The field of addiction treatment is facing a growing cultural backlash that threatens its future as a viable social institution.
Cultural ownership of an intractable problem vacillates over time. Vague but passionate promises of a new approach always garner more hope than the known limitations of current efforts. And any industry that has attracted substantial financial capital will draw a subset of individuals and organizations who will sacrifice public health and safety for personal and corporate profit. When such limitations and abuses are exposed, there exists the risk that a social institution's probationary status will be revoked and their functions transferred to new or existing institutions within their operating environment. Aware of such risks, most fields develop standards of organizational and professional practice that maximize effectiveness and elevate ethical decision-making. Such protective devises help assure that exposure of industry shortcomings are viewed as the misconduct of particular organizations and individuals and not a reflection on the industry as a whole.
Since its inception in the mid-1800s, there have been regular exposures of incompetence and profiteering within the addiction treatment industry. In recent decades, professional and regulatory standards, professional education and training programs, and clinical research studies have been developed to improve the legitimacy and quality of addiction treatment. In spite of such efforts, the frequency and intensity of criticisms of addiction treatment are presently in sharp ascendance. A week does not go by that one cannot read or view an indictment of addiction treatment as a whole or of one of its providers. These charges include allegations of financial exploitation and fraud, allegations that the dominant models of addiction are inherently flawed and scientifically indefensible, exposure of claimed treatment success rates as nothing more than marketing hype, reports of sexual exploitation with addiction treatment and recovery mutual aid organizations, headlines reporting staff members of addiction treatment organizations dying of a drug overdose or being arrested for drug trafficking, and media reports of legal suits related to patients dying during addiction treatment. There are days it feels like the whole industry is under attack. And from a historical perspective, it is.
The confluence of rising moral panic over ever-surging opioid deaths and rising cultural pessimism about the effectiveness of addiction treatment poses a significant threat to the future of addiction treatment as a social institution. When such a confluence occurred in the late nineteenth and early twentieth centuries, Americans embarked on a bold new experiment: let those currently addicted die from benign neglect and prevent a new generation of addicts by legally prohibiting alcohol and aggressively controlling the manufacture and distribution of opium, morphine, heroin, cocaine, and newly arriving sedatives. It was in the wake of such changes that America's first network of inebriate asylums, inebriate homes, and private addiction cure institutes collapsed.
To avoid modern replication of such a fate, it is imperative that the treatment industry embarks on a "fearless moral inventory" (i.e., state of the field review) and shares the results of that inventory with service providers, service recipients, policymakers, and the public. At least one aspect of that inventory should be the clear delineation of the ethical and standards of clinical practices that delineate the healers and hustlers within the field. The latter are most notably marked by aggressively marketed products and services that lack evidence of their effectiveness and that serve a singular goal: financial profit. My long-time mentor, Dr. Ernie Kurtz, used to collectively castigate such products and services as recovery porn.
Reputable providers of effective addiction treatment have been far too silent in confronting professional incompetence and unethical business and clinical practices within the field. As a result, the field is vulnerable to being cast in whole as little more than modern snake oil salesmen. While damage to the field's reputation among the policymakers, funders, public, and allied professions would constitute a severe wound, even more tragic would be disillusionment about treatment among communities of recovery who might then increasingly see themselves, not as a complement to professional treatment, but a preferable alternative to such treatment.
In spite of a half century of rapid growth, specialized addiction treatment holds only probationary status as a cultural institution in the United States. The growing backlash against addiction treatment is exposing critical areas of institutional vulnerability that could and should set a needed agenda for positive systems transformation. The field must assertively address these needs if it is to prevent revocation of its status and assureIts future viability and the continuity of recovery support for the individuals and families it is pledged to serve.
When the first serious criticisms of Alcoholics Anonymous (AA) broke into the public press in the early 1960s, many within the AA fellowship looked to AA co-founder Bill Wilson to provide a point-by-point response to such criticisms. Instead, Wilson suggested on the pages of the A.A. Grapevine (April, 1963) that criticisms of AA could be best met with public silence, internal self-reflection and, where needed, concerted self-correction. He further suggested that AA should offer thanks to its critics in such circumstances. The treatment industry would be well-served to heed Wilson's advice instead of responding only with defensive counterattacks on its critics. Efforts by the National Association of Addiction Treatment Providers, the American Society of Addiction Medicine, NAADAC: The Association of Addiction Professionals, theNational Alliance for Recovery Residences, and the Association of Recovery Community Organizations are to be commended for their work elevating service and ethical standards within the addiction treatment and recovery support arenas.