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Purpose – To compare the histories of two opioid medications that are pharmacologically similar but subject to contrasting regulations in their use in treatment of opiate dependence in the United States – methadone and buprenorphine – in order to analyze the role of racial imagery and racial politics in the legalization and clinical promotion of their use.

Methodology/approach – Historical methods of archival analysis of published articles and unpublished governmental records were used in researching methadone. Ethnographic methods of participant observation and semistructured interviews were used in researching buprenorphine.

Findings – Contrasting uses of racial imagery played a major role in shaping the current regulatory differences between the two treatments. The association of methadone with black and Latino heroin users has contributed to its increased federal regulation, while the association of buprenorphine with white, middle class prescription opioid users enabled its use in deregulated private physicians’ offices.

Originality/value of paper – Advocates of biomedicalization of behaviors and conditions thought of as social or moral, such as addiction, argue that biomedicalization reduces the stigma of the condition and imply that, in turn, it also reduces the racial inequalities associated with the condition. This study of the biomedicalization of treatment for opioid dependence indicates that the very process of biomedicalization depended on heightened racial imagery associated with each treatment and ultimately intensified, rather than reduced, the stigma of addiction for black and Latino low-income patients.

Purpose – Since the mid-20th century, drug addiction in America has increasingly been redefined as a disease and diagnosed as a widespread yet treatable disorder. The idiosyncrasies of addiction as a disease, however, have tended to block the journey of the addict from stigmatized moral failure to therapeutic reprieve. Centering in on the process of the “court-led diagnosis” of addiction, this qualitative case study uses ethnography and interviewing at a county drug court and one of its “partner” therapeutic communities to examine the process in detail, from the first negotiations between treatment and court personnel over the eligibility of the client, to the gradual inculcation of an addict identity by means of intensive cognitive education and behavioral modification.

Methodology/approach – Qualitative: ethnography and interviews.

Findings – We demonstrate that a shift from moral judgment to therapeutic sympathy is particularly unlikely for the fast-growing mass of criminal offenders whose diagnosis is spearheaded by the state in the form of the therapeutic jurisprudence of the drug court. For this group, the emphasis on the need for comprehensive resocialization and the close cooperation between the intimacies of therapeutic “rehab” and the strong arm of criminal justice “backup” not only maintains, but intensifies, moral tutelage, and stigmatization.

Social implications – The convergence of drug treatment and criminal justice tends to produce yet another stigmatizing biologization of poverty and race, lending scientific validity to new forms of criminalizing and medicalizing social hardship.

This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.

The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).

The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.

Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.

To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.

OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.

The OTAT approach has not been described in the addiction treatment literature so far.

The Philippines’ nationwide campaign on drugs has been under the limelight due to its controversial approaches in dealing with the problem of addiction. Despite the government’s current efforts, substance use disorders continue to persist within the population. The purpose of this paper is to provide recommendations for addressing the issue of substance use disorder treatment through a modification of the therapeutic community (TC) in the Philippine context.

This conceptual paper reviews the existing facts about the Philippines’ campaign against drugs, the approaches implemented by the government, current state and research developments of TCs, and its resulting impact on contemporary evidence-based treatment for addiction in the country.

A treatment framework outlining a recovery-oriented therapeutic community (ROTC) is presented. The ROTC aims to address addiction as a chronic, relapsing disease. This alternative approach for addiction treatment in the Philippines is based on the concept of recovery, principles of effective substance use disorder treatment, and recent developments in TC best practices from the international community.

This paper discusses different recommendations for policy development, interventions and research, aimed at improving the odds of securing recovery for people suffering from addiction.

Evidence suggests that the percentage of men seeking treatment for substance use disorders and other addictive behaviours is significantly higher than that of women. This fact raises several crucial questions concerning the field of addictions. This paper aims to emphasize to the study of addiction in the light of gender studies and especially in the light of theories of dominant/hegemonic masculinity.

The perspective of dominant/hegemonic masculinity in the field of addictions raises a number of questions: Can the dominant/hegemonic masculinity perspective contribute to the understanding of the phenomenon of addiction? What are the implications of male-dominated and male-centred treatment services on meeting the needs of other populations? Are androcentric approaches ultimately helpful for heteronormative men? This paper investigates the emerging questions through a critical review of the literature including the disciplines of psychology, sociology and anthropology.

The perspective of hegemonic masculinity can make an important contribution to the understanding of addiction as it sheds light on a dimension that is not well researched and used in the field of addictions. The influences of the androcentric approach to addiction treatment are significant and pose problems both in accessing and serving the needs of other populations. The androcentric approach to treatment is not helpful for heteronormative men either as there is a risk of not addressing the toxic dimensions of dominant/hegemonic masculinity that are directly linked to the problem of addiction.

This paper poses interesting research questions for further research in the field.

This paper raises important issues for practitioners in the field and at the same time suggests alternative perspectives on the interpretation and treatment of addiction.

The gender perspective that should further enrich psychosocial interventions is crucial for the equal access of all people with an addiction problem to appropriate support structures.

Gender studies can make an important contribution to further understanding of addiction problems and to the development of effective practices for dealing with it. The fact that in substance abuse treatment programmes the vast majority of participants are heteronormative men raises a number of concerns. These concerns relate to the extent to which structures are directed at meeting the needs of these men and whether because of this orientation the needs of other populations such as heteronormative women and those who do not meet the norms of heteronormativity are left uncovered. These concerns are linked to broader considerations of the role that dominant/hegemonic masculinity plays in the aetiology of addiction and in creating barriers to help-seeking for heteronormative men themselves.

Substance abuse is a major public health concern, with over millions of people suffering from it worldwide. Although there is an abundance of treatment options, many of these rehabilitative trajectories are subject to “drop-out”. In addition, “drop-out” is a significant risk factor for relapse. There is an urgent demand for effective treatment, which would enable patients to reduce abuse and prevent relapse. Takiwasi is an addiction treatment centre that combines traditional Amazonian plant medicine with conventional western medicine and psychotherapy. The purpose of this paper is to explore whether socio-demographics factors, such as education level and occupation, psychiatric comorbidities and primary drug use, are associated with treatment non-completion of Ayahuasca (AYA)-assisted addiction therapy.

Data on the first treatment episode of 121 patients were collected from the patient database from the years 2012 to 2017. To determine whether there is an association between the variables of interest and treatment non-completion, a χ² analysis and a logistic regression analysis were performed.

Of the 121 patients analysed, 48.2 per cent completed their treatment, whilst 51.8 per cent did not. Students compared to those who are employed showed significantly higher odds for treatment non-completion (p=0.006; OR=3.7; 95% CI=1.5–9.6). Other variables in the multivariable analysis showed no significant relationship with treatment non-completion. While several limitations restricted the study, the findings suggest that the AYA-assisted treatment in Takiwasi may benefit from additional support for patients who are students. Moreover, it is advised to conduct more long-term follow-up of patients in order to gain better insight into the outcome of treatment at an AYA-assisted treatment centre.

It appears that AYA-assisted therapy in a therapeutic community is a feasible type of treatment for addiction, for which further studies should elucidate the role of motivation in relation to socio-demographic factors and type of addiction in the risk of treatment non-completion.

Purpose – The chapter examines the historical pattern of interconnections between drug policy, research, and treatment in light of recent theoretical developments in the medicalization thesis advanced in the sociology of medicine.

Methodology/approach – The chapter uses interpretive methods to examine how the social construction of addiction as a “chronic, relapsing brain disorder” converges with or diverges from the conceptual framework offered by sociological theorists of medicalization and biomedicalization.

Findings – The approach adopted shows how the meanings of the bio/medicalization of addiction shifted and circulated within and beyond the institutions developed to respond to drug addiction as a hybrid social, medical, and biomedical condition during the 20th century.

Social implications – Bio/medical frameworks for addiction are the outcome of historical attempts to influence public attitudes and develop effective methods to treat and prevent this “disease” in ways that would positively affect the quality of life of people living with addictions.

Originality/value – This original contribution addresses both strengths and limitations of bio/medical models, assessing how their influence has changed over time.

Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience marks a new era because of its potential to locate the causes of addiction within the brain and to treat addiction through altering neurochemistry. However, little is known about how addiction neuroscience and new neurochemical treatments shape individuals' experience of addiction and constitute new arrangements of knowledge and power that shape subjectivity and governance. This chapter addresses these domains by drawing on an analysis of scientific literature about addiction neuroscience and qualitative interviews with people being treated for addiction with buprenorphine, a pharmaceutical treatment for opioid dependence. The chapter charts four major themes in the addiction neuroscience literature (pleasure and the limbic system, rationality and the role of the prefrontal cortex, theories of plasticity, and the role of volition) and explores how each of these is incorporated, adapted, or rejected by individuals being treated for addiction with a pharmaceutical. This analysis demonstrates how neuroscientific ideas are mediated by the lived experiences of those being treated under a neuroscientific model. It also suggests that while neuroscientific interventions, like pharmaceuticals, shape the experience of those being treated for addiction, so too do many other forces, including social circumstances, moral frameworks, the drive for autonomy, and the quest to be “normal.”

The purpose of this paper is to show that despite welfare retrenchment and political rhetoric towards welfare, spending on residential addiction treatment should be protected.

Examining benefits in context of costs, the research used social return on investment to monetise benefits and compare with costs. Based at a residential addiction centre, the research used questionnaires and focus groups with residents and former residents.

The centre created almost £4 of benefit for every £1 of cost. Whilst the bulk of savings came from health, housing and criminal justice, there was also a regenerative impact for the local economy.

Sampling in sensitive themes is always problematic, however, the research had contact with many respondents, achieved data saturation and used the centre's success rate as a guide to weight the findings.

The benefits of addiction treatment go beyond health outcomes and raise questions about how this should be reflected in cost distribution. Consequently, this has implications for the ways in which addiction services should be measuring their successes beyond solely health outcomes.

Existing research has largely overlooked the benefit of addiction treatment to the local economy and the fact that, as an investment, this benefit will continue to grow as more people enter the labour market over time.

The research recognises the political context of funding and measures success beyond solely health outcomes. Furthermore, the research recognises the regenerative impact of addiction treatment, which is often overlooked in similar research.

With expanded technologic and communication resources there is growing awareness worldwide of the public health problems caused by alcohol, tobacco, and other drug use, misuse, abuse and addiction. Trends vary by culture and region but use of tobacco and alcohol is almost universal and is associated with high rates of mortality and morbidity. While nurses have not universally embraced the prevention and treatment of substance‐related disorders as their province, this is changing as a function of organisations, World Health Organization (WHO) and national initiatives, and the strengthening of nurse education. Actions to promote consensus, identify and review competencies for nurses must consider national and cultural variations, traditions of social change and the need for evidence‐based practice. Collective action by nurses in newly formed and existing organisations, which focus on addictions prevention and treatment, have resulted in initial professional steps. Such progress can be facilitated if achieved in the context of larger international policies and initiatives and in collaboration with members of other professional disciplines.