News

AFS Response to PHS Decline in Treatment Report

Public Health Scotland (PHS) recently published their long-awaited report into a decline in referrals to specialist alcohol treatment services.

The report was commissioned by the Scottish Government in 2023 following an answer to a Parliamentary Question which revealed that the number of referrals to specialist alcohol treatment fell from a peak of 32,556 in 2013/14 to 19,617 in 2021/22. Further analysis carried out by Alcohol Focus Scotland confirmed  a staggering 40% drop in access to specialist alcohol treatment between 2013/14 and 2021/22.

Even prior to the pandemic, access to alcohol treatment had dropped by 30%.

The decline in people accessing treatment has occurred against a backdrop of rising alcohol deaths in recent years, with Scotland recording a 15-year record high in 2023, before a modest 7% reduction was recorded in 2024.

Among the conclusions from PHS on the reasons for the decline were:

• Alcohol services deprioritised: Participants in the qualitative survey of stakeholders felt alcohol treatment was deprioritised following implementation of the Medication Assisted Treatment (MAT) Standards, which focused on drug services. This led to reduced alcohol-specific contracts, fewer counselling options and less recovery-focused support, despite rising concerns about alcohol-related harms.
• Inadequate detoxification provision: Many participants raised serious concerns about reduced alcohol detox services, including shortages of inpatient beds, long waiting times, and insufficient community-based detox. There were concerns that iIndividuals with clinical risk factors were not receiving detox under clinical supervision due to lack of resources.
• Referral pathway breakdown: Health referrals decreased from around 5,000 per quarter to around 2,000 per quarter, whilst self-referrals remained relatively stable at 2,000-3,000 per quarter. Participants across all localities discussed unclear, fragmented and overly complex referral routes into treatment. They perceived an absence of consistent, visible and user-friendly routes into treatment which could have contributed to a decline in referrals.
• Systemic challenges: Funding uncertainty and short-term funding cycles impacted capacity to recruit and retain staff. High staff turnover, persistent recruitment challenges, limited training opportunities, and increasing reliance on volunteers undermined service quality and consistency. Outdated prevalence data (from 2014-15) hindered effective service planning in 2024

Laura Mahon, Deputy CEO of Alcohol Focus Scotland, said:

“This report confirms that the 40% decline in alcohol treatment over 10 years is real, but does not represent a decline in demand. It serves to add to a picture of a wholly inadequate systemic response to Scotland’s alcohol emergency.

“The report echoes the long held and loudly voiced concerns of AFS and partners, recently validated by Audit Scotland, that alcohol treatment and policy has been deprioritised while Scotland has sought to tackle the drugs deaths crisis. Whilst this is of paramount importance, it cannot be at the expense of efforts to reduce and tackle alcohol harm – with these dual public health emergencies requiring equally urgent responses.

“The beginning of the decline in referrals to treatment coincided with a period during which funding to Alcohol and Drug Partnerships was cut by 20%, which no doubt contributed to many of the issues identified in the report. The Covid pandemic has subsequently made a bad situation worse.

“Evidently, issues abound in primary care and with referral pathways, with too many patients – among the most vulnerable in our society - expected to take on too much responsibility for their own healthcare, and left to navigate complex systems and pathways with little assistance or support.

“Earlier this year, AFS was joined by more than 70 other organisations, in calling for urgent action to tackle alcohol harm in Scotland. We provided the Scottish Government with a road map that included increasing funding for alcohol treatment and support, as well as improved access to detox services, the establishment of nurse led Alcohol Care Teams in acute hospitals and expanding successful pilots to help detect liver disease early and save lives.

“It’s time for the Scottish Government to move without delay to enact this plan.”