Medicalisation is a key technology of power through which drug users are governed. It is the process by which non-medical problems come to be defined and treated as if they are medical issues. Another key strand of drug policy discourse in the UK, US and Canada operating alongside prohibition and punishment is that of public health. The technology of medicalisation underpins public health discourse, and compliments prohibition and punishment regimes. Medicalisation operates as a form of social control and regulation whereby social structural issues, such as poverty and social inequalities, are individualised and regarded as symptoms of a disease. It has provided legitimacy to punitive and intrusive policies and practices aimed at drug users. The interdependence of the criminal justice and treatment systems, and the way they reinforce each other in the governance of drug users, can be seen as a ‘deadly symbiosis’ (Wacquant, 2001).

The technology of medicalisation is grounded in the disease model of addiction. Historically, this was dependent on a distinction between the normal and pathological, and involved a ‘stratification of the will’, whereby individuals with weak, defective characters were constructed as unable to act freely and responsibly. Constructions of a lack of will on the part of female users are bound up with notions of their mental health, sexuality and maternal role. They are situated as pathological, prone to addiction and weaker-willed than their male counterparts. In its more contemporary configurations, combined with discourses of ‘risk’, the disease model situates all drug users as rational, free, choice makers. Thus, female and male dependent users are constructed as, on the one hand, irresponsible, irrational, bad choice makers, and on the other, as responsible for their predicament and for coming off drugs. How female users navigate their way through disease and choice discourses and construct their identities is explored in this chapter.

An overview of recent trends in drug treatment policies and practices, how female drug users are situated in relation to these, and the impact they have on their lives in the UK, US and Canada, is provided here. This includes a discussion of the ascendance of harm minimisation in relation to the HIV/AIDS pandemic, methadone maintenance, the current focus on ‘recovery’ and coerced treatment.