Throughout the 1990s, thousands of Scottish drug and alcohol addicted patients from all backgrounds and local areas were able to step out of their chaotic lives and find sanctuary and hope of recovery at addiction centres such as Castle Craig.

Following treatment, they would return home to aftercare support, and 12 step groups such as Alcoholics Anonymous, where their recovery would continue successfully in the community. Our outcomes studies from this period show enviable rates of long-term recovery and overall improvement.

Surveying the wreckage of the drug-deaths scene in Scotland today, it is hard to imagine that hospital-grade care in an uplifting environment was once accessed automatically by people from all walks of life, including those on income support. In those days the yearly toll of drug deaths was a fifth of what it is today.

There was not only Castle Craig, but also the Alexander Clinic, Ronachan House, Red Tower, Rainbow House. These were residential rehabs that could have been expanded and improved over the past decades during Scotland’s drug deaths crisis, as part of a developed continuum of care.

Instead, they were forced to close due to lack of funding, and at Castle Craig we have been forced to downsize and treat patients from other countries, or those who could afford to pay privately.

Healthcare is expensive - try paying for your heart-bypass surgery out of your own pocket. Addiction treatment is no different, and as red-tape was added and access to rehab denied, so the middle class and the poorest were cut-off from an essential part of a quality treatment system.

Health and social care budgets were diverted to local services with “local” becoming a badge of allegiance which meant that all treatment had to be provided ‘in the community’, regardless of how well those services fitted the needs and wants of the local people.

Harm reduction is an important approach for many, but it should be a means to an end, not the end goal. Harm reduction needs an alliance with a continuum of treatment services, including with abstinence based treatment services. Harm reduction is like throwing a life-vest to someone who is drowning. Recovery is teaching them how to swim and has to be a choice which is made when the person is ready.

Scotland’s drugs death crisis shows that having a universal health care system is not enough, if you implement the wrong ideas. For the last 20 years Scotland’s policies have been driven by a group of academics and lobbyists who were incredibly one-sided in favour of harm and crime reduction strategies.

Anyone seeking to challenge the consensus found an unnerving uniformity of opinion among policy influencers. And what this group-think led to was harm production on world leading and national shame-inducing proportions.

Scotland is at a genuine crossroads with the Proposed Right to Addiction Recovery Bill sitting before the Scottish Parliament. This bill, championed by Douglas Ross and the Conservative party, incorporates a shift from social and criminal justice narratives about addiction to a health and recovery narrative.

This is a bill that can empower people to make a choice about their own recovery, and access healthcare at the moment they are ready for it. The future direction of Scotland’s drug and alcohol deaths crisis depends on the outcome of the debate now taking place.

Letting go of the need to control is a life skill that we teach our patients at Castle Craig, and could be applied to the Scottish Government who will feel threatened by a bill which passes power for decision making about treatment options into the hands of members of the public.

An announcement by the Scottish Government in November that it was expanding residential rehab beds was an example of the top down approach which this government prefers. The two services that were selected for £11 million of funding are misrepresented as being residential rehabs. One is an outpatient service with associated housing, and the other is a therapeutic community with no clinical care provided.

Scotland’s drug deaths problem will not be solved by micro-managing which services to fund in this way. The Right to Recovery Bill presents a viable alternative which will empower individuals, families and local support groups to help themselves and help each other.

It is part of a much-needed drive to embrace the recovery agenda, which cannot be built by social workers and politicians, but has to be grown from the ground up, and the first step in that process is empowering people who live and breathe recovery.

The arrival of the Conservatives at the debate is a welcome development; traditionally conservatives haven’t had much to say about drug and alcohol policy, but all stakeholders need to come together, and new voices need to be heard.

A favourite maxim of the 12-step recovery model is “nothing changes if nothing changes”, and positive change will start when room is made at the table for new and erstwhile voices.

If Scotland is going to find a way forward, then squabbling, and territorialism will need to be replaced by genuine collaboration, and a balance found between different approaches and different points of view.

The table needs to be shared between the public, private and charity sector, between pharmaceutical advocates as well as recovery and abstinence-oriented experts. This multifaceted approach needs to consider the place of residential alongside outpatient programmes, for professional support alongside peer-led support and learned experience organisations.

Pitting one side against the other is not the answer when both are potentially life-saving measures. Abstinence based services should not need to compromise on abstinence in order to be part of the solution. There should be a spectrum of choice, with the individual being allowed to self-determine the right approach for them at the right time.

If a genuine attempt is not made to make all options available again, and to put the individual at the centre of decision making, then the next 20 years will just see more of the same, or else incremental improvements, which will keep Scotland in the league of drug deaths shame.

The problem of addiction is not going anywhere in the decades ahead. Disempowerment, social deprivation, and pessimism about the future are the fertile soil in which drug addiction flourishes, and there are surely enough of these in the world today.

By opening up the closed door of treatment service design and delivery, and empowering individual and recovery communities, the Scottish Government will then be able to focus on addressing the myriad of social and economic problems that contribute to the high rates of drug problems and drug deaths in the most deprived areas of Scotland.

Dominic McCann is Chief Executive Officer at Castle Craig, a drug and alcohol rehabilitation facility in Peeblesshire