Scotland’s drug and alcohol deaths remain among the worst in Europe despite increased spending to tackle the problems, a significant report by auditors has found.

A national mission on drug deaths was announced in 2021 and last year spending increased to £161.1 million – more than double the figure from 2014.

However Audit Scotland noted there had been no analysis of the cost effectiveness of drug and alcohol services.

Progress in improving services has been mixed, it said, with the workforce coming under “immense strain”.

The auditors warned a further transition plan is needed for when the national mission funding comes to an end in 2026.

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While there has been an increase residential rehabilitation beds, which are up by 8% from 2021, the report said it is unclear if the target of 650 beds by 2026 will be enough to meet demand.

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

There were 1,172 drug misuse deaths, the second lowest number in the last six years.

Scotland’s drug-induced death rate is the highest in Europe based on the latest available data.

At 27.7 per 100,000, it is almost three times higher than the next highest country, Ireland.

There have been further challenges in recent years due to changing drug use habits and the growing prevalence of synthetic opioids.

Audit Scotland last formally reviewed drug and alcohol services in 2009, though it published briefings in 2019 and 2022.

The auditors analysed data and conducted interviews with those who have lived experience in the alcohol and drugs fields.

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.

“With many alcohol and drug workers reporting feeling under-valued and at risk of burn-out, there is also an urgent need to put a timeline against plans to address the sector’s staffing challenges.”

Health Secretary Neil Gray said: “We want every person experiencing harm from alcohol or drug use to be able to access the support they need to help them recover.

“The Scottish Government is determined to do everything it can, working with a number of partners, to make that a reality.

“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 (ADPs) 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.”

Conservative MSP Annie Wells urged the Scottish Government to back her party’s Right to Recovery Bill.

She said: “This stark report must be an urgent wake-up call for SNP ministers.

“They shamefully took their eye off the ball and drug deaths continue to be the worst in Europe as a result.

“Alcohol deaths have hit their highest level in 15 years on the SNP’s watch too, and a growing number of families are grieving the loss of a loved one to addiction.

“The report makes it clear that all too often those who require support are facing barriers to getting it, and only get it after they have reached crisis point.

“The SNP’s Health Secretary is detached from the reality facing those suffering with drug and alcohol addiction on a daily basis.”