This paper questions the notion that problem drug use is essentially a physiological medical problem that requires coercive treatment, from which success is measured by way of drug testing to determine the abstinence from the drug. The article argues that the causes and solutions to problem drug use are as much more to do with socio-economic factors than physiological or psychological factors. In particular it explores the connections between the emergence and sudden rise in problematic drug use that occurred across the UK in the mid 1980s, with deindustrialisation and the decline of opportunities for unskilled non academic young people. Further the paper critically examines the notion of the ‘problem drug user’, in particular how those identified and labelled, are perceived and treated by wider society, and how this adversely impacts upon drug rehabilitation and social integration.