Introduction
When I wrote my first SHAAP blog on residential rehabilitation (RR) in Scotland – five years ago – we were just starting a long‑overdue journey. At that time the data painted a grim picture: postcode lotteries, missing pathways, and stark access inequalities. Back then, to be sure of getting to RR, you had to be rich, insured or just plain lucky.
Fast‑forward to today: we’ve made real progress, but there’s still work to do. Let’s take a quick look at where we began, what’s improved, and where the next steps lie.
The starting point
Just over five years ago, the Scottish Government convened an expert working group to examine RR and tasked it with making recommendations to Ministers. Those recommendations[i] were accepted in full and powered by an investment of £100 million, earmarked over five years. This was part of the National Mission – focussed on boosting access, expanding capacity, and improving outcomes.
The group was asked to support Scottish Government officials to put the recommendations into practice. That work has continued over the lifetime of the National Mission.
The work
Various workstreams were commissioned or enabled. With the support of our group, (the Residential Rehab Working Group) government officials commissioned Public Health Scotland to develop a national dataset for RR reporting and set up an evaluation of the RR programme. Healthcare Improvement Scotland worked with Alcohol and Drug Partnerships and people with lived experience to develop clear pathways in each part of Scotland.
Scotland Excel developed a national procurement framework to assure quality. The Scottish Government commissioned an online RR directory and set up a funding stream for additional placements when local resources couldn’t keep up with demand. Significant amounts of funding were released to expand capacity, improve services and purchase placements.
The evidence
One of the challenges that gets put to those of us who work in the RR sector is that ‘there’s no evidence that it works’. That fallacy can be put to bed. There was always evidence, but it’s become stronger. A review of the literature[ii] was published by the Scottish Government which evidenced positive impacts associated with this type of treatment.
A Scottish RR outcome study[iii] that we published in 2023 showed sustained positive changes for patients four years after RR completion. Those changes covered a range of meaningful outcome measures including abstinence.
In that study, in keeping with wider outcome studies, almost half of patients were maintaining abstinence at four years post RR. For those who completed RR, this climbed to more than 60%. These were people whose dependence was marked and who had often struggled over years. Those with alcohol dependence did better than those with other substance dependence, suggesting RR is particularly impactful for that group.
What’s happening?
The headline news is that in Scotland RR placements funded through the public purse practically doubled between 2020 and 2024. That amounts to around1000 publicly funded RR placements per year.
The largest single group going to RR is there for alcohol use disorder (42% alcohol, 32% for drug use and 26% for alcohol and drugs).
Although direct comparisons are not necessarily reliable, data from Public Health Scotland[iv] give an indication that those going to RR are similar in terms of age (median age early 40s) and male to female ratio (twice as many men as women) as those undergoing community treatment.
However, a greater proportion of those going to RR come from more deprived backgrounds. It would appear that RR clients are more likely to be unemployed, homeless and have other health issues than their community treatment equivalents, suggesting that those with greater needs are getting to the more intensive treatment option.
It would be good to be able to compare treatment outcomes from RR with community services, but that is not currently possible as community treatment outcome reporting is very limited. We do have some encouraging early data on outcomes from RR looking at baseline to early recovery in a sample of clients:
Table: Public Health Scotland (2026)
Where do the challenges lie for the future?
There is still much work to be done. Currently, there are clear gaps in regulation, leading to concerns about assurance. Referral rates vary between areas, teams and individuals suggest that access barriers remain. Clinical governance concerns need to be addressed. Detox provision in Scotland is patchy and there are problems for those needing detox on RR pathways in terms of access and continuity of care – this needs to improve. For some people, stabilisation may be needed before they can meaningfully engage with RR and community services, but such services are uncommon.
Conclusion
Much work and investment have made a huge difference to individuals and their families who might benefit from residential rehabilitation. Accessing RR in Scotland is now far easier than it was five years ago, and early signs point to solid outcomes – especially (though not only) for those seeking help for alcohol dependence.
All this is caveated on government continuing to support and further the gains that have been made in terms of policy and funding. It would be good to see a continued growth in capacity to allow us to catch up with other similar-sized European countries in terms of the proportion of treatment episodes that happen in residential rehab.
RR isn’t a silver bullet – no treatment intervention is – but for high‑need individuals it’s finally being recognised as a vital component in the treatment and recovery toolbox.
(David is writing in a personal capacity)
[i] https://www.gov.scot/publications/residential-rehabilitation-working-group-preliminary-recommendations-drug-alcohol-residential-treatment-services/
[ii] https://www.gov.scot/publications/residential-rehabilitation-review-existing-literature-identification-research-gaps-within-scottish-context/documents/
[iii] MacKenzie N, Smith DJ, Lawrie SM, M Rome A, McCartney D. Substance use, risk behaviours and well-being after admission to a quasi-residential abstinence-based rehabilitation programme: 4-year follow-up. BJPsych Open. 2023 Mar 13;9(2)
[iv] https://publichealthscotland.scot/media/35647/residential-rehab-analysis-of-2023-client-level-data-241025-revision-final.pdf