The recovery crisis: Treatment, rehab, and alcohol deaths

The plan was backed by a £100 million investment - part of the £250m allocated to the National Mission - and was designed to fund an increase in beds, as well as enabling local Alcohol and Drug Partnerships (ADPs) to purchase more rehab placements for people recovering from alcohol dependency or drug addiction.

According to a report from Public Health Scotland, £38m has been allocated so far.

This has enabled an extra 172 beds to be "planned" to date, but only 32 were operational - all of them limited to people in the Lothian area with children.

An additional 53 beds still need to be planned and delivered to hit the 2026 target.

PHS said the Scottish Government appeared to be 'on track' to reach its target of 1000 publicly-funded residential rehab placements a year by 2026 (Image: PHS)

PHS noted that the number of people being publicly-funded for residential rehab each year is "not being tracked directly", but estimated that it has risen from 542 in 2019/20 to 812 in 2022/23.

This "upward trend" suggests that the Scottish Government is "on track" to reaching its goal of 1000 publicly-funded placements a year by 2026, said PHS.

The agency added that feedback from providers also indicated that the extra funding had "helped secure the survival of at least one rehab centre", indicating that beds might have been lost without the programme.

READ MORE: 

• CASE STUDY: 'I was completely clueless about recovery - I thought you just stopped drinking'
• How did we get here? A history of Scotland's drinking culture, from 1950 to now
• Think Scotland has always been Europe's problem drinker? These graphs might shock you

However, the report - published on February 13 - pre-dated the closure of Turning Point 218, a charity-run rehab in Glasgow which supported around 50 women a year with substance abuse problems.

It also found that half of ADPs have no rehab beds in their area and 74% of providers surveyed said that family or caring responsibilities were a barrier to potential patients accessing rehab.

Rod Anderson, a recovery coach based in the Borders who overcame his own alcohol dependency a decade ago following a home detox by his GP, said more could be done.

He said: "More people in the Borders are able to access residential rehab than they ever have before - that's hugely positive. Up until a couple of years ago, we didn't send anyone to residential rehab.

"Now there's a budget for that and we send people all over the place - mostly to Glasgow, but also to some other paid-for rehabs as well.

"But there is a whole issue around that: why can't people living here have a rehab that's run by the NHS?

"We have a brilliant one in Edinburgh run by NHS Lothian and it's a model that any other NHS board could adopt, but none of them do. Why is that? That's a question that needs to be answered."

Rod Anderson, a recovery coach who has struggled with his own dependency on alcohol in the past, questioned why residential rehab is not available to more people on the NHS in their own areas (Image: Colin Mearns/Herald&Times)

The Scottish Government says it is investing a record £112 million in ADPs in the current financial year.

A spokesman added that three out of the eight residential rehab facilities being created or expanded as a result of government funding - in Edinburgh, Dundee and Ayrshire - are "fully completed and operational".

He added: "Though building and renovation work can take time, other work is ongoing in Falkirk, Ayrshire, Aberdeenshire and Argyll & Bute and we expect the expansion and refurbishment of CrossReach’s Beechwood House in Inverness to be completed in October.”

For the past 20 years, Abbeycare has been providing specialist addiction treatment in Scotland - initially at Murdostoun Castle on the outskirts of Wishaw in Lanarkshire, but over the past three years from a purpose-built facility in Erskine, Renfrewshire.

The 34-bed centre accommodates 220-240 clients a year, mostly from Scotland.

Over the past year, 48% of its clients were in alcohol-only treatment with 19% recovering from co-dependencies on drugs and alcohol and 4% from alcohol problems in combination with addictions to sex, gambling or eating disorders.

Half their clients are aged 31 to 50, and the gender split is roughly 70-30 male to female.

As a private provider, many patients are self-funding - but a growing number of referrals are coming from ADPs according to operations director Liam Mehigan.

He said: "There has definitely been a shift. It can vary depending on the referrals but it could be up to half at times.

"There's also been an increase in female admissions and referrals, and more recently younger men where they are co-dependent on alcohol and cocaine."

Liam Mehigan, of Abbeycare, said at times 'up to half' of their clients were now publicly-funded (Image: Colin Mearns/Herald&Times)

As well as detoxing, patients at Abbeycare receive counselling, cognitive behavioural therapy, group therapy and access to doctors, psychiatrists and nurses over a 12-week stay.

Mr Mehigan said: "By the time people are presenting at our type of service, their dependency has had a significant impact on their life - on their physical health, their family relationships, their career.

"People present with a lot of trauma. Maybe prior to their dependency, but even just through maintaining a dependency - a lot of trauma can be associated with that as well.

"It's complex, but so rewarding to see people walk through that door initially broken who then grasp that hope and put the work in."

Residential rehab is still a very small part of the equation, however.

Many more people are treated in the community, where activity levels have been falling for reasons that remain unexplained.

Between 2003 and 2012, the number of people entering specialist alcohol treatment doubled from around 17,000 to 32,500, but by 2021/22 that had dropped to 19,600 without any concurrent fall in demand or availability of these services.

Public Health Scotland is currently investigating what caused the decline, with a report expected in May.

Over roughly the same period, from 2012 to 2022, alcohol-specific deaths increased from 968 to 1,276.

"We know that there's an inadequate level of treatment and help," said Dr Peter Rice, an addictions psychiatrist who has worked in alcohol recovery for decades.

"Even when we were at 32,000, the estimate – which I think was a bit optimistic – was that there was capacity in treatment for one in four people with alcohol dependence.

"Now, that’s pretty good in international terms – most places are much worse – but one in four still isn’t great.

"So even when we were at our peak there was a lot of unmet need, and that unmet need will be even bigger now."

The number of deaths wholly attributable to alcohol misuse has been climbing in Scotland since 2012 (Image: NRS)

When Public Health England (PHE) investigated a similar 18% drop pre-pandemic it found that referral pathways had become more fragmented and complicated as a result of austerity-related cuts.

Another theory is that the decision, in 2016, to end the ring-fencing of alcohol money for Scotland's ADPs left alcohol misuse as the "poor cousin" to drugs, especially as fatal overdose deaths rocketed.

Laura Mahon, deputy chief executive at Alcohol Focus Scotland, said that the £250m announced for the National Mission was "very much communicated as a response to the drug deaths crisis", which claimed 1,051 lives in 2022.

She added: "The ADPs are in receipt of that additional investment, but with that additional investment comes the pressure to meet the mission to reduce the drugs deaths.

"What we're seeing from some of our ADPs is that, because there is so much focus on the drugs side of things, they are not able to put in the resources and capacity - even at a local level - to ensure that there is an equal or similar response to tackling alcohol."

However, dependent drinkers - those who go into withdrawal if they suddenly stop or reduce their alcohol intake - make up a fraction of Scotland's harmful drinkers: women routinely consuming over 35 units a week and over 50 for men.

There are fears that this group may be drinking their way towards liver cirrhosis and other alcohol-related diseases without ever becoming addicted, or being confronted.

Evidence shows that GP-led alcohol brief interventions - a short consultation where a patient is talked through the potential dangers of their alcohol consumption - were highly effective.

"People used to go to their GP and that's how you would have conversations about alcohol - but seeing the pressures that primary care is under, it's fallen off the priority list," said Graeme Callander, policy lead at the substance misuse charity, We Are With You.

'Harmful' drinking is consuming more than 35 units a week for women - roughly three and a half bottles of wine - or more than 50 units a week for men (Image: Getty)

He added: "As an organisation, we try to promote a healthier relationship with alcohol. What does 14 units a week look like?

"Well, it's a bottle and a half of wine, or it’s six pints of beer, because to this day people don’t always marry those figures up.

"They think '14 units – that’s 14 drinks’. Well, 14 pints of beer would be 30-plus units a week.

"We try to guide people that making any change can have a really huge impact, so if you drink every night taking two nights off is going to be really beneficial.

“But with alcohol, unlike drugs, it can take a long time for some of the harms to come through.

"People can drink at a problematic level for quite a long time before seeing any health effects. It can be 10-20 years before you experience the harm.”