The Questions That Forced Me to Clarify What I Actually Believe About Recovery, Society and Hope

What I Actually Believe About Addiction: Twelve Questions and My Answers

I received an email from a friend with a specific interest in the church’s role in responding to Scotland’s addiction crisis. Attached were twelve deceptively simple questions.

1. Why does Scotland have such a serious problem with drug and alcohol deaths?

2. Do you think this is more of an urban problem than a rural one?

3. What are the main drivers of drug or alcohol addiction that you come across in your work?

4. Do you think that family, community or church support improves a person’s prospects?

5. What is the most effective way to support a person to exit drug or alcohol addiction?

6. Do you recommend harm reduction or abstinence-based approaches, or both?

7. Do people face barriers in accessing support for drug or alcohol addiction?

8. What should major investors prioritise to make a difference in years to come?

9. What kind of infrastructure do we need more of in Scotland, and in which locations?

10. Aside from prayer and giving, are there other ways that local churches could help?

11. What actions should central and local government be pursuing to make a difference?

12. If you could change anything about the state’s approach in this area, what would it be?

I realised my answers had been forming over almost three decades of working alongside people affected by addiction, campaigning for policy reform and watching Scotland’s response evolve and, in many respects, lose its way.

The questions forced me to gather thoughts that had previously been scattered across countless articles, speeches, academic papers, campaigns and conversations into one coherent account of what I actually believe.

Looking back over my own writing, I noticed something else.

My earliest articles tended to focus on individual policies. One week I would be writing about residential rehabilitation, another about drug consumption rooms, another about the Right to Recovery Bill, another about the misuse of language or the failures of commissioning.

Each piece examined one part of the puzzle.

But somewhere along the way the subject or my understanding of it has changed.

Addiction remained the case study, yet increasingly I found myself writing about something much larger. Institutions. Bureaucracy. Civil society. Family. Faith. Social cohesion. Accountability. The meaning of compassion. Human flourishing.

I realised that I had slowly stopped writing only about addiction.

I had been writing about the kind of society that either helps people recover or quietly teaches them to expect nothing more than survival.

That matters because every addiction policy rests upon a much deeper question, whether we acknowledge it or not.

What is a human being?

Is someone struggling with addiction primarily a patient to be managed? A risk to be minimised? A service user to be processed? A permanent victim of circumstance?

Or are they a person whose dignity is inherent, whose future remains unwritten and whose capacity for change should be the starting point of every public policy?

Everything else follows from how we answer that question.

As I worked through the questions, another pattern became impossible to ignore.

Almost every answer led me back to the same conclusion.

Jesus Washing Peter’s Feet 1857–8, Ford Madox Brown

Over the past thirty odd years we have become remarkably good at constructing systems around addiction. We have produced strategies, commissioning frameworks, standards, performance indicators, action plans and increasingly sophisticated ways of managing crisis.

Yet somewhere along the way we forgot something far simpler. People recover through people. No government can commission belonging. No strategy can manufacture forgiveness. No funding stream can create love. No policy can produce hope.

Those things arise within families, friendships, neighbourhoods, recovery communities and churches. They arise within what previous generations simply called civil society.

That is why I have become increasingly convinced that Scotland’s addiction crisis is not merely a healthcare problem, nor simply a policy problem.

It is a crisis of relationships. It is a crisis of meaning. It is a crisis of the institutions that help human beings flourish.

That, I think, explains why the Church has such an important role to play.

Not because churches possess better clinical interventions than the NHS. They do not.

Nor because they should attempt to become miniature treatment providers. They should not. Their contribution is altogether different.

The Church begins with an understanding of the human person that modern public policy has too often forgotten. It sees each individual not as a diagnosis, a risk profile or a collection of adverse childhood experiences, but as someone whose dignity is inalienable, whose life possesses meaning and whose future always remains open to redemption.

Government has indispensable responsibilities. It should fund treatment, protect the vulnerable and ensure that people have access to the help they need.

But government cannot do everything. It cannot manufacture friendship. It cannot legislate for trust. It cannot purchase purpose. It cannot commission hope.

Those things grow within families, communities, churches and the countless voluntary associations that together make up a healthy society.

Catholic social teaching has long understood this through the principle of subsidiarity. Strong societies are not built by replacing local relationships with central institutions, but by strengthening the families, communities and intermediary institutions in which people actually learn responsibility, service, solidarity and love.

One of the great mistakes of modern addiction policy has been to assume that professional services can substitute for the relationships that ultimately sustain recovery.

They cannot. Treatment matters. Professional expertise matters. Harm reduction has an important role. None of that is in dispute. But recovery ultimately happens when people rediscover belonging, purpose, responsibility and hope. Those things cannot be prescribed.

Another lesson emerged as I wrote.

Much of our national debate is not actually about evidence at all.

It is about language.

Words such as recovery, treatment, rehabilitation, harm reduction, peer support and even lived experience have gradually become so elastic that two people can use exactly the same vocabulary while describing entirely different philosophies.

Unless we define our terms carefully, we often imagine we agree when we are, in fact, arguing from completely different understandings of what recovery itself means.

Perhaps that explains why our national conversation has become so confused.

There is one final reason I wanted to publish these answers.

Too much discussion about addiction now happens behind closed doors, inside consultation exercises, strategy groups and policy forums that few members of the public ever see. Yet the people with the greatest stake in these questions are not politicians, civil servants or academics. They are the parents who have buried children, the people still trapped in addiction, those quietly rebuilding their lives in recovery, and the communities living with the consequences of policy decisions.

They deserve to hear not only our conclusions, but the reasoning that leads us there.

Some readers will disagree with parts of what follows.

I welcome that.

The addiction field has spent too long confusing consensus with truth and compassion with the absence of challenge. Progress has always depended upon people willing to ask difficult questions, especially when the fashionable answers no longer match reality.

If someone were to ask me today, “What do you actually believe about addiction?”, what I publish below is probably the closest answer I could give.

It is not intended to be the final word.

It is simply the most complete account I have yet written of the principles that have guided my work for many years.

If you only read one thing I publish this year, I hope it will be this.

Because beneath every debate about drugs, alcohol, treatment, harm reduction or recovery lies a much more important question.

What kind of society still believes that broken people can become whole again?

So here are my responses to the 12 questions.

1.Why does Scotland have such a serious problem with drug and alcohol deaths?

Scotland’s crisis has several layers, and anyone offering one fashionable explanation is selling snake oil with a PowerPoint presentation.

Poverty, deindustrialisation, trauma, poor mental health, unstable housing and the breakdown of family and community life all matter. Drug and alcohol deaths are concentrated heavily in our poorest communities. People living in Scotland’s most deprived areas are more than fifteen times as likely to die from drug misuse as those in the least deprived areas. Alcohol deaths also show a steep deprivation gradient. This is not simply about individual behaviour. It is about what happens when disadvantage becomes intergenerational and hope slowly drains from a place.

But deprivation alone cannot explain why Scotland performs so much worse than comparable parts of the United Kingdom. Northern England has also experienced deindustrialisation, poverty and fractured communities, yet its drug death rate has not followed the same trajectory. We therefore have to examine Scotland’s treatment system and the philosophy behind it.

My central argument is that Scotland developed a profound imbalance. Harm-reduction measures such as naloxone, needle exchanges and opioid-substitution treatment became the dominant organising philosophy rather than one part of a complete system. Meanwhile, detoxification, residential rehabilitation, psychosocial treatment, mutual aid, recovery housing and long-term community support remained scarce or patchy. We built a system better equipped to manage addiction than to help people leave it.

I do not believe harm reduction caused every death, nor would I remove interventions that keep people alive. That would be foolish. My criticism is that Scotland too often treated immediate survival as the final outcome. A person could remain prescribed, monitored and technically “engaged” for years while their relationships, health, confidence and prospects continued to collapse. The paperwork said treatment. Their life said otherwise.

The National Mission then poured considerable money into the existing architecture without fundamentally changing its incentives, culture or accountability. Scotland had strategies, taskforces, standards, training programmes and an expanding vocabulary of compassion, but still lacked a dependable route from crisis to recovery. In 2024, Scotland recorded 1,017 drug-misuse deaths. That was lower than in 2023, but still 3.6 times the age-standardised rate recorded when the series began in 2000.

The alcohol story contains a similar warning. Minimum Unit Pricing may have affected purchasing and population-level consumption, but it has not repaired the lives of the most dependent drinkers. In 2023, Scotland recorded 1,270 alcohol-specific deaths, with the poorest communities carrying a vastly disproportionate burden. Price mechanisms cannot substitute for treatment, relationships, housing, purpose and hope.

My article on the treatment imbalance is here:

My broader critique of Scotland’s policy failure is listed here:

2. Do you think this is more of an urban problem than a rural one?

The highest rates of drug and alcohol deaths are generally found in urban and highly deprived communities. Glasgow and parts of the west of Scotland carry an appalling burden. Recent Scottish Government analysis also reports higher drug and alcohol death rates in urban areas.

However, describing this as an urban problem can conceal what happens in rural Scotland. Rural addiction is often less visible rather than less serious. There may be no open drug scene, but there can be severe alcohol dependence, prescription-drug problems, loneliness, domestic strain and people deteriorating quietly behind closed doors.

The barriers are also different. Someone in a city may live near several services but find that none offers the treatment they want. Someone in a rural community may face a fifty-mile journey, poor public transport, no local detoxification, little anonymity and a real fear that everyone in the village will know they have asked for help by lunchtime.

The deeper dividing line is therefore not simply urban against rural. It is connection against isolation, functioning infrastructure against scarcity, and whether a person can reach appropriate help at the moment they become willing to accept it. And many find that when they do reach out the help just isn’t there to get clean or sober just a variety of harm reduction measures not actual treatment that treats dependency and help you get freedom form dependency. That moment can be painfully brief. A system that asks someone to return in three weeks has often missed it.

3. What are the main drivers of drug or alcohol addiction that you come across in your work?

Trauma is important, but it has become such an all-purpose explanation that we sometimes stop thinking. Not every traumatised person develops an addiction, and not every addicted person can trace their condition to one identifiable traumatic event.

What I repeatedly encounter is an accumulation of vulnerability: childhood adversity, neglect, violence, family addiction, exclusion from school, unemployment, bereavement, loneliness, untreated mental distress, homelessness, shame and the absence of a believable future. Drugs or alcohol initially provide relief, belonging, confidence, sleep or emotional anaesthesia. Eventually, the solution becomes the prison.

There is also a social dimension that modern policy tends to neglect. Addiction flourishes where bonds are weak and where people have lost meaningful roles. Human beings need to be needed. They need family, friendship, work, responsibility, faith, service and a community that notices whether they turn up. Remove enough of those things and a chemical relationship or any obsessive compulsive behaviour can begin to replace human relationships.

That is why I have become increasingly interested in social cohesion and deaths of despair. Addiction is not merely located inside an individual brain. It develops within families, neighbourhoods, cultures and economies. Medical treatment may be necessary, but medicine alone cannot supply belonging, restore a broken family or give someone a reason to get out of bed.

If I could recommend just one piece of my writing before we speak again , it would be this. More than anything else, it captures how I think about recovery, not simply as the absence of drugs or alcohol, but as the restoration of relationships, purpose, responsibility, dignity and hope.

My wider civic argument about managed decline and national recovery is here:

4. Do you think that family, community or church support improves a person’s prospects?

Yes, enormously, provided the support is healthy and does not become enabling.

Recovery rarely survives as an entirely private act of will. People recover in relationship. They need someone who can tell them the truth without withdrawing love, someone who remembers who they were before addiction and can imagine who they may become afterwards.

Research on recovery capital supports what people in recovery have known for generations: supportive social networks, stable relationships, meaningful community participation and access to positive peers are strongly associated with better recovery prospects.

Families matter, but they also need help. Addiction can turn a family into an exhausted emergency service. Relatives become detectives, cash machines, counsellors, prison visitors and undertakers-in-waiting. Good family support teaches people how to remain loving without financing or concealing destructive behaviour.

Recovery communities matter because they provide visible proof that change is possible. A professional can explain recovery, but a person who has lived through addiction can embody it. Peer support says, “I know the road because I walked it.” Evidence suggests peer-support groups can improve engagement and can help reduce substance use and other risks.

Churches can offer something even deeper: belonging that is not conditional upon professional status, diagnosis or funding criteria. At their best, churches say that a person is not reducible to the worst thing they have done or the worst thing that has happened to them. They can offer friendship, ritual, forgiveness, service, moral formation and a community that remains after the funded programme has ended.

Faith is not a substitute for competent medical care. Neither is medicine a substitute for meaning. We need to stop behaving as though recognising the spiritual and relational dimensions of recovery somehow violates science. It violates nothing except the modern bureaucracy’s desire to turn every human need into a commissioned service.

5. What is the most effective way to support a person to exit drug or alcohol addiction?

There is no single intervention that works for everyone, but there is a recognisable architecture of effective support.

First, engage the person quickly when they ask for help. Do not make motivation pass an obstacle course. Assess immediate medical risk, including withdrawal, overdose, suicide, physical illness and safeguarding concerns. Provide “stabilisation” or medication where clinically appropriate.

Then establish what the person actually wants. Some may need community treatment. Others require medically supported detoxification, residential rehabilitation or a therapeutic community. People with co-occurring mental illness need genuinely integrated care, not addiction services sending them to mental health and mental health sending them back like an unwanted parcel.

Treatment should then connect the person to long-term recovery supports. This includes suitable housing, peer relationships, family work, mutual aid, employment, education, physical healthcare and opportunities to contribute. Dame Carol Black’s independent review reached much the same conclusion: treatment cannot be separated from housing, employment, commissioning quality and clear accountability.

The decisive question is not merely whether someone entered treatment. It is whether their life became safer, freer, healthier, more connected and more purposeful. We should measure sustained recovery, housing stability, family relationships, employment, wellbeing and reduced offending, not simply appointments attended or prescriptions issued.

The most effective support therefore combines professional treatment with recovery capital. Treatment may open the door, but relationships, meaning and responsibility help someone remain outside the prison of addiction.

6. Do you recommend harm-reduction or abstinence-based approaches, or both?

Both, but not as two equal philosophies competing for possession of the person.

Harm reduction is a set of practical interventions that can keep someone alive, prevent infection and create opportunities for engagement. Naloxone, needle provision, safer prescribing and good wound care have legitimate roles. Nobody can recover after they are dead.

But keeping someone alive is the floor of compassion, not its ceiling. Harm reduction should be connected to an open and credible route towards treatment and recovery. The ethical failure occurs when the state offers tools for continuing drug use but cannot offer detoxification, rehabilitation or recovery housing when the person wants to stop.

Abstinence should be available, respected and properly funded. For many people with severe addiction, abstinence provides the clearest basis for sustained recovery. It removes intoxication and allows the painful but necessary work of emotional, relational and moral repair to begin.

That does not mean forcing abstinence upon people before they are ready or abandoning them if they relapse. Relapse is often part of the journey and should be met with compassion, not exclusion. Medication such as methadone or buprenorphine can be clinically appropriate and lifesaving, reducing the immediate risk of overdose and creating the stability needed to begin rebuilding a life.

However, we should be very careful not to confuse stabilisation with recovery. One of the central arguments I have made in my writing is that addiction, by its very definition, is a disorder characterised by the loss of control over substance use. If someone remains physiologically dependent on an addictive substance, even a prescribed one, I would describe them as being in treatment or stabilisation rather than recovery. Recovery, in its fullest sense, means freedom from dependency and the restoration of health, purpose, relationships, responsibility and hope.

Stabilisation has an important clinical role, but it should be understood as a bridge rather than a destination. The danger is that a temporary intervention designed to buy time becomes a long-term model of care. In my view, this has happened too often in Scotland. We have become increasingly comfortable managing addiction rather than helping people overcome it. Our ambition should always be to support people towards the greatest degree of health, independence and flourishing that they are capable of achieving.

This is an argument I explore in more detail in my article The Illusion of Stabilisation: Why Addiction Cannot Be Controlled,

where I argue that addiction cannot be indefinitely “managed” in the way we manage conditions such as diabetes or hypertension. Harm reduction interventions undoubtedly save lives and have an important place within a compassionate system, but they are designed to create an opportunity for recovery, not to replace it. If stabilisation becomes the end point rather than the beginning of the journey, we risk institutionalising dependency instead of restoring freedom.

My position is therefore neither permissive nor punitive. It is recovery-oriented. Use whatever ethical intervention keeps the person alive today, but never abandon the possibility that they may be free from dependency tomorrow.

This is the argument I develop in my discussion of the missing recovery worldview:

Professor Keith Humphreys’ analysis of the Pacific Northwest is one of the most balanced critiques I have read of contemporary drug policy. In particular, he examines the gap between the promised outcomes and the actual evidence surrounding supervised drug consumption facilities and the wider policy reforms that accompanied them. I’ve summarised it here

Annemarie Ward 💜@Annemarieward

THEY SAY IT WILL “BENEFIT THE CITY” HERE’S WHAT HAPPENED WHERE THEY TRIED IT @TheScotsman #Edinburgh #DrugConsumptionRoom #Consultation We’ve heard the script before. A supervised drug consumption room will reduce harm. It won’t attract more users. It will clean up public

The Scotsman @TheScotsman

Edinburgh drug consumption room: Consultation will launch next month, as health chiefs say proposal will benefit city as a whole https://t.co/qZaV3XdJLm

3:59 PM · Mar 17, 2026 · 47.3K Views

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16 Replies · 84 Reposts · 189 Likes

Full report here

https://www.brookings.edu/articles/the-rise-and-fall-of-pacific-northwest-drug-policy-reform-2020-2024/

My discussion of the Glasgow drug-consumption facility and the absence of onward recovery pathways is here:

7 to 12 published next.