An increased focus by the Scottish Government on reducing drug misuse has "led to a shift in focus away from tackling alcohol harm" at a time when deaths are at a 15-year high, a watchdog has warned.

A joint review of alcohol and drug services by Scotland's Auditor General and the Accounts Commission found that while the government had "made progress" on previous recommendations such as increasing residential rehabilitation capacity and implementing treatment standards, progress "has been slow" on developing a workforce plan and on reform of alcohol marketing.

The report states: "Alcohol consumption and binge drinking are a deep‑seated part of Scottish culture, but the Scottish Government’s increased focus on drug harm through its National Mission programme is shifting the balance of attention from, and effort on, tackling alcohol harm."

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Scotland has the highest rates of drug and alcohol deaths in Europe.

In 2023, there were 1,277 alcohol-specific deaths - the highest since 2008.

There were also 1,172 drug misuse deaths, up from 291 in 1999.

Alcohol and drug funding has risen nationally from £70.5 million in 2014/15 to £161.6 million in 2023/24, but funding for Alcohol and Drug Partnerships (ADPs) - the bodies responsible for delivering local services - has shrunk by 8% in real terms over the past two years due to inflation.

Most alcohol and drug funding goes to NHS specialist services to treat people at crisis point, meaning that "investment in preventative measures is limited".

The report notes that drug-related hospital admissions decreased by 23% between 2021/22 and 2022/23, in comparison to an 11% fall for alcohol-related admissions.

The underlying reasons behind the decreases in hospital admissions "are not fully understood", said the report, which found that while 93% of ADPs had drug death review groups only 7% had carried out alcohol death audits in 2022/23.

Only 7% of ADPs had conducted alcohol death audits (Image: AuditScotland) It added: "Alcohol-specific death audits that allow a better understanding of the people most at risk, and the underlying causes, of alcohol harm are rarely undertaken.

"This is despite the fact that more people die from alcohol harm than from drug harm."

The Scottish Government is said to be "on track" to meet its target of publicly-funding 1000 residential rehab placements per year by 2026 - up from 540 in 2021/22 - but the report notes that it is "not clear whether this figure, if met, will be sufficient to meet the level of demand for residential rehabilitation required across Scotland".

The report also found that many drug and alcohol workers feel undervalued and are at risk of burnout.

Stephen Boyle, Auditor General for Scotland, said: “The Scottish Government needs to develop more preventative approaches to tackling Scotland’s harmful relationship with alcohol and drugs.

"That means helping people before they get to a crisis point.

“Ministers also need to understand which alcohol and drug services are most cost-effective, and plan how they will be funded when the National Mission ends in 2026.

"That’s especially important at a time of increasing strain on the public finances.”

Drug deaths have rapidly increased, but in 2022 and 2023 they were exceeded again by the number of alcohol deaths in Scotland (Image: AuditScotland) Christine Lester, a member of the Accounts Commission, said there was also a need to "tailor services to individual needs", adding:  "Right now, not everyone can access the services they need, and that experience is worse for people facing disadvantage.”

Dr Peter Rice, chair of Scottish Health Action on Alcohol Problems (SHAAP), said: “The Scottish Government needs to heed the findings of this report and now put in place a clear plan to tackle Scotland’s significant alcohol problem, alongside its work on drugs.

"We cannot afford one public health emergency to be overlooked in favour of another and we need clearer national leadership and improved accountability at a local level if as a country we are serious about protecting people from the health and social harms caused by alcohol.”

Prof Susanna Galea-Singer, chair of the Addictions Faculty at the Royal College of Psychiatrists in Scotland, criticised the lack of any "robust plans" to provide addiction care and treatment to patients whilst they are in hospital for drug and alcohol-related admissions. 

“It’s clear from this report that this situation cannot continue," she added.  

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Health Secretary Neil Gray said the Scottish Government is "determined to do everything it can" to ensure people experiencing harm from alcohol or drug use can access recovery support.

He added: “While we know there is much more to do, this report acknowledges improved national leadership and progress in tackling Scotland’s longstanding issues with drugs and alcohol, and in increasing residential rehabilitation capacity and implementing treatment standards.

"Many of its recommendations are already being undertaken and we will carefully consider it as we continue to take action to improve services.

“Through our £250 million National Mission we’re taking a wide range of actions, including opening the UK’s first Safer Drug Consumption Facility pilot, working towards drug-checking facilities and widening access to life-saving naloxone.

"We’ve maintained a record £112 million to local Alcohol and Drug Partnerships for treatment and support services and we’re working with partners to support and build ADP leadership across Scotland.

“We’re also addressing challenges to recruitment and retention and investing in preventative measures to help stop people starting substance use at an early age and working to ensure people with problematic alcohol use continue to receive the same quality of care while taking measures like Minimum Unit Pricing to address alcohol dependency.”