Alcohol and other drug treatment commissioning and purchasing: Is it health care or social welfare?

Abstract

Treatment for alcohol and other drug (AOD) problems entails health and social-welfare responses. This can be seen in the calls for integrated, holistic responses for those with AOD problems. The Australian National Drug Strategy (2017-2026) states: <br/> '[I]n recognition of the social determinants of alcohol, tobacco and other drug problems and that the age and stage of life issues associated with substance use can result in different risks and harms require integrated, holistic and systems based partnerships. This includes partnerships between both government and non-government agencies in areas such as education, treatment and services, primary health care, justice, child protection, social welfare, fiscal policy, trade, consumer policy, road safety and employment'. <br/> Similarly in the UK, their current Drug Strategy refers to a 'recovery system', which includes greater engagement with other health and social services such as housing, employment, children's services and mental health. Appreciation of the social determinants of health, and the precarious circumstances of many people experiencing alcohol or drug dependence, including homelessness, unemployment and poverty, serve to reinforce the importance of a comprehensive care and support system that is capable of spanning both the health and social-welfare needs of clients. <br/> In this commentary we explore the relationship between a health or social-welfare framing of treatment, and the ways in which AOD treatment is commissioned and purchased. We focus on Australia and the UK because treatment commissioning and purchasing is specific to both time and place (for work focussed on the USA, see Ref.). The ways in which treatment is commissioned and purchased, that is the machinery of government, brings into being a frame for and understanding of what AOD treatment is, in line with a post-structural perspective.