Is Addiction Treatment Health Care or Social Welfare? Unpacking the Debate

Samir D’Costa in Health & Wellness August 2025 • 5 min read.

"Explore the evolving landscape of addiction treatment: is it primarily a health issue requiring medical interventions, or a social welfare concern needing community support?"

Treatment for alcohol and other drug (AOD) problems sits at the intersection of health and social welfare. Integrated, holistic approaches recognize that substance use issues are influenced by a complex web of factors, encompassing not only physical and mental health, but also social determinants such as housing, employment, and community support. This perspective is echoed in national strategies that call for partnerships between government and non-government agencies across various sectors, including education, healthcare, and social services.

In the UK, a similar emphasis on a 'recovery system' highlights the importance of connecting individuals with a range of health and social services, including housing, employment support, and mental health services. Recognizing that many people struggling with alcohol or drug dependence face precarious circumstances like homelessness, unemployment, and poverty, it's crucial to have a comprehensive support system that addresses both their health and social welfare needs.

This article delves into the complex relationship between framing addiction treatment as either a health issue or a social welfare concern. It also explores how AOD treatment is commissioned and purchased, with a focus on Australia and the UK. These two countries offer valuable insights because their treatment commissioning and purchasing systems are specific to their unique contexts, shaped by both time and place. The mechanisms of government, including how treatment is commissioned and purchased, play a significant role in shaping the understanding and approach to AOD treatment.

Healthcare vs. Social Welfare: Understanding Treatment Models

Crossroads representing the decision between healthcare and social welfare approaches to addiction treatment

In Australia, healthcare services, particularly hospital care, are typically commissioned and purchased through a variety of mechanisms such as block grants, activity-based funding, and fee-for-service arrangements. The UK employs similar purchasing mechanisms, largely through the National Health Service (NHS), and is exploring competitive commissioning to ensure access to healthcare services for its population. These healthcare purchasing models align with assumptions about the need for a highly skilled medical workforce, high-quality care standards, specialized staff, and managing rising healthcare costs.

Social welfare services, however, follow a distinctly different approach. In both Australia and the UK, these services are primarily purchased through competitive tendering. Non-government organizations (NGOs) compete for contracts to provide essential services such as housing, homelessness support, employment assistance, and child and family care. This competitive environment contrasts sharply with the healthcare model.

Healthcare Model: Focuses on medical interventions, skilled workforce, quality standards, and specialized staff.
Social Welfare Model: Emphasizes competitive tendering, cost-effectiveness, and community-based services.

AOD treatment, however, doesn't neatly fit into either category. Since the mid-1990s in Australia, AOD treatment provided by non-government organizations has largely been purchased through competitive tendering—a model typically reserved for social welfare services. While some exceptions exist, such as government-provided AOD treatment in New South Wales, the dominant trend leans toward the social welfare approach. In the UK, the shift toward social welfare models for commissioning and purchasing AOD treatment is a more recent development. AOD treatment has been transferred to Public Health England, in collaboration with local commissioning authorities. AOD treatment budgets have been integrated with broader public health and social services, with competitive tendering as the primary purchasing mechanism. This move has effectively removed AOD treatment commissioning from the National Health Service commissioning structures.

The Path Forward: Integrating Health and Social Welfare

The debate over whether addiction treatment should be framed as health care or social welfare has profound implications. As AOD treatment services are increasingly commissioned and purchased through social welfare systems, it can have far-reaching consequences for the types of care available, the workforce involved, and how society perceives addiction. Further research is needed to understand the relationship between commissioning processes and treatment outcomes, and to explore innovative purchasing mechanisms that integrate both health care and social welfare approaches. Models like individualized funding, which empower individuals to choose their own care, may also hold promise for the future of AOD treatment.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/dar.12871, Alternate LINK

Title: Alcohol And Other Drug Treatment Commissioning And Purchasing: Is It Health Care Or Social-Welfare?

Subject: Health (social science)

Journal: Drug and Alcohol Review

Publisher: Wiley

Authors: Alison Ritter, Katinka Van De Ven

Published: 2018-10-22

Everything You Need To Know

What is the central debate around addiction treatment, and why is it important?

The core debate is about whether treatment for Alcohol and other drug (AOD) problems is primarily a health issue or a social welfare concern. The nature of the answer has implications for funding, service delivery, and how society views addiction. The shift in AOD treatment towards the social welfare model, especially in countries like the UK and Australia, is a recent trend with profound consequences. It affects the available types of care, the professional workforce involved, and societal perceptions about addiction. The debate is complicated by the integrated nature of AOD issues, which require both health and social support.

How do healthcare and social welfare models differ in how they commission and purchase services in countries like Australia and the UK?

In Australia, healthcare services, especially hospital care, are commissioned and purchased using mechanisms like block grants and fee-for-service arrangements. The UK utilizes similar methods, primarily through the National Health Service (NHS). These healthcare models emphasize a skilled medical workforce and high care standards. Social welfare services in both countries primarily use competitive tendering. Non-government organizations (NGOs) compete for contracts to provide essential services like housing and employment assistance. Unlike health care, social welfare focuses on cost-effectiveness and community-based services.

What are the key differences between the healthcare and social welfare models for addiction treatment?

The healthcare model emphasizes medical interventions, a skilled workforce, high-quality standards, and specialized staff. This model is often associated with traditional medical approaches to treating addiction. In contrast, the social welfare model emphasizes competitive tendering, cost-effectiveness, and community-based services. The social welfare model often involves non-government organizations providing a range of services. Neither model perfectly fits AOD treatment, which requires a combination of both. The choice between models shapes the funding, delivery, and perception of the treatment.

How has the commissioning and purchasing of Alcohol and Other Drug (AOD) treatment changed in Australia and the UK?

In Australia, AOD treatment provided by Non-Government Organizations (NGOs) has largely been purchased through competitive tendering, a method mainly associated with social welfare services. In the UK, the shift has been more recent, with AOD treatment budgets integrated with broader public health and social services, again using competitive tendering. The UK has moved AOD treatment commissioning away from the National Health Service (NHS), indicating a shift towards a social welfare approach. These trends influence the type of care, the workforce, and societal perceptions of addiction.

Why are the examples of the UK and Australia significant when considering addiction treatment?

The UK and Australia provide relevant insights because their systems are shaped by unique circumstances and historical contexts. These countries offer examples of how AOD treatment is commissioned and purchased, which affects the understanding of treatment approaches. The mechanisms of government, including how AOD treatment is commissioned and purchased, affect the understanding and approach to treatment. The ongoing research explores how different purchasing mechanisms and models of care can improve treatment outcomes, and how to integrate both health and social welfare approaches.