Drug policy and control at the international level

p123 those services that are deisgned to change the behaviour of drug users with the aim of benefitin g them and those people around them and society in general. the goals can be diverse from initaiating and maintaining abstinence, to reducing frequency, to changing other behaviours such as needle sharing and crime.

some durg policy analysts attempt to divide drug-related servcies into two non-overalpping categories ie demand and harm reduction , the authors deliberately do not adopt this disntinctio for two reasons, all servcies attempt to reduce harm and those profesionals and servcies that do so by addressing drug use directly are as committed to reducing suffering as those who strive to reduce iother drug-related beahviour and it is incorrect to imply taht only the later are concerned with reducing harm. Secondly clcincal practice usually conatins a blend of these allegedly distinct approaches for example many people who use nsp are referred to demand redcution servcies, similarly someone who becomes abstinent through joining NA certainly redcues the level of drug-related harm to themselves and others.

All these servcies explicity or implicity assume that they can produce individual level chnage that will translate into redcued use, infections, death, unemployement and crime, (note negative focus)and therefore beneifit both individuals and socitey (benefits that radiate beyond the individual . Services can be evaluated on the extent to which they achieve individual change that radiate beyond the individual. While detailied knowledge of the natural progression of use and dependence is spare for many drugs it is clear that level of use can change markedly independant of intervention and while it is clear that volumn frequency and risks tned to increase with the development of dependence, it is also well recognised, if only scantly studied, that many individual who qualify for a diagnosis of dependence can and often do reduce or entirely cease drug use without the assistance of services. For example MATES study The phenomenon of what has been called natural recovery poses a considerable problem for the evaluation of services when a non-intervention comparison group is not available. The interventions evaluated may be credited with changes that may have occurred anyway through this process of natural recovery.