Contrasting and Converging Philosophies of Three Models of Alcohol/Other Drugs Treatment

Abstract

The Institute of Medicine and Project MATCH have promoted the concept that various treatment programs are equally effective. Yet little attention has been paid to common treatment models in current use. This paper compares three dominant models evident in public and private substance abuse treatment today: the Minnesota Model, the California Social Model Programs, and the addiction Therapeutic Community. We explore their common roots in Alcoholics Anonymous (AA), and how each approach selectively borrowed particular AA principles (e.g., abstinence as the goal, reliance on the experiential knowledge of recovery, etc.) while rejecting others (i.e., Therapeutic Communities adapted some of AA's 12 steps, but without spirituality as an ingredient). We then examine the dominant forces that were exerted on these emerging treatment approaches, including the development of the treatment industry (with alcoholics and drug addicts initially treated separately, but later merged), the professionalization of counselor roles (with Social Model Programs most vulnerable), and managed care to achieve cost containment. The current status of each model is presented which indicates that the differences among them had significantly narrowed by the year 2000. Homogeneity among models raises the issue of when a treatment center can legitimately identify itself as using a specific model: How can a policy maker, funder, or researcher be assured that a treatment center operates with its advertised model? Finally, we discuss the common therapeutic ingredient that remains: the peer-group process.