Let’s take a look at some of the statements Bill White makes in his 2003 paper on the lost roots of addiction counseling. And as we do, let’s think about the context we currently see in the addiction treatment and SUD services space.
What points in this paper help us have clarity about our work today?
Summary
The paper is written from the point of observation within Bill’s career. It describes a major decision in the history of the SUD services arena. The fork in the road was at a basic conceptual level. Would SUD services be (1) non-professional and community based, or (2) professional and clinic-based? The decision was made. And the decision was to turn the field of SUD services professional.
As a side effect of that decision and the passage of time, the modern SUD arena has forgotten the existence of the non-professional and community-based model that pre-dated our modern SUD services.
It’s important for us to look back at this model. Why? Any model has advantages and disadvantages. We can glean lessons from knowing and understanding the non-professional and community-based model that pre-dated our current professionalized era. Here are two specific hints for us today.
What if evoking, supporting, and maintaining recovery was our primary directive?
What would we change about our current work if it was?
Five Key Themes
- Professionalizing recovery-oriented services of any kind (addiction counseling, recovery coaching, peer support, community health worker, etc.) brings the installation of academic and clinical knowledge and methods. These are applied to the person served. But that content can also be found in a burden of regulatory requirements and the regulatory environment in general. That is, we might end up serving the model, instead of the person.
There are also concerns that the role of the addiction counselor is being corrupted by an inordinate preoccupation with regulatory compliance and financial profit (and the resulting paper processing) rather than on transforming lives.
2. In 2003 when the paper was written, people thought the “recovery coach” concept and function were new. But history shows us that the idea of the so-called recovery coach, as well as its function, predated the modern formation of the recovery coach concept by a number of decades. This serves as a warning, because that role and function were previously professionalized out of the field. And later they needed to formally re-emerge.
This…is being countered in some quarters by adding what are lauded as new roles to the interdisciplinary addiction treatment team: outreach workers, recovery support specialists/coaches/mentors and peer counselors. The focus of these roles is to personally engage and motivate clients and to link them to the recovery community Ironically, these are the very functions (and the traits of assertiveness, persistence, and hopefulness) that first distinguished the role of the addiction counselor.
3. We should be students of our own field’s history. The roots of our field contain valuable components not found elsewhere.
Lost Roots. During the 1960s and early 1970s, there existed an alternative to the medical model of alcoholism intervention…
….and it…
focused attention on building capacity to address alcohol problems not within a treatment center but within the larger community.
4. One of those roots is an emphasis on non-clinical support, delivered in the community rather than a clinical setting, aimed at connecting the person served to community-based non-professional supports.
The Iowa model focused on organizing and mobilizing natural resources within the community that could aid the recovery process, and on linking the alcoholic to these
resources…The …model also emphasized – years before the introduction of motivational interviewing – that the job of the “counselor/consultant” was to “motivate and accelerate progress toward recovery” even when the alcoholic was not yet ready for help
5. Financial interests and the activities of initiating and sustaining recovery are not necessarily aligned.
In that rising tide of professionalization and industrialization, voluntarism within the
addiction problem arena slowly declined and was replaced by an ever-growing class of
paid helpers. Mulford charged that the alcoholism field “sold out” in its search for federal and state funding
There was a similar shift in the history of social work from community-oriented casework to psychotherapy. This shift marked a relocation of service delivery – from the community to the consulting room – and a shift in the target of such services from the environment of the client to the unique developmental history and mental/emotional processes of the client. In its search for professional status, the field of social work shifted its emphasis from social and political action to the mastery of clinical technique – a shift that brought greater status and higher salaries
Relevance for Today’s Addiction Professionals
Today’s professional addiction counselor would do well to include the study of the history of our field as a relative constant throughout one’s career. We can retain what should be retained, and improve what should be improved, perhaps more efficiently and effectively, by knowing the lessons of the past.
The community is an oasis of resources (people, places, things, etc.) that constitute recovery capital. But the community can also be a target of our efforts that we aim to improve over time with the presence of (1) recovery, (2) people in recovery, and (3) the vibrancy of a wellbeing that is communicable.
We can take action in our own communities by showing up in community settings. And in those settings, we can come to know, and be known.
And we can take action within our clinical settings by actively creating living linkages that allow recovery, people in recovery, and the experience of the fellowship, to take root where we help people professionally.
I encourage everyone to give this brief article a careful read. I wonder what other lessons and action steps the reader will gain from doing so – from reading this portion of our history.
And some further resources are down below.
Suggested Resources
2005 Manual for Recovery Coaching and Personal Recovery Plan Development.
David W. Best, Ph.D. Cultivating Recovery Capital.
The Icelandic Prevention Model. Michael J. Mann, John P. Allegrante, Megan L. Smith, Inga Dora Sigfusdottir, Alfgeir L. Kristjansson. The Icelandic Prevention Model Evaluation Framework and Implementation Integrity and Consistency Assessment. Evaluation and Program Planning, Volume 106, 2024, 102451, ISSN 0149-7189, https://doi.org/10.1016/j.evalprogplan.2024.102451.
The Icelandic Prevention Model (IPM) follows a systematic but flexible process of community capacity building, data collection, analysis, dissemination, and community-engaged decision-making to guide the data-informed selection, prioritization, and implementation of intervention strategies in preventing adolescent substance use. This paper describes two new evaluation tools intended to assess the: 1) integrity of IPM implementation, and 2) unique aspects of IPM implementation in different community contexts.
Recovery Review 
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