William (Bill) L White’s 1998 book Slaying the Dragon: The History of Addiction Treatment and Recovery in America is one of the best books that I have read. Here is how the book is described on the back cover:
‘This is the remarkable story of America’s personal and institutional responses to alcoholism and other addictions. It is the story of mutual aid societies: the Washingtonians, the Blue Ribbon Reform Clubs, the Ollapod Club, the United Order of Ex-Boozers, the Jacoby Club, Alcoholics Anonymous, and Women for Sobriety. It is a story of addiction treatment institutions from the inebriate asylums and the Keeley Institutes to Hazelden and Parkside. It is a story of evolving treatment interventions that range from water cures and mandatory sterilisation to aversion therapies and methadone maintenance. William White has provided a sweeping and engaging history of one of America’s most enduring problems and the profession that was birthed to respond to it.’
Near the end of his book, Bill looks to the future [I have broken down his section into short paragraphs—DC] ::
‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs within 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 relationship in a social environment. With this shift will come an expansion of the role of the 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 in the individual, tips the scale 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 system of support that exist within 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, hierarchal, and commercialised.’
These words, were originally written in 1998, predict a future of developing recovery communities, which is occurring today. But Bill adds words of caution in his last sentence. These recovery developing communities should not become ‘professionalized, hierarchal, and commercialised.’
There is a space for professional treatment, in helping people ‘get off’ drugs. However, it is must not dominate. As emphasised by many people in long-term recovery, it is much easier ‘getting off’ drugs than it is ‘staying off’ them. Today, professional treatment receives the vast majority of funding when compared to indigenous recovery communities. That situation must change.
NB. Bill says: ‘Treatment will be viewed as something that happens in indigenous networks of recovering people that exist within the broader community.’ I take the point that Bill is making, but I do not believe that we should use the word ‘treatment’ here—a better word would be recovery.