Stabilisation, detoxification and other crisis support in Scotland: Service mapping and capacity survey 2022/23

4. Conclusion

The survey found a total of 65 providers offering some form of detoxification, stabilisation or other support for people at a point of crisis with regard to their substance use in Scotland.

The majority of providers (n = 38) offer some form of stabilisation treatment, usually in combination with detoxification, to an estimated 3,143 people at the time of the survey (based on the 29 respondents who were able to provide an estimate). These services are delivered in both residential/in-patient or community-based/out-patient settings across Scotland (with the highest concentration in Glasgow City health board). Stabilisation was also reported to be provided in prison settings by all respondents to the prison survey and detoxification by all but one. However, it is clear that the delivery of substance use healthcare in prison settings differs significantly from that in the general population, and further research is required to better understand how treatment and support is delivered to the population of people in prison settings.

Self-funding was reported to be uncommon, with 84% of stabilisation providers saying that this is never the case. These services are most commonly funded by the NHS or local ADPs (76% and 58% of providers reporting this, respectively).

Of the 41 services that were identified to provide detoxification in Scotland, the majority (n = 36) were found to offer this in conjunction with some form of stabilisation treatment. The five remaining services came from a range of organisations and offered either treatment for drugs and alcohol or just one of these. All five were found to also offer behavioural or psychological interventions and an active connection to community recovery resources.

A total of 24 providers were identified as offering another form of crisis support, which did not include stabilisation and/or detoxification. These were primarily third sector or homelessness services principally operating in community-based settings (75%) and offered a range of treatment and support.

4.1 Definition of stabilisation

The results of these surveys suggest that providers of services for people at a point of crisis with regard to their substance use do not share a common understanding of how those services are defined. An operational definition of "stabilisation" and how this differs from other forms of crisis support is lacking.

However, a pattern can be identified in the results of this survey, which can be used to suggest a possible broad definition of stabilisation as it is practiced by providers across Scotland. The responses to the survey suggest that stabilisation commonly consists in the provision of medical prescribing treatment (e.g. OST prescription, OST optimisation or benzodiazepines prescription), combined with detoxification and/or psychosocial support ranging from low-intensity interventions to higher intensity ones with specialist clinical staff. These responses can be used as the starting point for developing a broad definition of stabilisation, such as:

"Stabilisation aims to support people to manage their substance use through medication prescription, in combination with detoxification and/or psychosocial support as required."

This proposed definition will need to be further considered by the SCCWG and would benefit from engagement with various stakeholder groups, including people with lived and living experience.

4.2 Considerations for future research

1. The results of this survey provide a basic understanding of the support available for people at a point of crisis with regard to their substance use. However, further research with service providers is required to better understand the level of need and demand; service-user profiles; pathways into, though and out of services; and differences between residential, community-based and prison-based service delivery of stabilisation and detoxification services in order to better understand how the services are delivered and to identify potential gaps in provision.

2. Further research is required to better understand the provision and definition of other crisis support services available for people who use alcohol and/or drugs in Scotland and how these differ from stabilisation.

3. It would be beneficial to go beyond the insights of providers of detoxification, stabilisation and other crisis support and conduct specific research on the lived and living experience of current service users, people seeking referral and those supporting them. This would enable a better understanding of the needs and barriers of the population of people who would benefit from these services.