In recent years, in response to an increase in awareness of the extent of problem drug use, there has been an expansion of services and a range of new approaches to treatment, largely influenced by the Treatment and Rehabilitation report of the Advisory Council on the Misuse of Drugs (1982). However, this was not accompanied by a great deal of debate about the general philosophy underlying services for drug users, and there is arguably insufficient clarity or agreement on what assumptions are operating in different agencies. In the past year (partly in response to the AIDS threat) there has been a revival of the debate around prescribing practices, which indicates both how difficult it is to reach agreement and the need for a re-think of treatment policies. The aim of this chapter is to explore the assumptions underlying drug services and the implications of these for treatment policies, looking in particular at what past experiences suggest for future directions in drug treatment. The focus will be on illicit drug use, particularly heroin, but many of the issues are relevant to wider aspects of drug services.
The basic question of why to treat problem drug use at all could be answered in several different ways, each of which has different implications for the kind of treatment that would be offered. Treatment can be seen as a logical consequence of any of several premises, for example:
Drug users should be offered medical and psychological help with the aim of achieving a drug-free life.
Treatment should aim to reduce the legal, social, and health