Book contents
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword by Nat Wright
- Preface
- 1 What works in drug addiction?
- 2 The development of the drug treatment system in England
- 3 Stimulant use still going strong
- 4 Adverse effects of khat: a review
- 5 What the clinician needs to know about magic mushrooms
- 6 What works in alcohol use disorders?
- 7 Management of alcohol detoxification
- 8 Nicotine addiction and smoking cessation treatments
- 9 Pathological gambling: an overview of assessment and treatment
- 10 Use of investigations in the diagnosis and management of alcohol use disorders
- 11 Laboratory investigations for assessment and management of drug problems
- 12 Pharmacotherapy in dual diagnosis
- 13 Dual diagnosis: management within a psychosocial context
- 14 Treating depression complicated by substance misuse
- 15 Treating anxiety complicated by substance misuse
- 16 An overview of psychological interventions for addictive behaviours
- 17 Motivational interviewing
- 18 Substance misuse in adolescents
- 19 Management of drug misuse in pregnancy
- 20 Intoxication and legal defences
- 21 Substance misuse and violence: the scope and limitations of forensic psychiatry's role
- 22 Literary and biographical perspectives on substance use
- Index
2 - The development of the drug treatment system in England
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Foreword by Nat Wright
- Preface
- 1 What works in drug addiction?
- 2 The development of the drug treatment system in England
- 3 Stimulant use still going strong
- 4 Adverse effects of khat: a review
- 5 What the clinician needs to know about magic mushrooms
- 6 What works in alcohol use disorders?
- 7 Management of alcohol detoxification
- 8 Nicotine addiction and smoking cessation treatments
- 9 Pathological gambling: an overview of assessment and treatment
- 10 Use of investigations in the diagnosis and management of alcohol use disorders
- 11 Laboratory investigations for assessment and management of drug problems
- 12 Pharmacotherapy in dual diagnosis
- 13 Dual diagnosis: management within a psychosocial context
- 14 Treating depression complicated by substance misuse
- 15 Treating anxiety complicated by substance misuse
- 16 An overview of psychological interventions for addictive behaviours
- 17 Motivational interviewing
- 18 Substance misuse in adolescents
- 19 Management of drug misuse in pregnancy
- 20 Intoxication and legal defences
- 21 Substance misuse and violence: the scope and limitations of forensic psychiatry's role
- 22 Literary and biographical perspectives on substance use
- Index
Summary
Summary Addiction treatment in England has evolved gradually over a period of more than 100 years, as theoretical models of treatment have changed and public concerns about addiction have ebbed and flowed. However, the past 20 years have seen a greater level of public spending on reducing levels of drug addiction, and with this has come a greater level of scrutiny of treatment services. Central government targets have been set in relation to both attracting drug users into treatment and retaining them for set periods of time. This chapter outlines the historical developments in drug treatment provision, the current position in terms of both what is typically available and the underlying structures and systems, and suggests some indicators of whether a local treatment system is working effectively and delivering adequate outcomes.
Historical overview of policy developments and evolution of treatment services
We will begin by summarising key policy developments in England and the resulting addiction treatment services, with specific focus on the socalled ‘British system’ (Spear, 2005). Although this summary provides a chronological account of the evolution of Britain's drug policies (Box 2.1), it is recommended that it be read in conjunction with two key references: Strang & Gossop (2005a,b) and Spear (2002). Space precludes detailed descriptions of the socio-political context within which the various British drug policies have developed, although it is worth noting that dramatic and unplanned shifts in policy have often been the result of a combination of changing political ideals, social structures and medical ideologies, rather than the consequence of any better understanding of addiction.
The 18th and 19th centuries
Although the origins of the British system are often traced to the Rolleston Report of 1926 (Ministry of Health, 1926), Berridge (2005) describes three systems that existed in Britain in the 18th and 19th centuries: the lay or commercial control system, the pharmaceutical control system and the medico-penal system. During the 18th and initial part of the 19th centuries, opium was freely available in pharmacies, grocers and other general stores. There was no regulation on its sale or purchase and, like alcohol, it was marketed just as any other product, i.e. subject to a lay or commercial control system.
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- Information
- Clinical Topics in Addiction , pp. 14 - 28Publisher: Royal College of PsychiatristsPrint publication year: 2007