THE number of NHS patients referred to residential rehab to undergo treatment for drug or alcohol addiction in Scotland is at an all-time low.

One of the country's longest-standing facilities, Castle Craig near Edinburgh, has seen taxpayer-funded admissions plummet from 257 in 2002 to just 12 last year.

HeraldScotland: Camley's cartoon: Concern over rehab referralsCamley's cartoon: Concern over rehab referrals

Only four of these were from NHS Scotland, however, with the rest of the referrals coming from NHS England. 

Dutch patients, funded through Holland's statutory medical insurance schemes, now account for a majority of the centre's clients - 292 last year. There were also 268 private patients from the UK and abroad.

Similar trends have been reported at Murdostoun Castle in Lanarkshire, run by Abbeycare Clinics, which received just eight referrals from councils and the NHS in 2019, while Phoenix Futures in Glasgow reports a "significant decline" in state-funded referrals in recent years.

A spokesman for the Priory in Glasgow said it only handles private clients.

The Scottish Government told the Herald it is launching a review into demand for rehab.

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It comes at a time when Scotland is battling record numbers of drug deaths - mostly opioid overdoses - and one of the highest alcohol-related mortality rates in Europe.

Official guidelines recommend residential rehabilitation for addicts with complex needs, but budget cuts and a shift to community-based care have been blamed for the decline despite evidence that rehab can be 10 times more effective than methadone at keeping heroin addicts clean.

Peter McCann, who co-founded Castle Craig with his wife in 1988, said: "I'm very concerned.

"We opened up 32 years ago in Scotland to treat Scots and now we're not able to unless they can pay for it.

"At one stage we were treating around 250 NHS patients a year, we had a contract with Greater Glasgow for 100 patients a year.

"It's all very well to focus on care in the community for some patients - but a lot of patients need much more than that."

A UK-wide report this week by recovery charity Phoenix Futures found that half of rehab residents found it "difficult or very difficult" to access funding for treatment, with waiting times of up to 12 months before approval was granted.

James Armstrong, director of marketing, said: "There has been a significant decline in the use of residential rehab across Scotland over the last five to 10 years.

"A number of services have closed, some have focused on providing for private clients in Scotland, others for private overseas clients, some are operating on a voluntary basis.

"We have remained focused on providing for state funded clients although we increasingly use charitable resources to support the provision of residential rehab in Scotland."

A slump in taxpayer funding for rehab has coincided with several detox facilities folding, including the closures in 2019 of Alexander Clinic Aberdeenshire and in 2010 of both Ronachan House and Red Tower in Argyll.

Meanwhile fatal drugs deaths crept up to 1,187 by 2018 - compared to 382 in 2002 - and are predicted to have exceeded 1,200 in 2019.

A further 1,136 deaths in Scotland in 2018 could be directly linked to alcohol.

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This week Glasgow is playing host to two separate drugs summits organised by the Scottish and UK Governments to address the crisis.

Liam Mehigan, director of Abbeycare Clinics, said: "It’s difficult to understand why we have seen residential services closing and others under-occupied when we have such a crisis in our country.

"I have heard of facilities having to deliver services at the rate of a bed in a B&B or travel lodge yet are expected to provide quality clinical services and therapeutic programmes.

"Something is wrong when we can afford to keep people in hospital beds without any therapeutic or recovery interventions or in prison settings with limited rehabilitation services.

"These settings are costly and I would ask are we getting value and, more importantly, are we helping our most vulnerable?"

David Liddell, CEO of the Scottish Drugs Forum, said addicts seeking recovery needed access to "the widest possible range of options and that includes residential rehabilitation".

Mr Liddell added: "There has been a long term decline in the numbers of people going to residential rehabilitation services. We have also seen a reduction in the length of time people stay in such centres.

"This has been driven partly by cost considerations.

"There has also been a recognition of the challenges of maintaining recovery when returning to the community.

"Sustaining recovery is particularly challenging for those individuals who are returning to very difficult life circumstances and very little support around them."

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A Scottish Government spokeswoman said it had invested £800 million on tackling drug and alcohol harms since 2008 and wants to "ensure everyone who requires drug and alcohol rehabilitation treatment has access to it".

She added: "Evidence supports community rehabilitation for most people as it allows them to remain within their local communities and supports safe reintegration.

"However, there is clear recognition of the benefits that residential services bring and, as a result, we have started work to review the need and demand for such services."