Sick, deviant or something else entirely? The implications of a label on drug treatment progression, recovery and service delivery

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Abstract

In an effort to shift away from the narrow medical model of drug treatment the Advisory Council on the Misuse of Drugs (ACMD), in 1982, introduced the idea of the ‘problem drug user’ (PDU) and recommended a multi-disciplinary approach in order to meet the increasingly evident multiple and complex problems presented by dependent drug users. However, despite the development of a series of drug strategies (HM Government, 1995; 1998; 2002; 2008; 2010) and vast increases in funding, dependent drug users are still struggling to receive the services they require to address their diverse problems (Neale, 2008; Buchanan, 2010). Through an analysis of in-depth interviews with dependent drug users and their keyworkers this thesis seeks to explain these deficiencies. The author argues that the broad umbrella of drug policy that has adopted a framework of risk-based strategies to regulate and control drugs and drug users has focused on the social and economic costs associated with problem drug use, particularly in relation to the belief that much acquisitive crime is drug-related. Hence, the focus has not been on the problems that drug users have but on the problems they cause. The medical model that has dominated the treatment of addiction has been reinforced, therefore, not only because ‘drug addiction’ has been described as a chronic and relapsing condition (NTA, 2002), but also because of the wider social control objectives (crime reduction, in particular) that this approach delivers (Lind et al., 2005; Gossop, 2005; Millar et al., 2008). The author examines the implications of these drug policy directions on the treatment journeys of dependent drug users. Firstly, the author demonstrates how the confluence of the health and crime reduction agendas has led to the paradoxical perception of drug users as being ‘sick-but-deviant’ that has served to exacerbate their stigmatised identities. Secondly, the author suggests that the closer alignment between the drug treatment workforce and the criminal justice system has led to the isolation of drug treatment from wider health and social care services. Together, these two consequences of drug policies have created further barriers to service access and successful recovery, thereby providing an explanation for the unmet need of dependent drug users attending treatment services.

Keyword(s)

Drug treatment; Drug use; Stigma

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