with strong two-way connections between statutory services and community-led supports, where appropriate.^[104]

Families can be integral to the recovery process, and their involvement can encourage engagement with treatment, and support positive outcomes for the person with substance use issues. It is important that family members receive dedicated support services for their own needs. This includes bereavement support if they have lost a loved one. Our Families Affected by Alcohol and Drug Use Framework recognises the importance of supporting families, and sets out a national model for delivery of a whole family approach and the principles for family inclusive practice.

Recovery communities, Lived Experience Recovery Organisations and mutual aid play a distinct and complementary role alongside medical treatment and other more formal forms of support. They provide connection, purpose, and hope - all of which are central to recovery. Peer support is fundamental within these settings - the relationships, trust and shared experience offered by peer workers and volunteers can provide a powerful form of support. Recovery communities bring together significant expertise and offer a range of structured activities and consistent support. They can also act as a bridge between individuals and services, providing advocacy, supporting transitions from prison or residential rehabilitation or crisis care, and ensuring that treatment exits are effective and sustained. Recovery communities grow from the ground up, led by people with lived experience of substance use. This strengths-based approach is recognised as a core component of a whole-system response to drugs and alcohol harms.

Commitment: We will continue to support wider communities of care through:

• Embedding the whole family approach and family-inclusive practice, in line with the ‘Families Affected by Drug and Alcohol Use in Scotland Framework’.
• Supporting the role of, and making better links from services to, recovery communities and mutual aid.

Case Study: Responding to Benzodiazepine Use

The use of benzodiazepines alongside opioids is widespread in Scotland and this combination has been strongly linked to the high rate of drug-related deaths.

To help tackle the harm caused by illicit benzodiazepine use, the Scottish Government is funding a pilot in Fife for a new model of care combining prescribing and psychological therapies to support individuals with benzodiazepine dependency.

The pilot involves projects which focus on: developing links between alcohol and drug services and mental health services; developing evidence-based guidelines to inform the care of individuals while in hospital (including advice and support for assessment and management of hospital inpatients, emergency department presentations and primary care presentations); and building capacity in primary care to undertake educational work and support engagement with GPs.

The longer-term aim of the service is to expand beyond benzodiazepine use to support people using other substances, especially when there is no substitute prescribing. For example, a suite of interventions for people using cocaine that includes psychological interventions, respiratory and cardiac health support, and peer support training opportunities.

Case Study: Lived Experience Holistic Support

Harbour (Ayrshire) is working to empower individuals recovering from substance use issues. Harbour is a lived experience-led recovery organisation with 14 volunteer-led peer support groups (including three for families and women only / men only groups) across Ayrshire, fostering community and mutual support.

They also run a Residential Rehabilitation Support Service which provides support to people ahead of entering residential rehabilitation and when they leave this service and return to their community.

Harbour offer individuals support and a chance to focus on personal growth and employability as part of their recovery – supporting individuals into employment and education. They also provide the Harbour Helpline, which offers out of hours crisis intervention and emotional support.

People who they work with can become Harbour Helpers, which includes professional development opportunities. These roles include assisting volunteers, learning mental health first aid, confidence-building and working with the Community Support Vehicle to help those fleeing violence or facing homelessness.