Drug addiction is a problem of increasing incidence and seriousness all over the world. Governments increasingly realize that treating the drug consumer as a criminal will help neither society nor the consumer, and that new approaches to the drug problem are needed.
In the mid- 1980s, two public health problems grew into epidemics that threatened to overwhelm the drug addiction treatment system. The first of these was the spread of the Human Immunodeficiency Virus (HIV), the virus that causes AIDS, among injection drug users and their sexual partners. HIV is transmitted through the shared use of contaminated syringes and other injection equipment, and through unprotected sexual behavior with infected individuals. By 1989, more than a fourth of reported AIDS cases were among injection drug users. At the same time, heterosexual transmission accounted for 5 percent of cases ( Miller, Turner, and Moses, 1990:44). More than 67 percent of heterosexually acquired AIDS cases in women, who are at more risk of heterosexual transmission than men, are attributed to unprotected intercourse with an infected male injection drug user ( Miller, Turner, and Moses, 1990:49). The second public health problem was a rapid increase in the use of "crack," a smokeable and highly addictive form of cocaine that is notorious for the remarkably short time in which it can dominate and devastate the lives of its users. After years of neglect, the drug addiction treatment system was ill-prepared to deal with either of these crises.
In 1989, as part of a larger AIDS prevention effort to reduce risk behaviors that spread HIV infection, the National Institute on Drug addiction (NIDA) developed a program of research demonstration grants to improve and expand treatment. Client populations for these studies were defined as those at risk of HIV infection or transmission, either through injection drug use or through drug use linked to sexual risk behaviors (e.g., prostitution or exchange of sex for drugs)..................
