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There has been much written on gender in the academic world and its impact on society. Women suffer disproportionately from inequality (Haralambos & Holborn, 2000) and substance use treatment is no different. The workplace and affluence are key areas where this problem has been tackled, though with limiting results. Here Jeff Fernandez asks why women are less likely to seek help for substance use and how, using common psychological techniques, we can entice them back again.

In the previous edition of Drugs and Alcohol Today Jeff Fernandez presented a new and effective method that is attracting hard to reach women to an alcohol clinic. Here he presents findings from field work, explores the nature of his methods, and shows why three times as many women attend his clinic than the national average.

In 2004 we brought you the story of a London PCT's efforts in tackling poor service engagement among Asian groups. The result of local interviews made for uncomfortable reading and the service had to make a number of changes on many fronts ‐ from changing opening times to working outside the medical model. Now a year on, after all the changes, Jeff Fernandez shares his experiences and highlights the dos and don'ts in one of today's biggest challenges ‐ understanding the changing face of racism.

Alcohol consumption is on the increase, particularly among women and young men (Waller et al., 2004). The Government, in showing its concern, has published a report on the extent of binge drinking alongside its long awaited alcohol strategy. While the binge drinking report focuses on the problematic nature of alcohol consumption and associated violence, the issue of dealing with the health consequences is often overlooked. Continuing our look at specialist nurses, Jeff Fernandez explores how they can take a key role in treating arguably the UK's biggest substance misuse and health problem ‐ taking care of Britain's drinkers.

This paper examines a common presentation to primary care and specialist drug services. Often patients who are experiencing opioid dependencies when stabilising on methadone often increase their consumption of alcohol. Also, increasingly so, polydrug use is a growing presentation with heroin, crack and alcohol use used in dependent patterns when presenting for treatment.There is often a lack of alcohol detoxification treatment packages given to those who are on methadone, and often some prescribers in the area of substance use regard an alcohol detoxification programme when prescribing methadone as too risky. This has led to a reluctance in general to prescribe an alcohol detoxification programme for many patients who request it. This is the case in Islington, London.This paper looks at a new service set up in Islington, London and looks at the way it has treated the cohort of patients who have presented with polydrug use, including alcohol. It has seen that patients who were more stable on their methadone and had longer histories in treatment were more likely to complete an alcohol detoxification programme with some ‘dry’ time off alcohol. It proposes that while there is a risk of prescribing alcohol detoxification regimes with methadone, there is a cohort of patients were this can be prescribed with a favourable outcome.

This paper looks at ISIS, the primary care service that was set up in the London borough of Islington to improve throughput into GP prescribing services from the drug‐using population. ISIS is a service developed from a statutory and voluntary sector initiative that was developed with a GP shared‐care model in its design. It is led by a GP and two non‐medical prescribing nurses to service a population that would not stay with the service but would be managed through the project to GP prescribing services.Over the course of the first year, however, while throughput to GP services improved, the numbers were still too low for the model to work effectively. Just under half of GPs were not offering services to this population, and there were a number of more complex patients who needed to be referred to a specialist drug agency.Results from the annual audit showed that there was a population of clients who were responding well to treatment but did not have a prescribing GP to be referred on to. This paper highlights these stable patients and argues that this population can be managed in a GP‐led service such as ISIS. Revisions to service design and commissioning objectives may be required, but should be easy to implement.

Cultural portraits usually begin with a description of the context, but as this material is covered elsewhere in this volume, this introduction will be mercifully brief. At any time during the last four decades, there have been dozens, perhaps even hundreds, of Stanford University faculty and doctoral students interested in studying organizations. They have been scattered across the campus, often in small groups within larger schools and departments. They have been based in the Sociology Department and the Organizational Behavior and Strategy areas at the Graduate School of Business. There were always a handful at the Education and Engineering schools, as well as a scattering of individuals doing related work in Psychology, Political Science, and Anthropology. In spite of their numbers, before the Stanford Center for Organizational Research (SCOR) was founded in 1972, many of these faculty, postdoctoral fellows, and doctoral students felt rather isolated. They had little contact with colleagues across campus who shared their interest in organizations and little collective clout when resources were being distributed.

The purpose of this paper is to illustrate how local drug services use their senior staff to respond to emerging ethnic groups presenting to treatment using flexible thinking and innovative processes.

The methodology was a case study design that used a semi-structured questionnaire that looked at two drug services and their staff’s influence on service delivery in different boroughs of east London.

The research found very innovative findings from the two boroughs. The boroughs had different racial mixes and therefore differing populations presenting to their local drug services. However, they used flexible approaches to structure their services to engage with emerging ethnic minority populations in drug treatment. From the findings, these different approaches and structures of providing drug treatment were very important. Approaches, for example, of clinical staff offering a “rapid assessment” are particularly important in engaging and retaining ethnic minority populations. Also, using flexible thinking within the staff team enables drug services to adapt treatments to be flexible in responding to emerging ethnic populations.

This paper shows that thinking in designing approaches to drug treatment shows that ethnic minority populations can be successfully engaged in drug treatment. This has implications for drug treatment nationally and across Europe where there are “emerging” ethnic populations presenting for drug treatment.

This paper shows that drug services can adapt and change to their different ethnic minority populations if they can able to be flexible in their clinical approach to service provision.