Key messages
1 The number of people dying in Scotland because of alcohol or drug use remains high compared with other parts of the UK and Europe. This is despite improved national leadership and increased investment in alcohol and drug services. The Scottish Government has made progress in addressing our previous recommendations for drug and alcohol services, increasing residential rehabilitation capacity and implementing treatment standards. However, progress in putting some key national strategies into practice, such as implementing a workforce plan and alcohol marketing reform, has been slow. 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.

2 Alcohol and drug services are complex and delivered by a wide range of partners. Alcohol and drug partnerships (ADPs) coordinate services at a local level, but they are not statutory bodies, and they have limited powers to influence change and direct funding. Accountability needs to be clearer across partnerships where multiple public bodies are providing services and how they are contributing collectively to improving outcomes. Integration Authorities direct most funding to NHS specialist services to treat the large numbers of people presenting at crisis point. This means investment in preventative measures is limited. Better information is needed to inform service planning and where funding should be directed and prioritised. This includes data on demand, unmet need, cost‑effectiveness, and spending on early intervention and community‑based support models.

3 Funding for tackling alcohol and drug harm has more than doubled over the last ten years, from £70.5 million in 2014/15 to £161.6 million in 2023/24. There has been increased funding through the National Mission – £63 million in 2023/24. However, ADPs have seen an eight per cent decrease in real terms funding over the last two years due to inflationary pressures. Annual and short‑term funding makes it hard for service providers to plan and deliver for the long term and to invest in prevention. The Scottish Government has yet to undertake an evaluation of the costs and effectiveness of alcohol and drug services to determine if they are delivering value for money. At a time when public sector finances are facing increasing challenges and risks, it is essential that available funding is directed in the most effective way. This is particularly important as there is uncertainty around how services will be sustained after the National Mission ends in 2026.

4 Progress in providing person‑centred services is mixed. Not everyone can access the services they need or is aware of their rights. People face many barriers to getting support, including stigma, limited access to services in rural areas, high eligibility criteria and long waiting times. People who already face disadvantage experience additional barriers to accessing services and there is more to do to tailor services to individual needs.

5 Better joined‑up working and data sharing is needed among all partners in health, social care, education, housing, prison, and community justice settings. The alcohol and drug workforce is key to supporting people but is under immense strain. The Scottish Government has set out how it aims to address workforce challenges in an action plan, but urgent action is needed as staff often feel undervalued and at risk of burn‑out and lack job security. People with lived and living experience are increasingly involved in shaping services. Their involvement varies, however, and cultural and structural shifts are needed to maximise their influence on strategic planning in local areas.