Is health or social welfare the right question? Response to commentaries

We thank the authors of the three commentaries, and we are pleased to have stimulated debate on what we think is an important topic-health versus social welfare framing of alcohol and other drug treatment. In the original piece, we focussed this framing problem specifically around the ways in which alcohol and other drug treatment is purchased and commissioned. The overarching argument, as noted in all three commentaries, is the need for integrated co ordinated treatment across systems of care. Changes in purchasing and commissioning arrangements are attempts to establish better systems of coordinated care, where attention to the social determinants of health, and wrap-around services, better meet client needs. To phrase it more directly; how can the person who is experiencing alcohol or other drug problems be provided with what she needs at the time she needs it?