When I started working in addiction treatment to reliably access residential rehab in Scotland you had to live in the right area, be wealthy or just plain lucky. I heard it too often from patients and families who could see what was needed and, despite their best efforts, couldn’t get near it. When we argued for change, we’d hear the same weary rebuttal from the doubters: ‘there’s no evidence that rehab works’. (Ten years earlier, they were saying precisely the same thing about mutual aid.)
So, it was with some excitement that I read the final report of Public Health Scotland’s evaluation of the Scottish Government’s Residential Rehabilitation programme, published in September. Official evaluations are always careful things. They are cautious, and caveated, though if you look underneath the hedged language, the story this one tells is remarkable.
Headline: the target was passed.
Back in 2021, the Scottish Government committed £100M (about $135M) over five years to residential rehab and set two targets: 650 beds, and 1,000 people a year publicly funded to go through rehab. In 2025/26, 1,125 Scottish residents started a publicly funded placement – a comfortable overshoot. This is likely an underestimate, since not every provider was submitting data. Overall access for Scottish residents is up by around 60% since 2019/20, and publicly funded placements have more than doubled.
Capacity
Bed capacity grew by 35%, from 425 to 574. More to the point, the growth was aimed at the gaps so that capacity was directed to where it was most needed. Mums can now be treated alongside their children. Aberlour’s Discovery Grove in Dundee and the Burrow in Falkirk were simply not there when this journey started. Rae House brought new provision to the North East. Nevis House extends reach across the Highlands and Islands. These were aimed precisely at the unmet need we mapped in the Working Group’s earlier days.
Referrers have changed their minds.
Three-quarters of staff surveyed say they now discuss rehab more often with the people they support. Two-thirds report making more referrals. Referrers are now far more willing to consider a placement for someone who has been through rehab before – up from 45% to 66%. That’s a positive because of the cumulative effect. Anyone who works in this field knows recovery is rarely linear. To be offered a second or third chance should be routine, and now it increasingly is. Meanwhile, the proportion worried that rehab increases overdose risk has fallen sharply. As referrers get more experience, they get more confident.
For the first time, we know what happens to people.
When the Residential Rehabilitation Working Group reported in December 2020, one of our nine recommendations was straightforward: outcomes should be measured, published and monitored. At the time, nobody in Scotland (or to be honest, anywhere in the UK) could tell you who was going to rehab and what happened to them. Now we have a national individual-level dataset, built from scratch, with almost all providers across the private, third and NHS sectors signed up.
The first full year of data shows that 55% of people starting publicly funded rehab finish it with a positive status – substance free, or stabilised – rising to 70% for alcohol placements. This compares very favourably with international completion rates. Nine out of ten of those assessed on the validated Outcomes Star improved in at least one area of their life, and most in several. Deaths following rehab were rare: one drug-related death in the six months after placement among the subset of 146 individuals who were followed up. Given our grim record on drug deaths and the potential risks, that really matters.
What still needs fixing.
None of this means the job is done. The report has a shopping list of problems waiting to be addressed. Waiting times for detox remain a serious bottleneck. Bed capacity still falls short of the 650-bed target, and funding still trails demand. The post-rehab pathway: housing, mental health support and aftercare needs to be the next focus. People going from structured, supportive rehabilitation back into the same challenges that contributed to their problems is not recovery. The good news is that the new Alcohol and Drugs Strategic Plan 2026–2035 contains commitments addressing these gaps. The evaluation gives all of us fresh ammunition to hold everyone (myself included) to them.
So what?
Over five years a postcode lottery became much more of a national pathway. A treatment that was for the rich, the insured or the lucky became a right for anyone for whom it is deemed clinically appropriate. A sector that operated largely in the dark now has a dataset that, to my knowledge, is unique in Europe. Huge thanks are due to all of those who have contributed to the Working Group over the years and to Ministers for accepting and enacting our recommendations.
A personal note, and a full circle.
Twenty years ago, frustrated at watching patients and families bounce off the same walls I’ve described here, I helped set up a rehab service rooted in the NHS, along with council and third sector partners, based on the therapeutic community model. Plenty of people told us the NHS couldn’t run an effective rehab programme. The premise was simple: services to aid recovery from addiction should be available on the same basis as services for cancer, diabetes or broken bones – comprehensive and free at the point of delivery.
We learned early that if you build it, they will come. Demand was never the problem. Because we wanted to know whether it worked rather than just believe it might, we commissioned rigorous evaluation from the outset: one-year outcomes, four-year outcomes, independently followed up and then published in peer-reviewed journals. Almost half of our patients were abstinent at four years; among those who completed, more than 60%. Remarkable.
Those lessons – make it easy to access and free at the delivery end, evaluate honestly, expect demand, and treat addiction like any other condition – are precisely the ones now scaled up across Scotland. The principle behind the now-established national dataset came from the same frustration we felt in 2005 when I couldn’t find rehab outcome data anywhere in Scotland, so we had to create the means to collect our own. The Mother and Child Units, the prison-to-rehab pathway, the commissioning framework – all of it started life as a recommendation from people who had run out of patience with the lottery.
When I see the PHS data now, I see the lessons of one small NHS-based therapeutic community in Edinburgh, learned slowly and at a cost, becoming ordinary practice across a whole country. Of course we had learned from others and ‘stood on the shoulders of giants’ (thank you Providence Projects and others) to some extent, but there was much new learning from our unique service too.
There are good reasons to be positive, and plenty of evidence with which to challenge the naysayers. The future looks brighter, not just for rehab, but for recovery from substance use disorders generally. And if we keep our nerve, our data and our funding commitments, the next five years can build on the last because the lesson of LEAP, and of the national programme, is the same: set the bar high.
Now, let’s get on with the rest of the work.
