The Future Redefinition of Treatment

‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs inside an institution – a medical, psychological, and spiritual sanctuary isolated from the community at large. In the future, this locus will be moved from the institution to the community itself. Treatment will be viewed as something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization. Such a transition does not deny the importance of the reconstruction of personal identity and other cognitive and emotional processes – or of the physical processes of healing – in addiction recovery. But it does recognize that such processes unfold within a social ecosystem and that this ecosystem, as much as the risk and resiliency factors in the individual, tips the scales towards recovery or continued self-destruction.

As these new community organizers extend their activities beyond the boundaries of traditional inpatient and outpatient treatment, they will need to be careful that they do not undermine the natural indigenous systems of support that exist in the community. The worst scenario would be that we would move into the lives of communities and – rather than help nurture the growth of indigenous supports – replace these natural, reciprocal relationships with ones that are professionalized, hierarchical and commercialized.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 341.