Recovery Housing in Scotland: Mapping and capacity survey of providers 2022/23

1. Introduction

There is a high level of problem drug and alcohol use in Scotland, which causes preventable harm to people and their families. Scotland has a higher drug death rate than any other European country – this is 2.7 times the rate of the UK as a whole^[1] and disproportionately affects people living in more deprived areas. The most recent evidence suggests that as of 2019/20, around 45,700-48,600 people aged 15-64 were opioid dependent in Scotland^[2].The most recent Scottish Health Survey found that over one in five people aged 16 and over (22%) self-reported drinking alcohol at harmful levels (in excess of 14 units per week) in 2022^[3]. However, the true size and scale or problem alcohol and drug use are challenging to determine.

In January 2021, Nicola Sturgeon, in her role as First Minister, made a statement to Parliament that set out a National Mission to reduce drug deaths through improvements to treatment, recovery and other support services. One of the five priorities was increasing capacity and improving access to residential rehabilitation.

The Residential Rehabilitation Development Working Group (RRDWG), chaired by Dr David McCartney, was established in April 2021 as a successor to the Residential Rehabilitation Working Group (RRWG). Its role is to advise Scottish Ministers and the wider drug and alcohol sector on implementing the recommendations made by the RRWG in December 2020. These recommendations were published in a suite of reports that provided insight into the pathways into, through and out of residential rehabilitation in Scotland. A specific “need to ensure robust exit planning and continuity of care for those leaving residential rehabilitation” was outlined as a recommendation for future work. The RRWG also highlighted the need to better understand the “local community-based resources […] and other recovery initiatives” that operate alongside residential rehabilitation (recommendation 6b) and the diversity of residential treatment interventions across Scotland (recommendation 7a).

Recovery housing has been put forward as a potential avenue for meeting early recovery needs that can be incorporated into the continuity of care for people in recovery. Although a definition of recovery housing is yet to be agreed, it is generally accepted that recovery housing is a shared-living, substance-free living environment, centred on peer support to promote sustained recovery and independent living. Recovery housing therefore acts as a bridge between residential treatment and independent living. Recovery housing is one continuity of care service that can run alongside or independently from residential rehabilitation. A recent review of the literature on recovery housing shows that although there is considerable evidence for recovery housing and information on models of care, this is mostly from research conducted in a U.S. context. It remains unclear how relevant and directly applicable this is to a Scottish context. The review also highlights that little is known about the current provision and capacity of recovery housing in Scotland, and that more work needs to be done to better understand the Scotland-specific landscape.

The research presented in this report intends to address this, by means of a survey of recovery housing providers in Scotland. The principle aim of this research is to better understand the provision and capacity of recovery housing facilities for drug and alcohol use in Scotland. Specifically, the objectives of this report are to identify the key characteristics of the services that operate and identify as recovery houses in Scotland, and to better understand access and current capacity of these services. This will inform future policy and planning around recovery housing and aftercare in general for people with problem substance use in Scotland.

The report first outlines the methodological approach taken in the survey before discussing the findings of the study, conclusions and next steps.