A landmark inquiry by the Scottish Parliament’s Criminal Justice Committee has laid bare the scale of substance misuse in prisons across Scotland. It reveals a public health emergency that policymakers have overlooked for far too long.

The Committee’s findings paint a troubling picture. Some 63% of people in Scottish prisons have an alcohol use disorder, with 31% classified as alcohol dependent. That compares to just 22% in the wider Scottish population, where alcohol dependence sits at around 1%. These are not marginal numbers. They represent a majority of the prison population who entered custody already struggling, and in many cases left in a worse condition than when they arrived.

A Treatment Gap Driving Substance Misuse in Prisons

Perhaps the most alarming finding is the sheer scale of unmet need. An estimated 5,000 prisoners with alcohol dependence enter Scottish custody every year. Yet services recorded only 167 referrals to specialist alcohol support in 2024 to 2025. That is roughly 1.1% of the prison population getting specialist help.

The figures around drug misuse tell a similarly stark story. The inquiry heard that overcrowding, insufficient purposeful activity, and prolonged periods of lock-up push people towards substance use as a way of coping. Some witnesses described individuals entering custody with alcohol problems, then switching to synthetic drugs because alcohol is far less available inside. Many left prison with new or more complex dependencies than they had on arrival.

Alcohol treatment requirements in Community Payback Orders have also fallen sharply. They dropped from 13% under the previous probation system to just 1% in 2021 to 2022.

The Human Cost of Alcohol and Drug Misuse in Custody

Failing to tackle alcohol and drug misuse in custody carries consequences well beyond the prison gates. Research cited by the Committee shows that men who have been in prison face a risk of death from alcohol-related causes three times higher than the general population. For women, that risk rises to nine times higher.

Public Health Scotland data, shared with the Committee, recorded 40 alcohol-specific deaths within 52 weeks of release between 2019 and 2023. The weeks immediately following release carry the greatest risk. Many people leave custody without adequate support or a clear route to community services.

Nationally, Scotland continues to bear a heavy alcohol burden. In 2024, 1,185 people died from alcohol-specific causes. Over 27,000 alcohol-related hospital admissions followed in 2024 to 2025. Every day, more than three people in Scotland lose their lives to alcohol and almost 100 more end up in hospital.

What the Committee Recommended on Substance Misuse in Prisons

The inquiry produced five specific recommendations to address the crisis.

The Committee called on the Scottish Government and relevant bodies to introduce consistent, validated assessment tools on admission and throughout a sentence, including at the point of transfer between prisons. It asked NHS Boards to review alcohol service provision in custody and bring support in line with actual levels of need, rather than the current trickle of referrals.

The Committee also acknowledged that the prison environment itself can deepen dependency. It recommended proactive steps to prevent substitution, including better mental health provision, meaningful daily activity, and access to evidence-based alcohol treatment. Prisons need to substantially strengthen pre-release planning. No one should leave custody without a coordinated pathway to ongoing support, including relapse prevention medication and links to community services.

Finally, the Committee pushed for more consistent use of alcohol treatment conditions within Community Payback Orders, alongside expanded recovery communities inside prisons and better access to aftercare and peer support after release.

Calls for a National Service Specification

The Committee’s recommendations provide a concrete framework. But advocates for those affected by substance misuse in prisons say the real test is whether the Scottish Government acts on them. There are clear calls to deliver a National Service Specification for drugs and alcohol, one that sets enforceable standards for treatment and support at every stage of the justice journey.

That specification needs to cover in-custody provision and the critical transition back into the community. Recovery communities, peer support and aftercare must reach people as they rebuild their lives after release.

The inquiry noted that initial assessment on admission is generally sound. The problem is what happens next. Support during sentences remains inconsistent. Access to talking therapies, peer support and evidence-based treatment is patchy across different establishments. Alcohol and drug misuse in custody cannot continue as a secondary concern.

A Clear Roadmap. Now Action Is Needed.

The Criminal Justice Committee has done the hard work of shining a light on substance misuse in prisons. The evidence gathered makes the scale of the challenge impossible to dismiss. Scotland now needs not more consultation or further review, but a committed, funded and measurable response from the Scottish Government.

Forty-one per cent of prisoners say they would accept help for their alcohol problem if someone offered it, both inside and outside prison. That is not an insignificant minority. That is a clear desire for support that Scotland continues to leave largely unmet.

The roadmap exists. The question is whether the political will to follow it does too.

Source: dbrecoveryresources