This book reports findings from research financed by the English Department of Health Drug Misuse Research Initiative (DMRI), which funded work on a wide variety of issues and questions of immediate policy and practice relevance, conducted by a wide sample of addiction researchers across England. Fourteen diverse research projects are squeezed into this book, along with two initial policy review chapters and a concluding chapter. This makes for a dense and not always easy read. But then drug misuse is a dense and not always easy problem. The book does a commendable job of presenting a complex spread of treatment oriented research, and treatment relevant issues, in recent England.

The UK has a developing practice of studying treatment and service provision as it actually occurs, as well as conducting trials and evaluations of specific interventions. Service provision in the raw is the primary focus of this book. Readers seeking clear-cut ways to translate research evidence into practice will often be frustrated, because the book poses more questions than answers. However, any frustration will be realistic and honest. It is unusual for research on treatment and the implementation of policy to look at reality with its defects and complexities. This book does an excellent job of this.

It begins with two chapters considering how recent UK policy has shaped perceptions and actualities of drugs problems and how the crime and disorder agenda has distorted things. There is then a review of cannabis and psychosis, which does not sit well with the rest of the book or adhere to its notional title of the psychosocial consequences of drug use.

Next is a series of chapters about the form of treatment, looking at: the diversity of what services actually do and how this deviates from what is on the menu; whether care is truly coordinated, which it probably often isn't; waiting times, which may matter less than services being unfriendly; early exit, which may be due to services not fitting client needs rather than clients being ‘chaotic’; barriers to treating injecting drug users, which again include poor fit between client needs and service provision. An emerging theme in this series of chapters is that some services can be prejudiced towards problem drug users. There may occasionally be overt stereotyping, but more commonly services can be organised in prejudiced ways that assume that problem drug users will be problematic and exploitative as clients, need firm handling and should accept gratefully whatever waiting time, attendance and treatment regime they are offered. The Care Programme Approach, which is required for all clients of specialist mental health services and which involves clients in planning their care, may not always happen in drug services.

Turning to the content of services, there are chapters on: prescription of injectibles, hindered by many clients not meeting eligibility criteria such as being current injectors on admission; cognitive behaviour therapy in services prescribing methadone, which is easier for services that have regular, planned appointments with clients, rather than brief unscheduled prescription pick-up sessions; user involvement, supposedly an intrinsic good, rolling out slowly in drug services, yet of undemonstrated benefit and often tokenistic and an additional burden for staff. Mind you, some of the challenges in earlier chapters would benefit from enhanced user involvement. An emerging theme here is that good ideas which ought to work are not necessarily easy to implement in the real world of service provision.

There are two chapters on comorbidity in substance use services/community mental health teams and in primary care. These chapters document that earlier findings elsewhere apply also in England. Comorbidity rates were very high, with most drug or alcohol patients having another diagnosis and nearly half of the clients of the community mental health team having alcohol or drug problems. Comorbid patients generally acquire both problems within about two years of acquiring the first problem, but that either a substance problem or another psychological disorder can come first.

Finally, there are three chapters on systemic issues, one showing a model for a service to black and minority ethnicity family members affected by drug problems. Although it is important that a family approach was acceptable to black and minority ethnicity families, much of this useful model would apply also to services for any families. A second discusses services for young people with drug-misusing carers. Current provision is patchy but seems beneficial. On the other hand, the third chapter identifies the difficulties of intervening with families where parents use drugs. Often, parents and children want to be left alone out of fear the family will be broken up. When that crisis point places children in care, it can be too late to intervene easily. These issues are challenging to address.

The editor concludes the book with a chapter discussing how policy has changed since. She suggests that there are signs of a welcome break from the ‘tough on drugs’ consensus. I would suggest also that this book shows the complexities of the realities of drug treatment. It does not always happen as it should, it is becoming more professional and evidence-based, yet there are considerable problems to work upon. Glib slogans, sound bites and monomaniacial interventions do not generally work with a client group who often have serious, multiple and enduring problems and who can have wide impact on their families and the community around them.