International Journal of Drug Policy 22 (2011) 196–197 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Response Rhetoric, reality and research: What they mean for achieving the best possible treatment system for addiction-related problems Peter Miller a,∗ , Adrian Dunlop b a Deakin University, Geelong, Victoria, Australia b School of Medicine and Public Health, Faculty of Health, University of Newcastle, Australia Policy options for dealing with alcohol and drug dependence are hotly contested and usually involve ideological, existential and financial considerations. Nowhere is this more obvious than in the discourses surrounding abstinence and harm reduction. The orig- inal research by McKeganey, Morris, Neale, and Robertson (2004), described in this journal issue by Neale,Nettleton, and Pickering (2011), fuelled the fires of debate without contributing new infor- mation. Worse still, were the subsequent press statements from those vested in promoting an abstinence-only agenda and willing to make throwaway statements around harm reduction ( Abetz, 2010; McKeganey,2005; Watt, 2007). Thankfully, Neale and colleagues have constructively addressed some of the pitfalls of the DORIS study through the use of qualitative methods to further unpack the question of what do people seek when they enter treatment (Neale et al., 2011). Research lacking clinical insight In their paper McKeganey et al.(2004) portrayed a status quo where harm reduction was the dominant treatment option without providing any evidence that this was the case,choosing to iden- tify it as ‘a social movement’ rather than describing the options drug users seeking treatment actually have (McKeganey,2005). This somewhat rhetorical strategy fails to paint an accurate picture of the marginalised and stigmatised reality faced by drug users in the UK. The overwhelming discourse surrounding drug treatment has always been and continues to be abstinence focused. It is from this background that the number of harm reduction services had been increasing and that many services which used to be abstinence only focused had moderated their stance, based on the overwhelm- ing evidence that abstinence only treatment fails to adequately meet the needs of the vast majority of the treatment popula- tion ( McLellan, 2006; Orford, 2008). Indeed, this situation was starkly demonstrated in McKeganey’s subsequent papers which demonstrated that few (12%) of the people who entered treatment remained abstinent (Roberts,2005). It is within this context that much of the rhetoric arising from McKeganey and his research has ∗ Corresponding author. E-mail address: peter.miller@deakin.edu.au (P. Miller). flowed. There seems to be little or no appreciation of the fact that social and cultural norms frame help-seeking and drug treatment practices, and that when people seek access to help via an institu- tion, such as a drug treatment agency, they may reproduce these norms in their efforts to gain admission ( Koutroulis, 2000). Today I’m on a diet, tomorrow I’ll probably want cheesecake Early in our research careers, we were fortunate enough to work at an institute which combined research, clinical practice and edu- cation with colleagues from many disciplinary backgrounds who had supported many people through their treatment journeys. One product of this environment was a series of reports (and later some journal articles) released through Turning Point Alcohol and Drug Centre in Australia ( Dunlop, Koutroulis, Lintzeris, Odgers,& Kellehear, 1996; Koutroulis, 1998, 2000; Koutroulis et al., 2000), based on qualitative work which investigated people’s journeys through treatment. This qualitative research showed how indi- viduals’ journeys through treatment were variable,perhaps even unique, and that the initial reasons motivating people to seek treatment may be subject to change.We found, as have others, that the expectations people have of treatment, and the outcomes they desire from it, normally change over the course of the first week ( Dunlop et al., 1996; Fischer, Cape, Daniel, & Gliksman, 2002; Fischer, Chin, Kuo, Kirst, & Vlahov, 2002). To oversimplify, most people seeking treatment do so from a position of desiring drastic change, which is clearly visible to oth- ers (Fischer et al., 2002b). A combination of factors usually plays a role in the decision to seek treatment, including health crises, fam- ily and relationship disruption, financial difficulty, or the threat of impending legal sanctions (Orford et al., 2006). For the most part, people attribute these problems to their drug use,and they just want them to go away. The most obvious answer, therefore, to a limited ‘tick box’ question about what people are seeking from treatment is the cessation of the behaviour they believe is causing their problems. Indeed, Neale et al. (2011) analysis shows just how flawed the option of a response of ‘abstinence’ was. When choos- ing ‘abstinence’ as a survey response, the majority of respondents would have been talking about a range of different outcomes all being described under the banner of ‘abstinence’ 2011). 0955-3959/$ – see front matter. Crown Copyright © 2011 Published by Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2011.04.002