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

The Wider Circle of Support

Outcome: People affected by alcohol and drugs have their wider needs supported by compassionate joined-up services.

Substance use does not exist in isolation, and neither should the response. It is crucial that we strengthen access to broader public services, and create thriving communities to ensure that people and families affected by substances are supported across the full spectrum of systems and settings that shape their lives.

From health, housing, justice, employment, social care and social work, every part of the system has a role to play in promoting wellbeing and enabling recovery. By fostering collaboration across sectors, we can build a more connected and compassionate system - one that meets people where they are and provides a bedrock of reliable and dependable support. We will apply the Charter of Rights to ensure that wider support systems are responsive to the rights and needs of people affected by substance use.

Our key priorities for the wider circle of support include:

• Promoting a joined up and person-centred approach across all services
• Addressing co-occurring substance and mental health issues
• Ensuring an accessible and responsive wider health system
• Supporting access to wider welfare services
• Promoting a public health approach to justice

Promoting a joined up and person-centred approach across all services

In taking a person-centred approach we recognise that many people experience multiple disadvantage and require holistic support that does not concentrate solely on their substance use. This is particularly important for people experiencing severe and multiple disadvantage, where intersecting experiences can significantly compound vulnerability. People experiencing alcohol and drug harms may have experienced domestic abuse; child sexual abuse; child removal through child protection processes; mental health challenges; homelessness and contact with the justice system.^[105] Responding effectively therefore requires coordinated support from a wide range of services, underpinned by appropriate and timely information sharing to enable joined up working. A number of national initiatives assist local areas to take a cohesive, whole system approach to these interconnected harms. This includes the National Public Protection Leadership Group which is working to address these interconnected harms.

Getting It Right For Everyone (GIRFE) is Scotland’s national adult practice model designed to improve how health and social care support is delivered, including for people affected by substance use. It places the person at the centre of decision-making, ensuring care and support is rights-based, personalised and co-ordinated across services. The Team Around the Person Toolkit aims to support practical implementation of GIRFE. As referenced in the preceding chapters, implementation of GIRFEC and a holistic whole family approach are also crucial for supporting recovery throughout the lifetime.

Value-based health and care and Realistic Medicine principles remain central to our ambition to deliver personalised care and focus on outcomes that matter most to people.

Commitment: We will continue to promote a joined up and person-centred approach across all services through:

• Improving coordinated support for people facing severe and multiple disadvantage.
• Collaborating with the National Public Protection Leadership Group to address the interconnectedness of risk across protection areas to better support individuals and families at risk of harm.

Addressing co-occurring substance and mental health issues

People with substance use issues often have co-occurring mental health issues and can face stigma and discrimination when accessing services.^[106] Meaningful progress has been made with the launch of the National Mental Health and Substance Use Protocol, which aims to improve care for people with co-occurring conditions by fostering better collaboration, consistency and integration across mental health and substance use services to remove restrictive criteria. Work has been undertaken by HIS to help local areas adapt the protocol to local circumstances and support implementation.

Our Mental Health and Wellbeing Strategy takes a whole system, prevention-focused approach, recognising the importance of community-based support in improving wellbeing. It aims to address the underlying causes of poor mental health and reduce the need for clinical interventions. Recognising the links between substance use, mental health and suicide, our joint strategies on Suicide Prevention and Mental Health and Wellbeing Strategy aim to challenge and reduce the impact of the causes of poor mental health and increased risk of suicide. A new Suicide Prevention Action Plan was published in 2026, with substance use remaining a key area of action.

Commitment: We will continue to support work to address co-occurring substance and mental health issues through:

• Enabling local areas to implement and embed protocols for people with co-occurring mental health and substance use issues.
• Building on work to improve unplanned and urgent mental health care to support the needs of people with co-occurring mental health and substance use issues.

Ensuring an accessible and responsive wider health system

People affected by substance use often need to engage with wider parts of the health system. There is strong evidence that people with drug and alcohol issues frequently experience physical health comorbidities and are at higher risk of developing a range of chronic conditions such as respiratory disorder, cardiovascular disease or pain related conditions.^[107] The Charter of Rights outlines the right to the highest attainable standard of physical and mental health and achieving this requires tailored support across the whole health system.

Primary care2 is often the first point of contact and provides an early opportunity for holistic support. GPs can take on enhanced services for drug treatment, and we continue to support health boards and HSCPs to promote the benefits of these services within local practices. Prescribing guidelines have been published that set out a seven-step approach to medication review, which should be applied across all care settings, including transitions between services. Community pharmacists play a vital role, often acting as the most regular point of contact through dispensing OAT and naloxone, and in wider initiatives such as Pharmacy First.

As part of addressing wider health impacts, we are also working to improve oral health outcomes. To support this, we have developed an oral health improvement education tool to help dental teams provide appropriate support to people who use drugs, while also encouraging improved self-care.

More broadly, our approach to Primary Care and Community Health is focussed on improving access, rebalancing the system, and enhancing the quality, coordination and personcentredness of care in primary and community health care services. This will drive the Scottish Government’s priority to shift the balance of care closer to home by strengthening primary care and community services, ensuring people receive the right care, in the right place, at the right time.

Acute and unscheduled care including through the Scottish Ambulance Service (SAS) and emergency departments, can be frequent touchpoints for acute presentations of alcohol and drug harms. Progress has been made through the SAS naloxone distribution programme and Peer Navigators within emergency departments.^[108] These settings often provide short-term crisis care, and it is essential that they can respond effectively and facilitate clear pathways into longer-term treatment and support.

Wider specialist services including, but not limited to, hepatology, respiratory, cardiology, urology, and BBV and sexual health services also play an important role. As drug trends evolve and new physical and psychological harms emerge, services must remain agile and responsive. For example, the rise in non-prescribed ketamine use is associated with comorbidities that require specialist urology intervention.^[109]

Women with substance use issues face unique barriers and specific needs in accessing healthcare, and this can be particularly acute during the perinatal period.^[110] We are exploring pathways and good practice to demonstrate what high quality perinatal care should look like for women who use substances and their babies. This includes ensuring women receive appropriate support to make informed choices, including around reproductive health, and providing ongoing care for women whose children are removed from their care. We recognise that child removal can bring profound grief, trauma and disconnection and facilities such as the Aberlour Mother and Child Recovery Houses, supported through the Whole Family Wellbeing Funding Programme, provide valuable holistic care that can keep families together.

Supporting women during the pre-pregnancy period is also a vital opportunity to reduce risks and improve outcomes for both women and their babies. By acting early, we can prevent conditions like Fetal Alcohol Spectrum Disorders and Neonatal Abstinence Syndrome, and ensure every baby receives nurturing care - breaking cycles of harm and improving long-term health and wellbeing for future generations.

Commitment: We will work to ensure that the wider health system is accessible and responsive to the needs of people affected by substance use through:

• Exploring and addressing the specific needs of people who use substances within wider healthcare improvement work - including primary care, acute and specialist services.
• Embedding good practice on supporting women who use substances and their babies during the perinatal period.

Supporting access to wider welfare services

People affected by substance use can face a range of challenges that extend beyond their immediate health needs – such as homelessness, unemployment and financial insecurity. Existing initiatives, such as the MAT standards recognise this and set expectations for joined up support.

For individuals experiencing substance use issues and homelessness, we are committed to expanding the delivery of Housing First, recognising the foundational role that safe, stable accommodation can play in recovery. We will also explore the role of different forms of supported accommodation for individuals who cannot sustain or who do not want a mainstream tenancy as well as recovery housing for individuals accessing residential treatment. Additionally, integrating alcohol and drug services into the development and delivery of new homelessness prevention duties, including new ask and act duties for named relevant bodies such as health boards through the Housing (Scotland) Act 2025 should help ensure that housing support is tailored to the realities of substance use.

Employment can play an important role in recovery. Access to meaningful work can provide structure, identity, and financial independence, all of which can be protective factors against relapse and social exclusion.^[111] The Scottish Government has published a range of employment toolkits including Guiding Principles, endorsed by COSLA, which offer employers best practice advice to support staff with lived and living experience of substance use. Access to social security is also crucial, as financial insecurity can exacerbate harm and create barriers to recovery. The Scottish Government is delivering activity to raise awareness of benefits and to ensure that people are receiving what they are entitled to.

Commitment: We will continue to ensure that welfare services are responsive to the needs of people affected by substance use through:

• Supporting the expansion of Housing First provision and exploring the role of other housing options for people experiencing substance use and homelessness, including supported housing and access to recovery housing.
• Ensuring that alcohol and drug services are involved in the development and implementation of the new duties to prevent homelessness.
• Continuing to support people with lived and living experience into work, by embedding the Employability Toolkits and Guiding Principles to ensure appropriate support.

Promoting a public health approach to justice

People with substance use issues are more likely to be involved with the criminal justice system as victims, witnesses or perpetrators of crime.^[112][113] The Scottish Government’s National Strategy for Community Justice aims to prioritise tackling the root causes of crime and support rehabilitation, shifting the balance between the use of custody and community justice options. Evidence indicates that community sentences reduce reoffending more effectively than short custodial sentences and may offer greater opportunity for rehabilitation.^[114][115] Existing initiatives - including Diversion from Prosecution, Specialist Problem Solving Courts, and Arrest Referrals - aim to reduce harm and promote recovery.

Community justice options can in some cases be the most appropriate route for people with substance use issues, offering a more person-centred and tailored approach.^[116] Interventions such as Community Payback Orders (CPOs), which can include treatment requirements, have consistently lower reconviction rates than short prison sentences.^[117] Work continues to consider the effectiveness of community sentences and to ensure strong links to support services. New technologies, including remote alcohol monitoring, are being explored with the aim of encouraging behaviour change and reducing reoffending.

In prisons, NHS boards are funded to provide healthcare, and joint work across justice and health is driving improvements. The Scottish Prison Service’s 10-year Alcohol and Drug Recovery Strategy aligns with our objectives including by taking a human rights-based approach, reducing stigma, delivering overdose prevention training and naloxone rollout, and strengthening prison-to-rehabilitation pathways. A multi-year Clinical IT project aims to improve healthcare throughout the prison journey. The National Prison and Police Care Networks^[118] have developed a nationally consistent service model for clinical services in prisons as well as for people in police custody. These include actions to improve alcohol and drug services provided in custody.

Recovery in prison is supported by third sector organisations, offering peer mentoring, support, and release planning. Scotland’s Prison to Rehab pathway enables people leaving custody to move directly into residential rehabilitation. Voluntary throughcare support is available for those released without statutory supervision requirements, helping to maintain continuity of care, which can reduce the likelihood of reoffending.

Individuals being released from custody represent a particularly high-risk population, including of drug-related death.^[119] National Throughcare Standards, introduced by Section 13 of the Bail and Release from Custody (Scotland) Act 2023, will be developed in 2026 to ensure consistent support for all people leaving prison custody, leaving long-term and short-term sentences, or on a period of remand. These standards will be created in consultation with each health board and local authority, ensuring they address physical, mental health and substance use needs.

A 2025 review of police response to drug harm reduction by His Majesty’s Inspectorate of Constabulary in Scotland found that Police Scotland embed a public health approach to reducing drug harm. This is supported by trauma-informed policing, local prevention work, and intelligence-led responses to emerging threats such as synthetic opioids and polydrug use, as well as work to disrupt high-harm supply chains. Recommendations have been made to further strengthen this approach.

Disrupting organised crime and diverting individuals away from criminal networks remain key priorities. The Scottish Government’s Serious Organised Crime Strategy places strong emphasis on identifying key threats, disrupting supply routes, pursuing offenders and reducing harms caused by the illegal drug market. Police Scotland works closely with UK and international partners to remove illegal substances from communities and prisons. Through sustained partnership efforts, we strive to build safer communities and support individuals to transition away from criminal involvement.

The Scottish Government’s revised Human Trafficking and Exploitation Strategy takes a public health approach and recognises that a shared preventative approach is vital to reduce vulnerability to exploitation.

Commitment: We will continue to promote a public health approach to justice through:

• Exploring ways to expand the use of community-based early interventions, problem solving courts and community sentences for people whose offending is linked to alcohol and drug use.
• Reviewing the current use of community interventions including CPOs, Drug Testing and Treatment Orders and structured deferred sentences to assess whether they can be used to better address the underlying causes of offending behaviour, including alcohol and drug use.
• Embedding recovery programmes across the prison estate to support people in prison and their families, with a focus on sustaining support during the transition and resettlement back into the community.
• Improving awareness and access to residential rehabilitation on release from prison and expanding this pathway across the wider justice system.
• Developing National Throughcare Standards and coordinated release planning, to ensure consistent, person-centred support for everyone leaving prison custody.

Case Study: Prison Recovery Communities

The Recovery from Within project, led by the Scottish Recovery Consortium and supported by the Scottish Government, is creating strong, peer-led recovery communities across Scottish prisons. The project has helped to make prisons safer and more hopeful environments, supporting individuals to recover from alcohol and drug use and reintegrate into their communities.

Through recovery cafés, workshops, and structured courses such as Recovery Essentials, Peer Support, and Facilitation Training, participants gain knowledge, skills, and confidence to support their own recovery and help others. A number of individuals progress to cofacilitating sessions for both prison staff and residents, strengthening the culture of recovery within the prison setting.

Post-liberation, participants often continue their recovery journey by engaging in local support groups. The support provided in prison is often described as key to helping people get well and find their recovery pathway. With this ongoing support, participants can feel confident in using the knowledge and skills they have learned in prison to grow and thrive in their recovery journey, while also supporting peers in their communities - communities they now feel part of.