“Would you like temporary accommodation or help to get your own place?” Surely the answer is both. It’s the same with help to stay alive or help to quit using drugs. People need emergency assistance and more long-term support to improve their situation. With publication of more tragic statistics on suspected drug deaths in Scotland we must acknowledge that a fraction of people are offered the help they need, both short-term help to survive and longer-term help to thrive.

The Right to Addiction Recovery Bill, proposed by Douglas Ross MSP, seeks to improve access to treatment for people living with dependence on alcohol or other drugs. The Bill is a response to the upwards spiral of drug and alcohol-related deaths in Scotland, by far the highest in Europe, and the relative defunding of residential treatment. The words ‘harm reduction’ are not included in the Bill. Harm reduction interventions seek to reduce harm without requiring a person to stop using drugs or alcohol. They start where people are, are non-judgemental and recognise that there are safer ways to use drugs.

The debate is polarised between those supporting harm reduction and those focusing on abstinence. In truth, we need both harm reduction AND abstinence approaches. People are different, so are their circumstances, risks, values and aspirations.

The Salvation Army has a long history of supporting abstinence. However, as a major provider of supported accommodation we are also big fans of harm reduction. Our lifehouses provide injecting equipment, blood-borne virus testing and the life-saving drug Naloxone. This has resulted in an impressive 51% reduction in deaths from overdose in the past four years, in stark contrast to trends in wider society. Interventions such as these, alongside opiate substitutes such as methadone, have an impressive evidence base. 

But during the nationwide push for harm reduction, many still worry about access to residential rehabilitation. Whilst the number of publicly funded placements has increased by an impressive 60% in the last three years, our staff report that access remains very difficult with multiple obstacles to overcome, and the recent funding windfall is due to end in 2026. Per person, residential treatment is expensive, and relapse afterwards is common. Harm reductionists rightly state that the time immediately after rehab is the most risky. Loss of tolerance means that people leaving rehab respond powerfully to even small quantities of drugs, making overdose more likely. 

The Salvation Army supports this Bill, but not unconditionally, and is suggesting amendments. The Bill brings an important issue to Parliament. It offers a much-needed step towards equity in treatment and parity with other patient groups and highlights the need for residential treatment, which is critical, particularly for those dependent on alcohol. It seeks to enshrine these rights in law. But with finite resources, we must be careful that prioritising residential care doesn’t mean deprioritising psychosocial support, access to methadone, and low-threshold harm reduction and outreach. 

We must not lose sight of related issues, many outlined in our Breaking the Cycle report, launched at the Scottish Parliament in May 2024. Whilst considering specific treatments for drug or alcohol dependence, we would highlight that recovery also relies heavily on adequate housing, financial income, employment and healthy relationships. People also need support to address the effects of trauma or underlying mental health conditions that can be both causative and consequential to drug and alcohol use.