Introduction

Those who have read the earlier chapters of this book will appreciate that there is no quick solution, no ‘cure’ for drug abuse, and anyone who has come into contact with drug abusers will know, from personal experience, that they can be one of the most difficult groups of patients to treat. So what does happen to them? What is the outcome for drug abusers and drug-dependent individuals? Do they get off drugs or are they always addicted? Do they carry on taking drugs until they kill themselves or are they likely to die from an unrelated illness? If they become abstinent, what brings about this fundamental change, and when is it likely to occur? Does treatment ‘work’? If so, which treatment is ‘best’?

There are no simple answers to any of these questions. Drug abusers are a heterogeneous population, and the individuals who make up that population have different personality attributes and exist in different life situations. They suffer from one or more of a range of drug-related problems, of variable severity, and the eventual outcome of their drug abuse, like its initiation, depends on the unique interaction between drug, individual and society. To this already complex formula must be added yet another variable – the effect (if any) of treatment intervention. Thus, while one heroin-dependent individual may successfully achieve and maintain abstinence, another attending the same clinic may die from an overdose, while a third may attain stability when provided with a regular prescription for methadone. Similarly, among a group of adolescents experimenting with glue sniffing, most will ‘grow out of it’, but an occasional youngster will persist in abusing solvent for many years and may, in the process, seriously damage his or her liver and kidneys.