American Public Health Association have recently issued a resolution that endorses needle exchange programs.
Treatment issues are complex and have engendered debates among service providers who are dedicated to helping individuals deal with their additions and who have divergent views about the appropriateness and efficacy of various methods that could be used to accomplish their goal. The panel decided that a more detailed discussion of the views presented above was warranted to more fully explore the underlying issues of concern.
The worrisome issue of competition for funds seems to derive from the fact that services (both addition treatment and needle exchange programs) focus on similar targeted individuals. However, the population being served is the only factor in common between needle exchange and bleach distribution programs and treatment programs. The primary focus of the former is to address the transmission of HIV as an immediate priority, whereas the latter attempt to address drug abuse, which places an individual at risk.
Researchers have found drug treatment to be effective (Rettig and Yarmolinsky, 1995; McLellan et al., 1992; Gerstein and Harwood, 1990; Hubbard et al., 1989). However, there is a strong tendency to think of total and permanent abstinence from drug use as the only sign of successful treatment, when in fact diminution in drug use may in itself be a valuable outcome. Drug-use disorders are a complex group of chronic conditions that vary not only according to the substance or substances abused, but also according to individual factors such as psychiatric comorbidity, heredity, gender, ethnicity, education, and occupation. Different types of patients require different types of treatment modalities (Normand et al., 1994).
Viewing these disorders as acute problems controllable by will power is a fundamental basis of the misperception that treatment is ineffective. Yet, from a medical perspective, drug abuse and dependence are chronic disorders, much like arthritis or diabetes. They develop gradually and have a course characterized by remissions and relapses, although there is often overall progression over time. Treatments reliably produce relief of symptoms and improvements in function, but not cures.
The introduction of methadone treatment in the mid-1960s represents a substantial shift in ideology by certain members of the treatment community. Abstinence was no longer the sole treatment goal; rather, it reflects an approach to treatment that attempts to minimize the negative behavioral