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This chapter describes services designed to change the behaviour of drug users, with the aim of benefiting them and those people around them. The goals of such services are diverse, and may include initiating or maintaining abstinence from drugs, reducing the amount or frequency of drug use, or changing behaviours other than drug use (e.g. criminal activity, needle sharing). The chapter focuses on the outcomes of various types of health and social services.

This chapter reviews existing research to identify key socioeconomic and cultural factors that need to be acknowledged when developing HIV prevention efforts aimed at Puerto Rican injection drug users (IDUs). Specific recommendations are provided with respect to improving HIV prevention with Puerto Rican IDUs. Although rates of IDU and HIV are alarming among this population in comparison to other groups of Latinos, and especially so on the island, this chapter describes how community-led prevention efforts are reducing stigma and bringing about positive change in helping community members to understand the impact of HIV/AIDS and substance abuse as not simply an individual’s deficit but rather a community-wide, public health problem also requiring structural–environmental interventions.

There is a growing awareness that palliative care as defined by the World Health Organization is applicable as a practice to many more fields than had previously been recognized. Services now see patients with a wide variety of diagnoses and from a widening spectrum of society bringing a new set of palliative challenges. These challenges can present both pharmacologically and organizationally. This chapter explores the evidence and practice of working with patients who have a substance misuse history and considers the specific palliative care needs of this group. Substances that are misused are many and varied and vary between countries and continents. Much of the research in this field comes specifically from a North American context and ignores emerging nations. It might be argued that as societies become more industrialized, so the influx of substances misused will change to mirror those seen in Western societies. There is little in the way of evidence based practice for palliative care and its use and delivery to this group.

This chapter first describes the changing patterns of drug misuse in the United States over the last forty years, which is necessary to understand the challenge now facing the criminal justice system. It then reviews what is known about the effectiveness of drug treatment in reducing crime at the individual level, and discusses interventions aimed at diverting drug-involved offenders from incarceration, such as drug courts, Proposition 36 (the largest diversion program in operation, even though it is restricted to California alone), and coerced abstinence/mandated desistence in Hawaii. Next, the chapter presents the empirical analysis of the surveys of jail and state prison inmates, showing the limited potential impact of drug courts under current eligibility rules. A commentary is included at the end of the chapter.

This concluding chapter evaluates alternatives to drug courts and the criminalization of drugs and drug users that entail neither punitive oversight nor coercion. It highlights the contradictions in the existing drug policy, where some people are punished for using mind-altering substances while others are encouraged to use them via prescription pharmaceuticals. It also challenges four major assumptions that guide our views on drug use: that habitual substance use is a disease, that abstinence is the only cure for the disease of addiction, that abstinence from drugs can be achieved only through treatment, and that coerced treatment is better than voluntary treatment for certain addicts. The chapter argues that combining punishment and treatment will never work to eradicate habitual substance use. Instead, it calls for a radical reorientation in the way we understand drugs, drug users, the value of sobriety, and the role of the state in coercing health.

This chapter critically considers the assumptions underlying policy proposals for sex-working drug users and drug-using sex workers in New Labour's prostitution strategy. It argues that by conflating sex work with other social problems, particularly drug addiction (see, for example, Cusick and Berney, 2005; Melrose, 2006a), the strategy conveniently sidesteps the wider structural problems associated with involvement in street sex work, such as poverty, social exclusion, and homelessness. The chapter explains that what the strategy offers are punitive responses that provide ‘individualized solutions to de-contextualized social problems’ (Phoenix, 2003), rather that structural solutions to socially contextualized social problems (Buchanan, 2004; Cusick and Berney, 2005; Melrose, 2006a).

This chapter further examines former prisoners’ experiences in the early phase of their imprisonment. With the example of the prison culture of ‘initiation ceremonies’, it argues that prison officers’ concern of maintaining control and order in the prison goes beyond producing the form of structural hypocrisy discussed in the previous chapter and actually forces former prisoners to act in hypocritical ways themselves. What should have been a process of learning and rehabilitation through education turns instead into a veritable culture of hypocrisy.

This chapter provides a brief overview of interventions aimed at the general population and populations at high risk of HIV infection. Its focus is primarily in prevention of mother-to-child-transmission (MTCT), and specific groups such as injecting drug users (IDUs), men who have sex with men (MSM), and sex workers. The majority of infections globally are caused by heterosexual transmission, and this issue is not specifically addressed here. This review is by no means exhaustive, but it meant to provide a context for more detailed examples outlined in subsequent chapters. Where appropriate, this chapter discusses the implications of these findings for healthcare systems, and makes suggestions for future research.

This chapter examines how Nelson Rockefeller's 1973 “tough” proposal attempted to resolve the governing problems that arose from the therapeutic regime. It analyzes the ideological and political work accomplished by the proposal and the response by policymakers, opponents, drug users, and the diverse members of the general public. The drug laws were the result of the interaction between Rockefeller's personal political ambitions, diverse popular frustration with the period's social movements and political insurgency, and the persistence of heroin use and street crime in New York during the late 1960s and early 1970s. Rockefeller's dramatic and harsh proposal was built upon the premise that therapeutic programs failed to curtail drug use and street crime.

This chapter examines the overall cost-effectiveness of methadone treatment for injection drug users (IDUS) as an HIV prevention measure. It begins by reviewing several studies that document the efficacy of methadone treatment. It then discusses two models: a basic model of HIV transmission without treatment and a simple model that incorporates methadone treatment. Analysis suggests that methadone treatment significantly reduces disease prevalence at a cost of $100,000 to $300,000 per infection averted.

This chapter introduces readers to the narrative style used throughout the book with a glimpse of Ted, a baby boomer who used drugs and alcohol to address his pain. It also introduces the “maturing out” theory of drug use, which predicted that most people who used drugs would stop by age thirty-five. The generation born between 1945 and 1964, the baby boomers, did not follow previous patterns of maturing out of drugs. Instead, older adults who actively used illegal drugs increased in numbers and rates. Examining the historical and social context is critical for a comprehensive understanding of the causes of this phenomenon. Boeri uses engaging stories and thick descriptions to provide insight on socioeconomic influences that produced the War on Drugs and mass incarceration of drug users. This chapter includes Boeri’s standpoint position and a brief description of the methodology she used in her ethnographic study of older drug users, from which the stories in this book are drawn. It ends with a short description of the book’s organization and how the chapters are woven into a tapestry that depicts a suffering population in a devastated landscape.

This book explores the arguments put forward by advocates of drug courts and coerced treatment of drug users. It frames drug courts, often touted as “alternatives to incarceration,” within contemporary discussions of punishment, deviance, and drug addiction. It analyzes the claim that drug courts are a solution that allows the criminal justice system to regain legitimacy and retain control of drug users. In addition, it discusses medicalized theories of addiction employed by drug court advocates to stake their claim over addicts. It also examines medicine and punishment as important ideological vehicles for advancing the social control of drug users, along with the connection between drug use and crime.

A wave of violence associated with drug trafficking is taking place in Mexico. Illicit drug trade has been in Mexico for almost 100 years, dating to the Porfiriato when cross-border trade increased dramatically and U.S. demand for narcotics was very high. This chapter examines organized crime as a source of violence in modern Mexico, focusing on narco-crime and narco-violence and their relation to Mexican state and society in the twentieth and early twenty-first centuries. It first considers the distinction between the low-level, individual, and quotidian violence perpetrated by drug users and the high-level, organized violence committed by (and against) drug cartels. It then discusses how drugs and violence are connected to state-making and analyzes the economics, politics, and social basis of drugs and violence in Mexico since the 1980s.

This chapter discusses the stigma attached to those who use drugs. We are accustomed to using language to distance ourselves from those with substance use problems, making sure we mark those who use drugs as “the other,” as not like us. Indeed, we have used nouns to label those who use drugs so that they are discredited; this has consequences for their self-identity. Part of the challenge of the opioid epidemic is the ongoing stigmatization of persons who use drugs. We have shown ourselves to be comfortable letting the problems of persons who use drugs remain their business, deluding ourselves into thinking the health of drug users is not intimately tied to our own. The current epidemic has taught us that we all know someone who has developed a drug problem. In the face of this crisis, quibbling over words may seem like a distraction, a minor issue, but, in fact, using the right language to talk about drug use is a step toward ending this epidemic. It helps us remember drug use is not just a problem for “them,” but for everyone, and that only through compassion and collective effort can we effectively address the disease of addiction.

Here we explore how and why macro ideological and commercial processes produce a place such as Valdemingómez by contextualizing how the political and economic changes over the last 40 years have crippled the urban poor in places like Madrid. We firstly show that these are global processes are linked to structural undercurrents of deindustrualisation which have produced greater inequality, unemployment and poverty before showing how a politics of distraction dilutes our collective consciousness to these issues. Both these elements are reflected in how social planners and politicians have engaged in urban cleansing programmes which relegate problem groups like drug users to the city margins; out of sight, out of mind. We show the consequences of this in the final part of the chapter when we discuss the implications this has for the city and its urban outcasts.

This chapter proposes a research design for estimating the protective effects of prophylactic vaccines. Following the structure of the HIV vaccine trial of the Bangkok Metropolitan Administration cohort of injecting drug users (IDUS), the chapter simulates HIV transmission within this trial structure to investigate whether the proposed design is sufficiently powerful to estimate vaccine efficacy.

This chapter contains a brief biography and transcript of an interview with Sven Hessle, a leader in Swedish social work education, who was awarded the Katherine Kendall Award of the International Association of Schools of Social Work in 2006, for his contribution to international social work education. Trained as a psychologist, after early experience as director of a therapeutic community for drug users, he worked with vulnerable multi-problem families. He later moved into research and teaching about child welfare practice in Sweden and internationally. He led a variety of projects to reconstruct social work in the former Yugoslavia, involving UNICEF and the Swedish International Development Agency, later becoming involved in other international projects in Asia. He argues for seeing a social aspect to many world problems and fears trends towards academization will diminish the value of the practical aspects of social work education.