Dynamic dualities: the ‘British system’ of heroin addiction treatment, 1965-1987

Abstract

This thesis is concerned with the treatment of heroin addiction between 1965 and 1987. It examines a series of conflicts between seemingly opposed forces: between the medical and the social, the specialist and the generalist, the public and the private provision of healthcare, and the short-term and the long-term prescription of drugs to addicts. The establishment of specialised Drug Dependence Units (DDUs) in 1968 demonstrated that addiction was seen as both a disease to be treated and a social problem to be controlled. It is argued that the effects of this dynamic duality can be observed in the subsequent response to heroin addiction. Tension existed between specialist consultant psychiatrists who treated addicts at hospital based DDUs and community based private and general practitioners involved in the treatment of addiction. This was the result of contrasting approaches to addiction and its treatment. Conflict between these groups was particularly evident in the General Medical Council’s (GMC) cases for serious professional misconduct in 1983 and again in 1986-1987 against Dr Ann Dally, a leading private practitioner involved in the treatment of addiction. These cases highlighted the continuing differences between medical and social approaches to addiction but also demonstrated how these elements were inseparable and equally crucial to the formulation of drug treatment policy in this period.