Some reflections on dynamics and dilemmas in a DDU

Some difficulties in the management of addiction in a Drug Dependence Unit are discussed. Staff time with clients on prescribed methadone is dominated by enquiries into covert drug abuse and they must contend with passive aggression and denial. Dependency issues, to which the DDU may contribute, arise with chronic clients. Psychodynamic themes, even where identified as important, are difficult to follow through and link to outcome. There are inherent constraints in a medical model of management addressing behaviours which are as much the property of social context as of definable individual psychopathology. The AIDS crisis may bring new funds but also new pressures: DDUs may come to be judged essentially by their ability to shield the general population from HIV. This would have implications for the ethos of individual treatment and for team make-up.