The level of substance misuse in Britain has fluctuated over recent centuries, reaching its nadir in the early twentieth century. Since then, the trends for alcohol and drug abuse (though not for tobacco consumption) have risen steadily. British physicians have played a major role in the emergence of the addiction concept, from the initial challenge to Galen's theories to the now widely adopted Alcohol Dependence Syndrome. While treatment has been influenced by contemporary attitudes, it has been generally underpinned by pragmatism and has avoided the punitive responses seen in other parts of the world.