Abstract

Substance dependence is recognized in the scientific community to be a medical condition rather than a willful misbehavior, but in societies and in politics a connotation of moral weakness, of irresponsible behavior or even of criminal intent can be observed, in attitudes and arguments and in a stigmatization of addictive behavior. Therefore, treatment of substance dependence must respect both the individual and the societal values at stake, in designing and implementing therapeutic approaches, avoiding neglect as well as undue coercion. The empirical evidence on what can be achieved, for whom and under what circumstances, is the basis of treatment, in line with the principles of consequential ethics, of human rights and of medical ethics in general. The implementation of these principles, however, is affected under the conditions of war or similar disasters. Also, health policy has to minimize the risk factors for and the negative consequences of substance dependence, as well as the negative consequences of non-dependent substance use (e.g., accidents under the influence of alcohol) besides providing treatment and care. This is evidenced in a confrontation of two major types of drug policy: namely an abstinence-oriented prohibitionist drug policy on one side, and a risk of use reduction oriented policy on the other side.