Abstract
It might be surprising that a new system of specialist, state-funded Clinics could be set up with so little idea of how to approach their task, but seen through the eyes of senior psychiatrist Thomas Bewley, such was the situation in the early days of the Clinics. According to the minutes of a meeting of Clinic leaders and civil servants in 1969, when discussing the possibility of changing the law to allow compulsory treatment of patients, ‘the view was expressed that the philosophy and aims of treatment were at present too ill-defined for a decision to be reached on the subject’.2 It was in this state of uncertainty that the Clinics tried a number of approaches such as cocaine prescribing which was quickly abandoned.3 Heroin and methadone were prescribed in injectable form on a long-term maintenance basis and treatment could involve cocktails of stimulants and depressants, bargained over by doctors and patients.4 With the Clinics prescribing generously to addicts without the many restrictions that were later introduced, their approach was closer to that of the private prescribers. Patients had less to gain from ‘going private’ and from 1968 to the mid-1970s there was a degree of peaceful co-existence between the Clinics and private prescribers. Criticism of other doctors by the Clinics, if expressed, tended to focus on GPs instead.
No one had the faintest idea of what they were doing and were all expected to solve the problem of drug dependence.1
Dr Thomas Bewley
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Notes
Department of Health and Social Security, ‘Heroin Dependence: Clinical Conference’ [Minutes of meeting] (18th September 1969), Private archive.
See also T. Bewley, ‘The Illicit Drug Scene’, British Medical Journal, 2 (1975), 318–320.
H. B. Spear (and ed. J. Mott), Heroin Addiction Care and Control: The ‘British System’ 1916–1984 (London: DrugScope, 2002), p. 194.
P. H. Connell, ‘Drug dependence in Great Britain: a challenge to the practice of medicine’, in H. Steinberg (ed.), Scientific Basis of Drug Dependence, Coordinating Committee for Symposia on Drug Action (London: J&A Churchill, 1969), pp. 291–299, p. 293.
DHSS, Better Services for the Mentally Ill (London: HMSO, 1975), p. 67.
M. Mitcheson, ‘Drug Clinics in the 1970s’, in J. Strang and M. Gossop (eds.), Heroin Addiction And Drug Policy: The British System (Oxford, New York, Tokyo: Oxford University Press, 1994), pp. 179–191.
H. B. Spear (and ed. J. Mott), Heroin Addiction Care and Control: The ‘British System’ 1916–1984 (London: Drugscope, 2002), pp. 275–276.
T. H. Bewley, ‘Prescribing Psychoactive Drugs to Addicts’, British Medical Journal, 281 (1980), 497–498, p. 497.
The Lancet, ‘Drug addiction: British System failing’, The Lancet, 1 (1982), 83–84, p. 83.
For example, A. Dally, ‘Personal View’, British Medical Journal, 283 (1981), 857.
ACMD, Treatment and Rehabilitation, DHSS (London: HMSO, 1982).
DHSS, Better Services for the Mentally Ill (London: HMSO, 1975), pp. 69–70.
G. V. Stimson and R. Lart, ‘The Relationship Between the State and Local Practice in the Development of National Policy on Drugs between 1920 and 1990’, in J. Strang and M. Gossop (eds.), Heroin Addiction And Drug Policy: The British System (Oxford, New York, Tokyo: Oxford University Press, 1994), pp. 331–341, p. 336.
ACMD, Treatment and Rehabilitation Working Group, First Interim Report (London: DHSS, 1977).
For a full discussion of the first working group and its interim report, see S. G. Mars, Prescribing and Proscribing: The Public-Private Relationship in the Treatment of Drug Addiction in England, 1970–99 (University of London: PhD Thesis, 2005), pp. 63–69.
S. MacGregor, ‘Choices for policy and practice’, in S MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 170–200.
Interdepartmental Committee on Drug Addiction, Drug Addiction. The Second Report of the Interdepartmental Committee [second Brain Report], Ministry of Health, Scottish Home and Health Department (London: HMSO, 1965), p. 9.
DHSS, Better Services for the Mentally Ill (London: HMSO, 1975).
ACMD, Treatment and Rehabilitation Working Group (1977), p. 9.
M. Plant, ‘The epidemiology of illicit drug-use’, in S. MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 52–63.
J. Strang, ‘A model service: turning the generalist on to drugs’, in S. MacGregor (ed.) Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 143–169.
B. Thom, Dealing With Drink. Alcohol and Social Policy from Treatment to Management (London and New York: Free Association Books, 1999), pp. 105–134.
J. Strang, ‘“The British System”: past, present and future’. International Review of Psychiatry, 1 (1989), 109–120.
V. Berridge, ‘Historical issues’, in S. MacGregor (ed.), Drugs and British Society. Responses to a Social Problem in the 1980s (London and New York: Routledge, 1989), pp. 20–35.
A. Kerr, ‘In conversation with Thomas Bewley’, Psychiatric Bulletin, 31 (2007), 220–223.
R. Cawley, Obituary: Dr P H Connell, The Independent (Monday 10th August 1998).
GMC, Minutes of the General Medical Council and Committees for the Year 1979 with Reports of the Committees, etc. CXVI (London: GMC, 1979).
GMC, Minutes of the General Medical Council and Committees for the Year 1991 with Reports of the Committees, etc. CXXVIII (London: GMC, 1991).
T. Bewley, ‘Prescribing psychoactive drugs to addicts’, British Medical Journal, 281 (1980), 497–498.
A. Dally, A Doctor’s Story (London: Macmillan, 1990), pp. 141–144.
A. Thorley, TRWG (82) 15, Memorandum to David Hardwick (22nd March, 1982) File DAC 28, DH Archive, Nelson, Lancashire.
C. Webster, The National Health Service. A Political History (Oxford: Oxford University Press, 1998), pp. 140–219.
A. M. Blythe, Memo from to J. M. Rogers (19th February 1982), File 16/DAC 28 Vol 2, DH Archive, Nelson, Lancashire.
ACMD: Report on Treatment and Rehabilitation. Draft Submission (November 1983) From File DAC 14 Volume 4, DH Archive, Nelson, Lancashire.
K. Clarke, Memo to Secretary of State (31st October 1983), File DAC 14 Volume 4, DH Archive, Nelson, Lancashire.
ACMD. Treatment and Rehabilitation DHSS (London: HMSO, 1982).
A. Thorley, ‘Longitudinal Studies of Drug Dependence’, in G. Edwards and C. Busch (eds.), Drug Problems in Britain: A Review of Ten Years (London: Academic Press, 1981), pp. 117–169.
For example, ACMD, AIDS and Drug Misuse Part 2 (London: HMSO, 1989).
A. M. Blythe, Memo to M. Moodie. ‘Services for Drug Misusers. ACMD’ (5th February 1982), File DAC 7, DH Archive, Nelson, Lancashire.
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© 2012 Sarah G. Mars
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Mars, S.G. (2012). Prescribing and Proscribing: The Treatment and Rehabilitation Report. In: The Politics of Addiction. Science, Technology and Medicine in Modern History. Palgrave Macmillan, London. https://doi.org/10.1057/9781137272218_3
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