To assess the views of opiate-dependent individuals about supervised methadone consumption. Three groups of opinions were sought: (i). new patients referred for assessment and treatment, using rating scales; (ii). the consensus view of the Methadone Alliance (a national users' forum); and (iii). the consensus view of a local service users' forum. All three groups expressed the view that supervised consumption has an important place in methadone treatments. Users understand the need for daily supervision of methadone and are generally willing to accept it. Users' views provide support for the introduction of flexible methadone prescribing regimes incorporating supervised consumption. Privacy in pharmacies and the possibility of moving away from supervision are important elements in an acceptable programme. Supervised consumption is an important component of safe, effective and responsible methadone prescribing.

Hostage situations differ greatly – in the aims and goals of the hostage-takers, the frequency and intensity of maltreatment, the type and quality of conditions, the duration of captivity, and the processes by which they are ultimately resolved and concluded. Although there is a paucity of research-based data about hostage reactions, clinical management, and outcome, there are general descriptive accounts in the medical and popular literature. A number of key texts are highlighted in the references, and examples of different conditions are briefly summarised in Box 1.

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Data on SADQ, GHQ, disciplinary, financial and relationship problems were collected from 103 problem drinkers and 96 controls. Problem drinkers were significantly more severely affected than controls on all measures except financial problems. Of the problem drinkers, 55% had a positive family history, and this group were more severely affected on SADQ, GHQ and financial problem measures than family history negative subjects. The most severely affected group were those with a positive family history who also reported significant childhood problems, and the least affected were those without a family history who did not report significant childhood problems.

Substance misuse is an important public health problem as well as a major clinical challenge (Nuffield Council on Bioethics 2007). Arguably, these aspects are intimately related. In public discourse, substance misuse is routinely associated with increased burden on national health and social services, loss of productivity and the commission of often violent criminal offences. These uniformly negative connotations reinforce stigmatising attitudes towards substance misuse that might not only discourage people from seeking professional help in a timely fashion, but also stand in the way of successful recovery. In turn, relatively high relapse rates (Levy 2013) exacerbate the negative impact of substance misuse on public health. Philosophical work on the nature and scope of akrasia, or weakness of will (Arpaly 2000;Davidson 2001; Radoilska 2013a,b), offers a promising way of breaking out of this impasse by providing the conceptual resources required to challenge an implicit notion of control over one's actions that seems to be at root of the problem. This article focuses on variant models of akrasia, although it also acknowledges the potential role of other factors that could complement a holistic approach to a viable recovery plan. Substance misuse: three fictitious case vignettes Mr Miller: biological causationMr Robert Miller is a 65-year-old retired chief executive. His mother died at the age of 82 from 'old age'. His father died at the age of 58 from carcinoma of the oesophagus, having been a heavy drinker throughout his adult life. Mr Miller was an only child and described a happy and stable childhood despite his father's drinking. He excelled at school, enjoyed good peer relationships and obtained a first class honours degree at university. He married in his late 20s, had two children in his 30s and, in his mid-40s, became the chief executive of a national company. He was described by his family as a good husband and father, with a reputation for honesty, integrity and fairness. Throughout his working life he drank alcohol most days, attributing this to the stress of his job and frequent socialising. In his early 60s he developed a morning tremor of his hands, which he thought was due to anxiety. His wife and children became increasingly concerned about his drinking, especially as he was known on occasions to drink and drive. Under considerable family pressure he saw his general practitioner (GP) and was referred for cognitive-behavioural therapy (CBT) to treat anxiety, stress and depression. He attended these sessions regularly, but did not find them helpful and his drinking pattern did not change. Following a blood test to check thyroid function, his GP detected markedly deranged liver function and referred him to a consultant psychiatrist, who diagnosed moderate alcohol dependence. Mr Miller declined the offer of medication, believing that he was strong willed enough to reduce his drinking on his own, but he did accept two counselling sessions with a substance misuse liaison worker.Lessons from akrasia in ...