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Executive Summary
1. This report was commissioned by the Scottish Advisory Committee on Drug Misuse ( SACDM) to address the additional non-medical aspects of service required to ensure that people with substance use problems are given every opportunity to recover from their problems.
2. Scottish services - often in association with methadone prescribing services - have successfully increased the numbers of people in contact with care and treatment and have delivered approaches dominated by 'harm reduction'.
3. Harm reduction and recovery have often been seen by some in the field as opposing philosophies - rather than a continuum of care.
4. As is the case in the management of other chronic relapsing conditions in Scotland - such as the recovery network in mental health - there is an opportunity, in the field of problem substance use, to develop an approach which is more aspirational and places the service user at the centre of care.
5. Such an approach would involve the development of a national philosophy of care with a focus on recovery.
6. Service delivery should reflect key principles, including:
a. recognition that people with substance use problems have aspirations to have healthy and happy families and to experience fulfilling lives. Disadvantage, poverty and exclusion are closely aligned with problem substance use and plans to improve health must reflect this;
b. recovery must become a key focus of the care available for problem substance use rather than an ideology which advocates any particular type of treatment;
c. recovery may not involve abstinence - all services and commissioning partners must put service users at the heart of their activities;
d. all people should have access to a full range of the essential services described in this document in an accessible location;
e. care plans must be holistic in approach and address the totality of peoples' lives; and
f. all people with problem substance use must have access to the same generic services as everyone else - this includes the right to be registered with a General Practitioner ( GP) and to access primary health care services.
7. The local commissioning process must become more effective and must involve the 'core components' of needs assessment, governance and accountability, data sharing and outcome measurement.
8. Operational delivery must increase effectiveness of the services participating in the care process. The 'primary requisites of effective care' - assessment, review, named key workers and agreed written plans - are essential elements.
9. Essential services - 'key aspects of service provision' - include services addressing an individual's physical, psychological and social functioning. These must be available in every area and there should be governance processes in place to promote equity of access.
10. Key recommendations are listed for the Scottish Government, local commissioners and services. If delivered, people with problem substance use will have more opportunity to overcome their problems and progress towards more mainstream lives with the impact of improving their health and functioning.
11. Substance users have the right to the same quality of care as the rest of us
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