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Aims: This study investigated the commissioning and delivery of advocacy for problem drug users. We aimed to quantify provision, describe the commissioning of advocacy services in Drug Action Teams (DATs) and to identify factors influencing advocacy provision. Methods: A cross-sectional survey of a randomly selected sample of 50 English DATs. The purpose-designed questionnaire comprising a mix of closed and open questions was completed through a telephone interview. Findings: An 86%% response rate was achieved. Informants understood 'advocacy' as encompassing a range of activities including user involvement and peer support. A range of approaches classified as formal, informal and ad hoc were described. Whilst advocacy was identified as a need in 29 DATs (67%%), formal, independent advocacy was commissioned in only four (9%%). In eight DATs (19%%), there was no advocacy provision of any kind. Conclusions: Advocacy is described by the National Treatment Agency as an essential element of effective drug treatment systems. However, provision in English DATs is inconsistent, poorly integrated with treatment systems and characterized by the absence of strategic planning. Clarification of the concept and purpose of advocacy as either a right adhering to citizenship or a means to achieve treatment targets is an essential first step towards systematic and meaningful integration of advocacy within the treatment system. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented that discusses the need to encourage medical trainees to consider career in medical education.