A distinction has come to exist between people doing “recovery” and people doing “treatment.”
In order to feel the distinction, one must step into both camps. This doesn’t happen often enough. Among the approaches dividing the two is that recovery people have been relying on sober homes and peer support to help people develop long-term recovery from addiction.
Treatment people have been relying on short-term, acute-care models to treat a chronic disorder.
Within treatment circles the word “treatment” has come to mean residential care. This is also the public’s perception of what treatment for addiction is. Once a person completes a traditional 28-day stay in residential care, the expectation is that the disorder is cured. Unfortunately, the professional community acts as though we share that perception. The objective of residential care needs to be reducing a patient’s symptoms so that he/she can be addressed at a lower outpatient level of care. Completing the objectives of residential care is not a graduation.
Perhaps both treatment and recovery people need to stop treating addiction as a series of acute episodes.
In order to bridge a schism, the first task is to educate people to the fact that it exists. By dipping my toe into the “recovery” world (kind of by accident), I found out what a Recovery Oriented System of Care (ROSC) is. When I went back to the “treatment” world that I’ve been living in, the response to my excitement about ROSC was, “OK, sounds good, got to get back to work.”
My time spent in the recovery world brought me closer to the writings of Bill White, possibly the most widely cited professional I know of. Back in the treatment world, it’s, “Bill who?”
This needs to be considered. I’ve worked in treatment for more than 30 years. I know that I’ve been part of teams that have helped a lot of people. I’ve researched, published and presented. It’s taken that long to find out what a ROSC is and to learn about Bill White. Something's wrong with that picture. I’m not alone.
But we shouldn't let the recovery camp off that easy either. I’ve met people who believe that all that is necessary to treat addiction is something like residential care and long-term support in a sober home. There are occasions when residential care is skipped altogether.
The problem I have with that is that most of the patients I’ve worked with for the past quarter century will not and don’t need to move into a sober home. Do you just write these people off?
It may be crazy, but I think that people in the recovery camp write off people from middle- to upper-class socioeconomic groups. On the other hand, people in the treatment camp mostly treat people with health insurance. It is also my impression that the treatment camp has become much better at treating co-occurring disorders such as trauma and affective disorders.
There is no doubt in my mind that recovery people and treatment people have a lot more in common than they have differences:
Both camps want people to get well.
Both emphasize the importance of mutual support.
Both perceive addiction to be a chronic disorder.
Both perceive treatment as something that goes on for a relatively short period of time.
A person who participates in all of the residential and outpatient levels of care, as recognized by the American Society of Addiction Medicine, is likely to have met all treatment objectives in about a year. People with other chronic disorders (e.g., diabetes. hypertension) are monitored by professionals forever.
Recovery and treatment people can agree that people with addiction are deserving of the same high-quality, lifespan, professional care/monitoring that people with other chronic disorders receive, without question.
I suspect that people will either agree or disagree with some, or all, that I’ve written. That’s what’s good about a blog. Send a response to me at firstname.lastname@example.org. Let’s get a conversation going.