IF Scotland’s future is to be a healthier one we will need treat everyone with addictions better.

The appalling drugs deaths in Scotland do not tell the whole story –they only report deaths from illicit drugs, ignoring deaths from two legalised drugs: tobacco and alcohol. 

Politically these two drugs are seen as health problem, and illicit drugs as a criminal justice matter. This has denied thousands of Scots the help they need. 

Those that believe legalising all drugs, will reduce drug deaths, should consider the facts I present, because I believe that alcohol is now our biggest drug problem.

Scotland’s illicit drug problems began in the 1960s when cannabis, amphetamines, LSD and heroin were commonly available, along with tobacco and alcohol, the main killers. 

Today hundreds of different illicit drugs, some highly addictive and potentially lethal, are sold on the streets. The dark web and social media, exacerbates the problem, as does the leakage of doctor-prescribed drugs, especially Benzodiazepines.


In 2020, illicit drug-related deaths were 1,339. Some 61,500 Scots are known to have an illicit drug use problem.

There were 1,020 alcohol-related deaths in Scotland in 2019, excluding alcohol-related deaths from road traffic accidents, suicides, violence, other accidents or drink driving. 

Around four per cent of adults in Scotland, 106,500, have alcohol dependency. Now only 17 per cent of Scots smoke, and we have 10,000 smoking-related deaths yearly.

There are 10,509 hospital admissions annually from illicit drugs, 35,499 from alcohol and 100,000 from smoking.

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When alcohol, tobacco and illicit drugs are all included, drug-related deaths are 12,359. This shows the full scale of addiction and harm from all drug use.

We do not treat all drug addictions equally. 

The drug laws are not devolved to the Scottish Parliament. This prevents Scotland from trying new treatments, for example drug injection rooms and other holistic treatments to address childhood or lifetime trauma, undiagnosed and untreated mental health problems, which are the hidden reason for so many of us self-medicating on drugs.


Inevitably for many, that results in years of addictions for which they get no suitable treatment.

Hundreds of millions of pounds of public money have been wasted on drug rehabilitation treatments that are only successful for a tiny minority of those in need of treatment. 

The Scottish Government says it wants to hear of new ideas but in my 50 years of experience in the drugs field, they seldom follow up new ideas.

The Scottish Conservatives’ solution is that they want instant access to residential drug rehabilitation to all who need it. 


Sounds wonderful, but there are three problems with this. Firstly, there is no good evidence that this works for more than 5-10% of addicts. 

Secondly, it costs £38-48,000 per person for the initial 12-week of treatment. 

Thirdly, there are only 418 such beds available in Scotland. Most do not admit people who are not already drug free and most use the AA 12 steps programme, with a success rate of 5-10%. 

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It would take decades to offer even a tiny fraction of addicts such treatment, as some of these beds are for alcohol only. Many others are filled with people from outwith Scotland, whose costs are covered by health insurance.

If we are to meet the demand for drugs treatments, we need to know who needs it, will it work and is it affordable? 


We know that of those addicted to illicit drugs, approximately one third do not seek treatment, another third successfully deal with their addiction in their own way, in their home communities, with support from family or friends. So, only one third of addicts, 20,602, seek professional drug treatment.

Imprisoning addicts costs £730 per week or £38,000 per year, with unknown costs, for policing, courts and legal services. 

We know that this approach has badly failed thousands of addicts for decades. It is a waste of valuable resources that could provide better solutions.

An Addiction Recovery Passport (ARP) could fund a non-residential recovery programme, with a budget of £730 per week. 

The money would not be given directly to those seeking treatment. They would access it to fund the sort treatment they believed could work best for them. 

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Medically-approved detoxification would be part of the treatment so they would not be prohibited from accessing ARP until they were drug free, as happens in many other treatment models.

All ARP participants would be supported by a key worker from the start to finish of treatment. They would start their treatment with an assessment of what might work best for them, from a clinical psychologist. 

This is vitally important to achieve a successful outcome, because for some people, literacy limits what will work for them. 

Others find it difficult to deal with group work treatments, some might respond well to cognitive behaviour therapy, others need to start with motivational interviewing to help them build up the courage to start and continue with their treatment. 

For some, the goal of total abstinence is not one they can embrace, so other more realistic goals, are more likely to be successful for them. 

For most people addressing underlying mental health or trauma must be a priority because this is so often what led people into their addiction. 

One-to-one counselling, psychotherapy, acupuncture, hypnotherapy and a range of meditation techniques could help some individuals. 

Attending organisations like Alcoholics Anonymous, Cocaine Anonymous or Narcotics Anonymous, to follow the 12-steps approach may work, but not for everyone, especially young people, in my experience.

These groups do not incur financial costs. Why should  government not apply their levelling up agenda to our poorest, most damaged individuals trapped in addiction?

In Scotland’s future, 10% success rates from current addiction treatments can surely be improved with new and radical approaches.

Max Cruickshank is a retired youth worker who specialised in health issues affecting children and young people for more than 50 years.