Patients who entered heroin-assisted treatment (HAT) (n = 220) or abstinence-oriented residential treatment (AORT) (n = 982) in Switzerland in 2005/06 were compared. Patients entering HAT were older, spent more time in prison and had more previous treatment attempts, but AORT patients had more often unsafe injections. Selfreferrals were more frequent for HAT, referrals by court for AORT. Social conditions improved in both patient groups compared to patients entering 10 years ago. Average age at entry increased, particularly in HAT. Heroin as primary substance of abuse has decreased in AORT, mainly in favor of cocaine. Conclusions for other countries engaging in HAT are: HAT leads to a new balance among treatment approaches. AORT must be better adapted to the needs of nonopioid and younger addicts, while HAT takes care of older clients with more health problems and former crime involvement. Referral practice should consider this situation.