Introduction

Whatever else a drug misuse treatment service does, it must be able to withdraw individuals from addictive drugs successfully. In recent years there has been much emphasis on methadone maintenance, partly on harm-reduction grounds, but meanwhile in the UK heroin has become readily available in most localities, and many users with short histories are presenting as suitable for detoxification treatments. In particular, young people are commonly turning to heroin after recreational use of amphetamine, ecstasy, LSD or cannabis, and are then often distressed by the development of physical dependence, which is in contrast to their previous drug experiences. A proportion of this group become committed heroin users, but many present for help to come off the drug, and typically do not want methadone or any other substitution treatment. Some drug services have found it difficult to adjust to this group of users, who may be reluctant to attend a place which they see as dominated by maintenance candidates, and who have very different treatment needs. In our services we consider the detoxification of young heroin users to be one of the main priorities in providing an effective community treatment response, and particularly in North Nottinghamshire we have gained much experience in this type of work. The first part of this chapter describes the methods we use for nonopioid community detoxifications, where we find that successful detoxification can be achieved almost as a matter of routine, provided that much attention is paid to both patient selection and to organization in treatment.