Yesterday, Bill Stauffer revisited William White’s article, The Historical Essence of Addiction Counseling.
I won’t re-summarize the article, but I want to focus on one particular theme
If AOD problems could be solved by physically unraveling the person-drug relationship, only physicians and nurses trained in the mechanics of detoxification would be needed to address these problems. If AOD problems were simply a symptom of untreated psychiatric illness, more psychiatrists, not addiction counselors would be needed. If these problems were only a reflection of grief, trauma, family disturbance, economic distress, or cultural oppression, we would need psychologists, social workers, vocational counselors, and social activists rather than addiction counselors. Historically, other professions conveyed to the addict that other problems were the source of addiction and their resolution was the pathway to recovery. Addiction counseling was built on the failure of this premise. The addiction counselor offered a distinctly different view: “All that you have been and will be flows from the problem of addiction and how you respond or fail to respond to it.”
Addiction counseling as a profession rests on the proposition that AOD problems reach a point of self-contained independence from their initiating roots and that direct knowledge of addiction, its specialized treatment and the processes of long-term recovery provide the most viable instrument for healing and wholeness. If these core understandings are ever lost, the essence of addiction counseling will have died even if the title and its institutional trappings survive. We must be cautious in our emulation of other helping professions. We must not forget that the failure of these professions to adequately understand and treat addiction constituted the germinating soil of addiction counseling as a specialized profession.
White, W. (2004). The historical essence of addiction counseling. Counselor, 5(3), 43-48.
What I wish to draw attention to is the unique unitary nature of addiction as an illness of addiction requiring long term recovery (which White described as a “life and death struggle”) and often requires specialized treatment. Despite this uniqueness, that specialty addiction counseling was born from, addiction, addiction counseling, and addiction recovery are often confused and conflated with other problems and solutions. (His use of “AOD problems” here seems noteworthy. I’d confine his statements to addiction rather than all AOD problems.)
White presents an ominous warning with the possibility that “the essence of addiction counseling will have died even if the title and its institutional trappings survive.” This suggests that it could die without our full awareness.
In another writing, he discussed a couple of potential avenues for this process:
Diffusion and diversion constitute two of the most pervasive threats in the history of addiction treatment institutions and mutual-aid societies. Diffusion is the dissipation of an organization’s core values and identity, most often as a result of rapid expansion and diversification. Diffusion creates a porous organization (or field) that is vulnerable to corruption and consumption by people and institutions in its operating environment. Diversion occurs when an organization follows what appears to be an opportunity, only to discover in retrospect that this venture propelled the organization away from its primary mission.
White, W. L. (1998). Slaying the Dragon: The History of Addiction Treatment and Recovery in America, page 341
Relevance for Today’s Addiction Professionals
So… what threats exist for today’s addiction professionals and our specialty addiction treatment systems?
Ironically, one threat might be efforts to develop recovery-oriented systems of care, that use recovery as an organizing paradigm to unify the following into a single project:
- recovery advocacy,
- advocacy for AOD users,
- addiction treatment,
- SUD treatment (which includes lower severity and acute AOD problems),
- harm reduction, and
- peer services in each of the above areas.
In many cases, mental health and public health might be added the the list above.
The insistence that all of this should be unified into a single project produces significant friction that only occasionally seems generative. Further, the compromises necessary to unify these projects may result in the kind of diffusion and diversion that White describes above.
Trying to impose consensus on the boundaries of recovery and acceptable endpoints from people who have spent decades developing a philosophy of harm reduction and those who developed models of care for severe cases of addiction focused on facilitating abstinent recovery is likely to sacrifice the historical essence of both.
I increasingly find myself thinking that there’s room in the space for multiple projects and many of these efforts might be better off focusing on coexistence and cooperation rather than integration.
Recovery Review 