What a Radical 1970s Program Got Right about Treating Addiction

I was recently invited to give a talk on recovery housing research and found myself wondering where the term “social model” came from. I found this account, which claims it was coined by a book published in 1973, Recovery from Alcoholism: A Social Treatment Model. That book’s principal author, Bob O’Briant, would go on to help write some of the earliest policies for recovery housing in California.

I dare you to try and find a copy of this book for sale (Please let me know if you do). But through the great wonders of the Interlibrary Loan System, I was able to find one I could borrow.

I prepared myself for a heady analysis of treatment. But the book is really more of an evaluation report, describing the design and outcomes of a multi-stage alcoholism treatment program in San Joaquin County, California.

The program started in October of 1969, run out of Bret Harte Hospital in Murphys, California. It had treated more than two thousand patients by 1972. The program boasted a 75% sobriety rate after eight months, when this rate was flipped in the general hospital.

But the most striking thing about this program is its assumptions about addiction,

“The sustaining forces in the use of alcohol, therefore, do not reside in the individual alone, but lie in the whole context of events that sustain the individual’s pattern of behavior…It becomes evident that an alcoholic’s drinking pattern cannot be changed without making changes in his physical and social contexts” (p. 8-9, emphasis mine)

The solution for addiction (alcoholism) is then to be found by simultaneously treating both the individual and their context; grafting that individual to an entirely different environment, one that reinforces recovery, rather than drinking. That philosophy was exactly what underlay many of the program’s features, ones that seem progressive even today:

Total Peer Approach

Upon entering detox at the Bret Harte program, fellow patients provided support. Crisis was not managed by “the use of restraints”, but “relieved by the presence of other members”. This was deliberately designed to cultivate “interdependence”. It was believed that early, painful experiences helped bond patients who would eventually form a cohort. Patients were continuously encouraged to reach out to each other after finishing the program. Alumni groups were created to reinforce contact. The facility itself depended on patients; most of the running of treatment was “assumed by patients themselves”, including maintenance, cooking, and organizing activities.

Bridges from Clinical Care to Recovery Community

As the program matured, staff made inroads into the wider community. In the nearby Stockton, the program founded support meetings and hosted social activities like “dances and potluck dinners.” Former and current patients were invited to socialize and hang out with the program’s staff. The authors referred to the program as just a “temporary respite”; the social environment a patient would return to was much more important to success. At the book’s publication, the authors stated that program-sponsored “alcohol-free bars, stores, and coffee shops” were being developed nearby, aiming to develop a “counterforce” to pro-alcohol pressures.

Inclusion of Families

Anticipating something we’re only beginning to take seriously, the program strongly encouraged the participation of families. “Roundtable” meetings at Bret Harte were established for families and the teenage children of program participants. A couples’ meeting was held for participants during their stay. Each feature was meant to “expand, strengthen, and diversify the larger social network within which each member is embedded.”

What Can We Learn?

Community is a word you hear thrown around in recovery spaces, but what about “interdependence”? Baked into the design of Bret Harte was a system designed to turn solitary individuals into supportive cogs of a larger system. It echoes one of my favorite essays, which argues that Alcoholics Anonymous works by challenging the perspective of “Self”. Who is Self? Well, usually we draw the box around the body, or often, the mind, and say, this is the individual. But it fails to account for the “interlocking processes” that underlie life, the interdependence that we all have with each other.

This fallacy is ever deepened in addiction.

But you can make people realize the boundaries of Self are much wider than they appear when you allow people to depend on each other. Recovery housing accomplishes this through chores, through house meetings which invite shared decision making, through service positions that have a meaningful impact on the stability of the house. But Bret Harte started this process even earlier in the recovery process – from the very first day of detox. In order to get through this, you’re going to need other people. This lesson can be intentionally baked into programs, or it can be artifact of a natural process. But as long as mainstream culture is hostile to recovery, this lesson will be important for shaping recovery supports that produce long-term outcomes.