Abstract.This article should be considered not in isolation but in a context of private health provision in general, and examined from an international standpoint. In the UK there has been a growth of private health care and as pan of this growth, it is likely that patients with problems of alcohol and drug misuse will choose private facilities, which now increasingly exist. Patterns of treatment in any country are based on historical traditions. Thus in the UK the principle NHS response has been to provide specialised alcoholism treatment units, which increasingly provide out‐patient and day facilities, as well as in‐patients. Although there has been criticism of these units, they remain the principle approach. In West Germany in‐patient treatment has been the norm. In other countries in Northern Europe emphasis has been on out‐patient treatment with a strong social bias. More important, however, is that clearly patients with alcohol or drug problems, once they recognise such problems, wish to attend a treatment facility where they feel they will receive expert treatment. Their experience with non‐specialized agencies is often said to be negative and it is not surprising if they turn towards such specialized units, in the same way as patients with other medical conditions all seek specialist expertise. Patients are hardly likely to have analyzed research studies on effectiveness of treatment and it is questionable whether many studies alleging failure of treatment take into account poor compliance. Both on historical, traditional and common sense lines it is, therefore, likely that people will pursue private treatment, despite what so called ex