Billions spent but culture of addiction worsens

Published on Wednesday 25 March 2009 21:12

SCOTLAND'S addiction to drugs and alcohol is costing the country at least £5 billion a year – and ministers are not doing enough to tackle the growing problem, according to a new report.

An Audit Scotland investigation published today claims the level of drug and alcohol misuse in Scotland is among the highest in the Europe and getting worse, in contrast with other countries, which are reducing the harm caused by substance abuse.

In a damning critique of public-sector efforts to reduce the harm caused by alcohol and drugs, the report finds that ministers have failed to ensure effective treatment and prevention services amid a lack of clear direction and co-ordination.

The report says the Scottish Government has not set out what the tens of millions of pounds spent on drugs and alcohol services every year are meant to achieve, with ministers failing to enforce national standards drawn up three years ago.

This has led to a postcode lottery of services, with the range and accessibility of treatment varying across the country, without always being based on local needs.

"Although the Scottish Executive developed National Quality Standards for Substance Misuse Services in 2006, there is no national monitoring of whether they have been implemented," the report states.

"A different approach is taken in England where the government has set out and monitors a required range of drug services which should be in place and minimum standards of access."

It adds: "The Scottish Government has not set out minimum standards in terms of range, choice and accessibility that service users and their families can expect to receive.

"Spending decisions are not always based on evidence of what works or on a full assessment of local need."

While recent Scottish Government strategies have a focus on prevention, only 6 per cent of direct spending was on preventive activities.

The report acknowledges the SNP is addressing some of these issues. NHS boards have been told to spend an extra 24.8 million on screening and interventions to prevent people developing serious alcohol problems.

It also highlights the "added difficulty" faced by service providers of complex funding arrangements, with different sources of cash working to different criteria and deadlines.

"Drug and alcohol-related death rates are among the highest in Europe and have doubled in 15 years," the report states.

"This is at a time when indicators of drug and alcohol-related harm are reducing in other countries in Europe."

The report says that in 2007 health boards and councils spent 77 million on drug services and 26 million on alcohol services, although alcohol-related deaths, at 1,399, far outnumbered the 455 drug-related deaths.

The report puts the combined cost of drugs and alcohol misuse at just under 5 billion – 2.6 billion for drugs and 2.25 billion for alcohol – but says that figure is likely to underestimate the actual bill.

It recommends the Scottish Government sets minimum standards for drug and alcohol services, and clarifies what different agencies are responsible for delivering.

Robert Black, the Auditor General for Scotland, said drug and alcohol misuse was a "significant and worsening problem in Scotland".

"The range of services for people in need of help can depend on where they live, and there is not enough information about the effectiveness of these services," he said.

Annabel Goldie, the Scottish Tory leader, called on First Minister Alex Salmond to make a statement before MSPs and demanded a major drugs summit as "soon as possible".

"This report came about as a result of Scottish Conservative pressure in the 2008 budget. We suspected there was chaos in how funding streams were directed towards addressing addiction.

"The horrific truth has now been exposed and I am shocked at the sheer scale of the drugs and alcohol problem in Scotland."

Labour's Cathy Jamieson said: "I am particularly concerned that Audit Scotland's report states that the Scottish Government is not funding services in the most effective way as they have no way of measuring performance.

"This is completely unacceptable and must change."

Robert Brown, for the Liberal Democrats, said: "It simply doesn't make sense that only a third as much money is spent treating alcohol abuse as treating drug abuse."

A Scottish Government spokesman said the administration had asked for the report and welcomed its findings.

"It details the system we inherited from the previous administration," said the spokesman.

Dave Liddell: We need to invest in communities to break the cycle of abuse

THE Audit Scotland report highlights a number of important issues that many of us in the field have been flagging up for quite some time, as indeed have government administrations over the years.

There are enormous issues around substance use, which are evolving and changing. Compared, for example, with health where disease patterns may slowly change in a fairly predictable way, the nature and extent of drug and even alcohol use has changed very quickly.

In this context, the planning of services has been reactive. The problem is vast and linked to underlying and endemic problems of poverty and deprivation and responses are required from a multiplicity of agencies – enforcement, health, education, social services, housing, welfare agencies to name a few. There is also a one-size-fits-all character to much service provision. The provision of even this service is geographically patchy, but it is almost uniformly unsatisfactory. We need to have consistent high standards across the country.

The National Standards form a basis on which good service provision could be delivered. So we can do better to improve the quality and range of treatment and care services to ensure that they more closely match the needs of those with problems.

But it's also important that we are realistic in terms of what treatment and care can deliver. As the Audit Scotland report states, the cost to Scottish society of drug and alcohol problems is 5 billion and much of the financial response to the problem is reactive in nature – from enforcement to removing children into local authority care.

We need to be investing in those communities most ravaged by drugs and alcohol to break the cycle so the progression of problems from one generation to the next is halted, or at least substantially reduced. That will pose huge challenges for public policy in terms of its focus and spending choices, but it is strikingly clear that the status quo is not an option.

We have got to stop going down the road of just seeing problem drug use as an individual's personal failing. We need to start asking questions about wider society's responsibilities for creating the structures which allow problem drug use to flourish.

&#149 Dave Liddell is director of the Scottish Drugs Forum, a drugs policy and information umbrella group