Involving drug users in treatment decisions: An exploration of potential problems

Aims: This paper explores the problems that can arise when trying to involve illicit drug users in decisions about their own treatment. Methods: Semi-structured interviews (n = 187) were conducted in two specialist community prescribing agencies and two residential rehabilitation agencies. Seventy-nine new treatment clients were interviewed, and 59 of these were re-interviewed three months later. Interviews were also conducted with 27 agency staff and 22 individuals who had referred the drug users into treatment. Findings: Difficulties in implementing user involvement in drug treatment decision making could be grouped under five broad headings: (1) the perceived characteristics, needs and expectations of drug users; (2) the attitudes of professionals; (3) the dynamics of treatment encounters; (4) treatment programme design; and (5) structural factors affecting service provision. Conclusions: While involving drug users in treatment decisions is achievable, the problems can be substantial and complex. More financial resources to increase the availability and accessibility of treatment options; improved communication between service providers and their clients; and an investment in education, training and skills development can all potentially promote client participation. Nonetheless, some constraints to full involvement in decision making are likely to be inevitable and even necessary.