Alcohol and drugs strategic plan: equality impact assessment summary

Key Findings

1. Age

• Younger age groups (16-25) report the highest prevalence of harmful drinking behaviours (as measured by AUDIT scores ), although older age groups (55-64) report consuming more alcohol on average.^[1]
• Drug use patterns vary by age and substance. Opioid use is more common among older age groups (35+),[2] while cocaine harms have increased over time across most age groups.[3]^,[4] Benzodiazepines and polydrug use are prevalent across age groups.[5]^,[6]
• There are significant gaps in our current understanding of substance use among children and young people beyond alcohol and cannabis. Rates of drunkenness among adolescents have declined and are at their lowest in over 30 years.^[7]
• Drug-related harms (hospitalisations and deaths) are most common amongst people aged 35-54 years.[8]^,[9] Older age is a known risk factor for drug-related death. Alcohol-related harms (hospitalisations and deaths) are highest among those aged 45-64 years.[10]^,[11] The age profile of alcohol and drug deaths has become older over time.[12]^,[13]
• The median age for starting alcohol treatment is 47, and 37 for drug treatment.^[14] The median age of treatment for both alcohol and drugs has been increasing over time,[15] which could indicate a gap in young people engaging in services.
• Young people may perceive services as adult-oriented and lacking a tailored approach to their specific needs.^[16] Older adults may experience issues around stigma, social isolation, shame and health complications requiring age-sensitive approaches.[17]

The Plan is expected to positively support equality across all age groups by embedding a rights based, non-discriminatory approach and tackling intersecting stigma, while recognising that some age groups experience greater harms.

It improves equality of opportunity by strengthening preventative measures, and access to harm reduction and treatment services. It includes commitments to support services to implement standards for young people accessing treatment or support for alcohol or drugs, and priorities relating to prevention and early intervention to support the healthy development of children and young people.

The Plan also promotes good relations between age groups by addressing intergenerational harms through commitments embedding good practice to support women who use substances and their babies during the perinatal period and by strengthening family inclusive practice through the Families Framework. No negative impacts were identified, though effective implementation and ongoing monitoring will be essential to ensure equitable access and outcomes.

2. Disability

• Although alcohol or drug dependency are not defined as an “impairment” for the purposes of the Equality Act, evidence shows high levels of co-occurring mental health conditions and physical health comorbidities among people affected by substance use.[18]^,[19]
• Mental health problems are highly prevalent among people who use alcohol or drugs, often linked to coping with trauma, stigma or exclusion (including among LGBTQI+ and minority ethnic groups).[20]^,[21],[22]
• There are high demand and unmet needs in relation to mental health support.^[23]
• Although Scottish data is limited, international evidence shows high rates of chronic physical conditions (e.g. cardiovascular, respiratory) among people with problem substance use, ^[24] and additional risks for those who inject drugs (e.g. infections, amputations, poorer surgical outcomes).[25]
• People with co‑occurring physical health needs may face barriers to treatment, for example, many residential rehabilitation settings lack the facilities to support complex health conditions.^[26]

The Plan is expected to positively impact people with disabilities, recognising the high levels of co‑occurring mental and physical health conditions among those affected by alcohol and drug use. Priorities to improve support for co‑occurring mental health and substance use conditions and ensure a more accessible and responsive health system, and commitments to embed a trauma- and psychological informed approach, are likely to enhance engagement and outcomes for people with disabilities.

While no direct negative impacts were identified, evidence suggests that people with physical disabilities or long term conditions may face barriers to accessing treatment for alcohol and drugs as well as wider healthcare needs. The Plan commits to using data, service feedback and funding mechanisms to identify and address inequalities. Successful implementation, particularly at a local level, should ensure that the specific needs of these groups are fully considered and addressed. Measures to promote compassionate, joined up care and challenge stigma are also likely to improve relations between disabled and non-disabled people. Overall, the Plan is assessed as having positive impacts, with some areas requiring continued attention during implementation.

3. Sex

• Males are more likely to report hazardous or harmful drinking or having ever had a problem with drugs than females.^[27] Opioid dependence is more than twice as high for males in Scotland than for females.[28]
• Males experience higher levels of alcohol- and drug-related harms (hospitalisations and deaths) in Scotland.[29]^,[30],[31]
• The gap in drug death rates between the sexes has narrowed with female drug deaths nearly doubling over the past decade despite stable or declining opioid use.^[32] Contributing factors may include an ageing cohort, changing patterns of substance use, physiological differences between the sexes, and changes in relationships and parenting roles.[33]
• Males make up the majority of those starting treatment for substance use.^[34] Women are less likely to rate alcohol and drug support as good or excellent and more likely to report unmet needs.[35]
• Barriers for women accessing support include stigma, childcare responsibilities, fears around child removal and limited women-only or family-focussed services.^[36] Men may also face barriers including those linked to masculinity norms and underdiagnosed mental health conditions.[37]

The Plan places an emphasis on a gendered, rights based approach to eliminate discrimination and ensure that people affected by alcohol and drugs are treated with dignity and respect. It recognises that men and women experience substance use, harm, stigma and barriers to support differently and that this is mediated by their gender. It embeds commitments to design services that respond to these distinct experiences. This includes acknowledging the heightened risks women may face, such as domestic abuse, sexual violence, coercive control, and stigma around motherhood, and ensuring policy and service models actively prevent sex- or gender based inequality and discrimination.

To advance equality of opportunity, the Plan commits to ensuring services are trauma‑informed, gender‑responsive, and designed to address the specific barriers that affect the different sexes. The analysis highlighted considerations for implementation around the availability of women-only residential facilities, reinforcing the need for ongoing monitoring to ensure sufficient, accessible gender‑specific provision. Through improved workforce understanding of gendered experiences and joined‑up, person‑centred practice, the Plan also supports more respectful and inclusive relationships between staff and people of all sexes and genders. No negative impacts were identified, however opportunities for identifying how commitments will be tailored to reduce inequalities during implementation were highlighted.

4. Pregnancy and maternity

• There is limited robust evidence covering the protected characteristic of pregnancy and maternity, and specific challenges with gathering robust data during the perinatal period, including stigma and fear of child removal, as well as inconsistencies in data collection between NHS boards or local authorities.
• In 2023/24, drug use was recorded in 1.9% of maternities in Scotland (18.8 per 1,000) with cannabis, cocaine and opioids most commonly reported.^[38] Drug use during pregnancy is more prevalent among those living in the most deprived areas.
• Alcohol use was reported by a quarter of women in the 3 months prior to antenatal booking has fluctuated since 2019/20 but generally remained around a quarter of women.^[39] A 2018 study found that at least 15% of pregnant women in the west of Scotland were consuming significant quantities of alcohol during later pregnancy. This is likely to be representative of the wider Scottish population.[40]
• There is evidence to suggest that women with problem alcohol or drug use who are pregnant or have children face additional barriers to seeking treatment due to, for example, fear of child removal, childcare responsibilities and lack of family-friendly services.^[41]

The Plan is expected to have positive impacts for women who are pregnant or in the postnatal period. Its rights‑based and trauma‑informed approach helps reduce discrimination by promoting dignity, respect, and non‑judgemental care. This is particularly important for pregnant women and new mothers, who often face stigma and fear of child removal when seeking support. The Plan also advances equality of opportunity by addressing barriers to accessing perinatal support. It commits to embedding good practice for women who use substances and their babies. While the Families Framework does not explicitly reference pregnancy or early parenthood, its principles still offer potential benefits where applied in a way that reflects the needs of pregnant individuals and new parents.

In promoting good relations, the Plan strengthens trust and reduces stigma by encouraging coordinated, compassionate support across maternity, perinatal, mental health, primary care, and substance use services. Its gendered and lived‑experience‑informed approach is intended to improve continuity of care and support positive engagement during pregnancy and maternity. No negative impacts were identified under any of the equality aims.

5. Gender reassignment

• There is limited robust data available regarding gender reassignment and drug and alcohol in Scotland, particularly in terms of harms and engagement with services.
• Some evidence suggests that trans people may be more likely to use alcohol and drugs than the general population.[42]^,[43] Trans people are also disproportionately affected by mental health problems.[44]
• People who are trans may also face additional barriers to accessing services, partly due to fear of stigma or discrimination.[45]^,[46]

The Plan recognises the barriers that LGBTQI+ people may face in accessing support and its human rights‑based approach seeks to support this group by promoting dignity, respect and inclusive, person‑centred services. This approach supports equitable access, reduces stigma and encourages continuous improvement in the availability and quality of care.

The Plan’s commitments to improving data, understanding inequalities, and delivering trauma‑informed, person‑centred care offer opportunities to address these issues and enhance equality of opportunity, which would aim to reduce barriers to accessing services for trans people. No negative impacts were identified, though continued data development is important to ensure emerging inequities are recognised and addressed.

6. Sexual orientation

• There is limited robust data available regarding sexual orientation and alcohol and drug use in Scotland, particularly in terms of harms and engagement with services.
• Evidence from the wider UK suggests that LGB+ people are more likely to use alcohol and drugs and to develop problem alcohol or drug use than the general population.[47]^,[48] Evidence suggests that LGB+ people are disproportionately affected by mental health problems, with substance use being described as a coping mechanism for these and experiences of stigma.[49]
• People from LGB+ groups also face additional barriers to accessing services, partly because of heterosexuality being the default sexual orientation assumed by service providers and insufficient training around how sexual identity affects service use and LGB+ issues. [50]^,[51]

The Plan’s human rights–based approach promotes dignity, respect, participation and equitable access for all, regardless of sexual orientation. By emphasising inclusive service design, continuous improvement and ensuring non-discrimination, the Plan has the potential to reduce stigma and improve the accessibility, acceptability and quality of support for LGBTQI+ people.

The Plan’s commitment to trauma‑informed, person‑centred care supports the creation of safe, non‑judgemental services that respond to individual needs, though effective implementation will be important to ensure staff are equipped to actively challenge homophobia and biphobia. While the Plan does not explicitly address inclusive language or representation, its broader focus on improving data and service feedback provides scope to identify and address inequalities. No negative impacts were identified, although ongoing data development is necessary to better understand and respond to disparities affecting LGBTQI+ people, as well as additional opportunities for greater inclusion through implementation.

7. Race

• Scotland lacks routine, representative data on substance use and race, with incomplete existing data and UK-wide data being of limited use due to demographic differences between the nations.
• There is evidence to suggest that people from minority ethnic groups may experience additional layers of stigma, relating to their ethnicity or their culture, which can discourage help-seeking.[52]^,[53]
• People from minority ethnic groups may face multiple barriers to accessing services due to stigma, language issues and limited services trained to be culturally competent or sensitive.[54]^,[55]

The Plan’s human rights-based approach, supports dignity, respect and equitable treatment for people of all racial and ethnic backgrounds. Individuals from racial or ethnic minorities may experience compounded trauma linked to racism, marginalisation, and structural inequality. The trauma-informed approach set out in the Plan has the potential to address this, particularly if applied holistically and with cultural sensitivity, which should be a consideration for implementation.

The Plan also has the potential to advance equality of opportunity by addressing known barriers faced by people from ethnic minorities, including stigma, language barriers, lack of trust, and absence of culturally appropriate services. It includes commitments to improve data, strengthen feedback mechanisms, and apply frameworks such as AAAQ aim to identify and reduce inequalities in access, experience, and outcomes. While no negative impacts were identified, ongoing data improvement and careful implementation will be necessary to avoid unintentional bias and to strengthen trust with communities historically underserved by health and social care systems.

8. Religion or belief

• There is limited robust evidence on religion or belief and alcohol or drug use, harms and engagement with services in Scotland.
• Most of the evidence around religion relates to residential rehabilitation and is mixed. The existence of faith-based residential rehabilitation services may present a barrier or a facilitator depending on an individual’s preferences (regardless of their religious convictions) and the extent to which this is a factor in their choice of support.[56]^,[57]
• Use of alcohol and other substances are prohibited within some religions, which may create an additional barrier to accessing support and treatment.[58]^,[59]

The Plan’s human‑rights based approach, encourages dignity, respect, and agency for people of all faiths and beliefs. In advancing equality of opportunity, the Plan commits to improving data, strengthening feedback mechanisms, and using these insights to identify inequalities and improve service design. While the evidence base on the experiences of different religious groups remains limited, the Plan’s approach provides an opportunity to better understand and address barriers over time. One area for ongoing consideration relates to the role of faith‑based services, which may be valued by some but could act as a barrier for others who are uncomfortable with faith‑centred models of care. Although not identified as a current or widespread issue, this may require attention during implementation to ensure services remain inclusive and accessible. No negative impacts were identified.

9. Marriage and civil partnership

• There is limited evidence on marital status and relationships for people who use drugs, beyond very high-level data on the proportion of people in different types of partnerships.^[60]

The Plan is not expected to have a direct impact on individuals based on their marital or civil partnership status, but its human rights-based approach promotes dignity, respect, and equitable treatment for all.

In relation to advancing equality of opportunity, impacts are likely to be limited, though the Plan’s commitment to supporting local areas to embed a whole family approach and family inclusive practices recognises that partners may play a significant role within broader care networks. Importantly, the Plan also highlights the need for trauma‑informed, person‑centred services that can support individuals experiencing harm within abusive relationships, where substance use may intersect with coercion or control. This is reinforced through the Plan’s commitment to a gendered approach to policy and service design. No negative impacts were identified.