The role of treatment and indeed whether treatment is necessary is contested in the context of problem substance use. Some people address their substance use problem without support from medical treatment services. In fact this may be the most usual means for people to resolve their problem substance use. Some people address their substance use outwith the context of ‘addiction treatment’ services but get support from other medical services. Many people acknowledge the support they received from ‘addiction treatment’ services as helpful but that wider supports are required to address their substance use problem.

A consensus view may be that medical and pharmaceutical-based supports can help people in addressing and resolving their substance use problem and in addressing some of the physical and mental health issues that are a cause and consequence of problem substance use but these are unlikely to be the only supports or services required.

Beyond medical treatment, there are a wider set of supports and services which may help people address their problem substance use and the causes and consequences of their use of problem substance use. These may be regarded as wider ‘treatment’.

The aim of treatment is sometimes contested (see abstinence). Sometimes, this occurs because the definition of treatment varies. In treating chronic conditions there are pharmaceuticals that may give symptomatic relief allowing the patient to lead a more normal life, less affected by the symptoms of their condition. There are also medications that stop the condition becoming critical, for example for a diabetic patient, insulin prevents hypoglycemia that can lead to coma and death. People accept that these are treatments and that they do not ‘cure’ the person with the chronic condition. Likewise, opiate substitution therapy may offer patients symptomatic relief and may prevent health and other problem opiate use-related harms. It can also offer a person a basis to make other changes in their life (see opiate substitution treatment). To criticise this for not ‘curing’ a substance use problem is to misunderstand both the purpose of treatment and the nature of the problem (see ‘parked on methadone’).

A question remains, what is the role of OST if a person on OST reduces or stops their street drug use but does not engage with other supports, for whatever reason. Is this treatment? It is, at it clearly has health benefits in reducing health risks and harms including fatal overdose and preventing withdrawal and other symptoms. It is also, and in this there is no contradiction, a harm reduction measure (see harm reduction).