PreHab and the Pipeline to Recovery – Charles Maasz

I am writing this in February with my sister Sharron very much in mind. Sharron knew homelessness, rough sleeping, alienation, adversity, violence and all of the pernicious ways in which this life can do harm to a vulnerable woman. Sharron would have celebrated her birthday in February with her three now adult children, were it not for the accumulative effects of poly-substance addiction and multiple complex needs. Every service available was engaged with, all supports exhausted.  The race to the finish was not won by interventions or wonderful support workers but by one last session that tipped her over into God’s eternity.

Chronic addiction is a consuming shadowy force that devours the host. Addiction will hollow us out, slowly at first. It rips the heart out of families and destroys communities. As the CEO of a 200 year old charity in the heart of Glasgow that specialises in destitution and life at the hard margins, as the director of a residential addiction rehab all coupled with my own lived experience, I’ve seen a bit. I’ve seen some approaches that work and much that doesn’t.

In the last figures released (2023), Scotland recorded 1,172 drug misuse deaths. This marked a 12% increase from the previous year. Equating to an age-adjusted rate of 22.4 deaths per 100,000 people, up from 20.0 in 2022[1]. The death stats are horrendous but they represent the literal tip of the iceberg. Far too many families know the agony and helplessness of addiction hidden away behind closed doors and curtains. Not all of it is life endangering but all of it is life diminishing.

Despite all recent and historic drives to combat this crisis, addiction shows no sign of retreating. It is a paradox. We spend more on solutions and find only increase.

Scotland’s drug death crisis is the worst in Europe. Despite extensive investment in harm reduction strategies, traditional approaches—such as Opioid Replacement Therapy (ORT) and community-based support—have struggled to significantly reduce fatalities and relapse rates. This calls for a radical shift in addiction recovery; one that prioritises relationship-based, structured interventions.

What follows are my thoughts on a new approach building on principles and models that are proven to be effective. The working name for this approach is ‘PreHab’ – a preparatory rehab facility. The Prehab Centre presents an innovative solution that fills a crucial gap in the addiction recovery pathway, offering stabilisation and preparation for long-term rehabilitation with its primary aim – to save lives.

Prehab: A Transformational Approach to the Drug Deaths Crisis

Scotland’s drug mortality rate is 3.7 times higher than the UK average, with Greater Glasgow and other deprived areas disproportionately affected. Many individuals undergoing Methadone and other ORT routes remain trapped in cycles of addiction, unable to transition into residential rehabilitation due to strict entry requirements.

While ORT helps many individuals, it does not provide the structured, long-term support required for full recovery and ongoing sobriety. PreHab is a first stage of an abstinence based approach to recovery from addiction. Many established rehab facilities require individuals to be stabilised on low-dose ORT, fully detoxed or require a ‘cold turkey’ approach on entry. Without a structured environment to assist the transition from chronic levels of consumption, many never make it into long term or residential rehabilitation or if they do, they do not last the course and withdraw at an early stage.

Community addiction services, though valuable, often lack the structured intervention necessary for meaningful stabilisation. Without immediate access to a safe, wrap-around and supportive environment, those seeking recovery from addiction are highly vulnerable to relapse, increasing the risk of accidental overdose.

The Prehab Centre: A Bridge to Recovery
The Prehab Centre is designed to provide a vital link between the initial ‘cry for help’ and a full-time residential rehab, addressing the structural gaps that currently hinder recovery outcomes. How PreHab will help:

1. Immediate Intervention: When an individual expresses readiness for recovery, the Prehab Centre ensures they receive immediate support. This is crucial, as delays in accessing services can lead to lost motivation, isolation, despair and continued life threatening substance use.

2. A Safe, Structured Environment: Unlike community-based services, which require individuals to remain in high-risk environments, the Prehab Centre removes the individual from relapse triggers and places them in a controlled residential setting where they can focus on recovery.

3. Early exit from programmes: The PreHab recognises that for many new rehab residents the strong community frameworks, rules and discipline, and the mutual accountability found in many residential programmes represents too great a shock to the system. PreHab will offer the chance for residents to acclimatise and in so doing prevent many of the premature exits from full-time residential rehab programmes.

4. Personalised Stabilisation and Tapering Support: The programme will include gradual ORT and illicit drug use/alcohol reduction under medical supervision, ensuring individuals are physically prepared for rehab while minimising damaging withdrawal symptoms and associated risks.

5. Improved Graduation and Retention Statistics: A successful PreHab will improve referral processes into residential rehab programmes. Quality referrals ensure the right people are matched with the most suitable rehab programmes. Along with the culture-familiarisation and detox processes we expect to see rehab retention and graduation statistics improve along with improved post-graduation outcomes. 

6. A Relationship-Based Approach: Many individuals battling addiction have experienced isolation, trauma, and fractured relationships. The Prehab Centre fosters strong, trust-based relationships between residents and staff, recognising that relational support is key to long-term recovery.

7. Faith-Based Holistic Care: Rooted in Christian values, the Prehab Centre offers holistic care that addresses not only physical recovery but also emotional and spiritual well-being. While faith is a core component, the programme is inclusive and welcomes all individuals seeking transformation.

The Strategic Model and Impact

Collaborative Development: The Prehab Centre concept was conceived in conversation with a coalition of leading Scottish recovery organisations – Glasgow City Mission, The Haven Kilmacolm, Street Connect, The Arch, and Bethany Christian Trust. The collaborative partnership has ensured input from a wide range of expert practitioners in all stages of the recovery journey, operational expertise, and post-rehab support networks. The working partnership has been led by Glasgow City Mission with active engagement from The Haven and Street Connect with Life Housing and Bethany offering informal support and collaboration.

A PreHab centre will be registered with the Care Inspectorate and adhere to all legal and healthcare regulations, ensuring it meets the highest standards of addiction recovery care.

The service design leads us to aim for a facility that will accommodate 18-22 residents at a time, with an 8-16 week structured programme. Situated in a semi-rural setting near Glasgow, it is believed that the centre will balance accessibility with the need to remove individuals from urban relapse triggers.

Pathways beyond PreHab: Residents will have options based on their progress through the PreHab phase of the journey:

– Entry into long-term residential rehabilitation (majority of cases).
– Transition into independent living with continued partnership support.
– Community reintegration with aftercare services.

Alignment with Government Policy and Financial Viability

Supporting Scotland’s National Mission on Drug Deaths: The Scottish Government’s national drug strategy emphasises expanding rehabilitation services and improving access to recovery pathways. The Prehab Centre directly addresses these priorities by offering a preparatory stage for rehab entry.

Financial and Social Return on Investment: Human Cost Savings: Each person supported through addiction recovery reduces the likelihood of future overdoses and drug-related harm.

Economic Benefits: According to Public Health England, every £1 invested in drug treatment yields £2.50 in social benefits. Assuming these figures to be a ballpark estimate, a 50% success rate at the Prehab Centre could be read as a £2.9 million annual saving—four times its projected operational cost.

Overcoming Barriers to Change

Breaking the Cycle of Dependency: Current models often leave individuals indefinitely dependent on medication and opioid replacements, failing to provide a clear path toward full recovery and sobriety. Prehab disrupts this cycle, giving individuals the structured support they need to move forward.

Addressing Resistance to Innovation: Traditional harm reduction approaches remain dominant in policy and funding decisions. While these have a place in addiction care, they must be complemented by transformative recovery solutions like Prehab.

Challenging the Stigma Around Abstinence-Based Recovery: In some policy and expert circles, abstinence-based models are viewed with degrees of scepticism. However, lived experience and long-term success rates within our already established networks demonstrate that full recovery, not just harm reduction, ought to be the ultimate goal of PreHab.

A Call to Action

Scotland’s drug crisis demands urgent, innovative solutions. The Prehab Centre is not just another addiction service, nor is it a residential Rehab by another name—it is a game-changer, filling a critical gap in the recovery pathway. By offering immediate intervention, structured tapering support, and relationship-based care, Prehab provides individuals the chance of achieving the stability needed to embark on a successful rehab/recovery journey.

We urge policymakers, health & addiction specialists and agencies, investors, and community leaders to support this transformative initiative. With the right backing, a Prehab Centre can become the centre of a game-changing turning of the tide in Scotland’s drug crisis; saving lives and restoring hope. PreHab could provide a game-changing template for a replicable service in an area of need that desperately needs new approaches.

I am strongly persuaded that we are unlikely to find a way out of this drug deaths crisis by adhering to existing modes and practices. Throwing resources at addiction cannot fill the voids that drive it. That is not to say money does not need spent, because it does. But if there is one thing addiction can burn through quicker than a fire in a dry forest it is resources, especially money. Addiction has an appetite that none can satisfy. Only radical inner change and corresponding shifts in perception can affect meaningful and long-lasting recovery from chronic life threatening addiction. The kinds of interior and perception shifts that are required do not come easy to most of us, especially perhaps for those caught in addiction. There are no ‘silver bullets’, no shortcuts, no cheat methods. The hard work that brings stabilisation and sobriety is best achieved within a supportive therapeutic community environment. We believe that the missing link in addiction recovery services is a PreHab.

Charles Maasz is the CEO of Glasgow City Mission

[1] NRSCOTLAND.GOV.UK