Efforts are well underway to shift addiction treatment from models of ever-briefer acute care to models of sustained recovery management (RM) nested within larger recovery-oriented systems of care (ROSC). This shift involves extending the continuum of recovery support services across the stages of long-term recovery, but it also embraces a more activist stance in shaping community environments in which addiction recovery can flourish. RM and ROSC, through their recognition of the ecology of addiction recovery, force a rethinking of drug policy at national and state levels and place clinical interventions within a larger rubric of local cultural and community revitalization. The roots of such perspectives are many, but some can be traced to the early history of social work in the United States.
Social work in recent decades has emphasized clinical interventions into social problems. Early social work, however, was marked by its belief that social problems had social roots and that community and societal level interventions were needed to resolve and prevent the nation's most intractable social problems. The methods of RM and ROSC are closely aligned with the core values, principles, and methods of early social workers in the U.S. via their:
*activism in drug policy reforms,
*exposure of political, economic, and cultural marginalization as factors in addiction vulnerability,
*challenge to institutional influences (e.g., predatory marketing) that promote and then profit from excessive alcohol and drug (AOD) use and its resulting problems,
*preference for working with people in their natural environments via assertive outreach rather than the clinical consulting room,
*respectful, egalitarian, partnership relationships with those served (i.e., preference for empathy and support rather than judgment and confrontation),
*focus on client/community assets rather than deficits,
*emphasis on the healing power of client voice and choice,
*mobilization of affected people to advocate on their own behalf,
*efforts to forge mutual support groups and "healing sanctuaries" within local communities, and
*warning that short-term quick fixes can result in long-term harm to individuals, families, and communities.
The activist roots of social work declined under the growing influence of psychiatry and psychology. Growing numbers of social workers embraced clinical models of diagnosis and counseling, with many aspiring to a future in clinical private practice as the apex of one's professional achievement. Interestingly, by the mid-twentieth century social workers were also getting a reputation for ineffectiveness in their clinical work with people who were addicted. The bleeding heart trope emerged that social workers were too soft to work with hard-core addicts--that they failed to understand addiction, were too easily manipulated, and too often served as addiction enablers. Anyone familiar with the modern history of addiction treatment is aware that social workers went on to make significant contributions to clinical models of addiction treatment, particularly in services to addiction-affected families and children. Given these achievements, the contributions within the early history of social work that helped shape models of RM and ROSC can be easily overlooked. If RM and ROSC survive as effective organizing paradigms for addressing addiction at personal and systemic levels, and if the history of RM and ROSC is one day written, then the acknowledged pioneers who set the stage for these paradigms should include Jane Addams and other early pioneers within the activist tradition of social work.
The activist roots of social work, with their emphasis on environmental influences on social problems, provide needed balance in what many consider the current over-emphasis on biological models of addiction. For that balance, we owe much to the early history of social work and the current revival of its activist roots.
For more on the activist roots of social work and their infusion into RM & ROSC, see the following:
McKnight, J. (1995). The careless society: Community and its counterfeits. New York: Basic Books.
Specht, H., & Courtney, M. (1994). Unfaithful angels: How social work has failed its mission. New York: The Free Press.
White, W. (2002). A lost vision: Addiction counseling as community organization. Alcoholism Treatment Quarterly, 19(4), 1-32.
White, W. L., & Sanders, M. (2008). Recovery management and people of color: Redesigning addiction treatment for historically disempowered communities. Alcoholism Treatment Quarterly, 26(3), 365-395.