Crisis and Opportunity in Drug Policy: Changing the Direction of British Drug Services in the 1980s

During the 1980s illegal drug use in Britain appeared to be increasing at an alarming rate and spreading across the country on an unprecedented scale. An apparent growth in the use of heroin caused particular concern: the number of known heroin addicts rose from just over two thousand in 1977 to more than ten thousand by 1987.¹ Moreover, heroin use was being reported in urban areas throughout the country.² This was in contrast to previous decades, when it was thought that drug use was largely confined to London.³ By 1985 the Conservative government was able to assert that "the misuse of drugs is one of the most worrying problems facing our society today."⁴ Growing fears about drug use prompted a flurry of activity from both central and local government, from law enforcement bodies, voluntary organizations, and health professionals.

This article will consider the response to the development of a national heroin "problem" in the 1980s through an examination of the Central Funding Initiative for drug services. The Central Funding Initiative (CFI) was a multi-million-pound program dedicated toward the provision of services for drug users, particularly those in areas away from London and the Southeast. This was, however, more than just a reaction to the spread of drug use to the regions: it was indicative of broader changes within the drugs field and within health and social policy more generally. The CFI was designed to foster a multidisciplinary approach to drug use, providing a range of services, such as residential rehabilitation and street-based counseling, to drug users. This was in contrast to the primarily medically orientated response to drug use in existence since the late 1960s, based around out-patient treatment in the National Health Service Drug Dependence Units, a medical response with a much longer history.⁵ Through the CFI, less emphasis was placed on treatment alone, suggesting greater attention to the social as well as the medical consequences of drug use. This was to be achieved by involving a wider range of agencies in providing services for drug users. Particular encouragement was given to voluntary organizations because these were regarded as more flexible than statutory bodies, and thus better equipped to respond in new ways to the rapidly developing drug problem.

This article argues that these changes must be understood at two levels. At one level, the history of the Central Funding Initiative could simply be seen as a pioneering development in social policy, illustrative of the wider agenda of the Thatcher government of the 1980s. But at another level, it was also the product of long-standing tensions within drug policy and threw light on the ways in which British health policy was made. Let us briefly survey both these dynamics. Involving the voluntary sector in the provision of services for drug users reflected wider shifts within health and welfare in Britain during the 1980s. The Conservative government, led by Margaret Thatcher, regarded the state as an inefficient and ineffective provider of welfare, and considered its monopoly on the provision of services to have resulted in a culture of passivity and dependence among welfare recipients.⁶ The suggested solution to this problem was to "roll back the state"; to reduce the role of central government in the provision of welfare. The "rolling back of the state" was to be achieved in two closely related ways. First, by placing greater emphasis on the involvement of voluntary organizations in the delivery of health and social services, and second, by creating a "market" in welfare, allowing statutory and nonstatutory bodies to bid for contracts to provide specific services.⁷ In both these developments the role of the voluntary sector was crucial. Not only was the voluntary sector regarded as being more responsive, more innovative, and more cost-effective than the statutory sector, but it was also thought to be able to reduce reliance on the state through the "invigorating" experience of self-help and community care.⁸ However, there was a paradox in these changes, as social policy...