The history of treatment for dependence
The paper will provide a broad overview of the development of treatments and the delivery of treatment for dependence from 1800 to the present time. The focus will be on mainstream developments although more ‘exotic’ approaches will be acknowledged. Developments and changes in treatment will be viewed within wider social and ideological change and it will be suggested that treatment effectiveness is not the sole, or even the most important, factor in the adoption or rejection of particular treatment approaches. While technological advances have influenced the treatments on offer, other factors have played an important role – among other things, the growth of client ‘markets’ and the changing composition of client groups, the emergence of new professional groups introducing different theoretical perspectives on the nature of dependence and its appropriate treatment, and political and economic contexts which affect the treatment delivery system. Major debates in the field, such as an abstinence or controlled drinking goal, the need for intensive care or brief interventions for people with dependence, or the ethics of compulsory treatment must also be seen within their historical contexts and within the specific policy contexts of changing health, social and criminal justice approaches to the management and control of substance misuse.