Qualitative research on the social model approach (1998)

American abuse treatment and programs operate in a context in which medical and mixed-model (e.g., model/Hazelden) approaches to treatment dominate the field. The emphasis on medical/professional responses to abuse and addiction treatment not only has affected the treatment available and the funding decisions about treatment, but also has made medical/mixed-model programs nearly synonymous with substance abuse It has become difficult for many (especially those with medical or professional training) to imagine abuse treatment that does not have at least some significant clinical component. This is especially true in an era of increasing cost containment measures by insurers and other payors, for whom reimbursement is most often tied to tangible (and auditable) medical procedures. Yet as this special issue shows, professional clinical treatment is not the only legitimate approach to addressing abuse and addiction, nor is the medical the only possible paradigm under which treatment may be discussed. Quite to the contrary, the papers in this special issue reveal that the medical is just one possible paradigm for treatment, which may be balanced against another discrete and alternative paradigm-that underpinning the model approach. Social is not simply a stripped-down version of clinical treatment or a poor man's medical treatment. Neither is it simply some kind of reaction to medical/professional treatment, designed to be somehow everything that medical treatment is not. It is rather a truly alternative paradigm, with different origins and leadership and a measurably different approach to treatment. Thus recovery is a philosophy and a practice of treatment, in much the same way that the Minnesota model is a discernible mixed-model approach blending a clinic with AA principles. The papers in this special issue address various aspects of the model approach to abuse/addiction treatment and recovery. In so doing, they attempt to help define model and to give readers a sense of how social programs compare with what might be called conventional treatment. Social is an alternative paradigm that has gone largely undiscovered in scientific literature. This issue is largely a descriptive attempt to provide background and some insight into how social programs function, what beliefs drive the main practices and procedures that are inherent to the social philosophy, and how these structures differ from what may be thought of as typical American medical or mixed-model treatment. This type of an analytic discussion of the practices and philosophy of social seems a necessary prelude to any discussion of the comparative worth or efficacy of these different types of programs. In other words, it is first necessary to say what social is before one becomes able to question what social does (or how well). Counterposing social philosophy with that of conventional medical treatment illuminates not only the principles driving social but also the programs' areas of emphasis, which may guide future analyses of their efficacy. The papers in this special issue deal with three programs (two social one medical model) that were the subject of indepth qualitative observation over a period of more than four months. Their authors are for the most part members of the research team that conducted the observations, and each of the papers is informed by the quest to define and explain the social philosophy. The issue begins with a Brief Overview of the Social Model Approach. This introduction lays out the context for and the history of social programs. This literature-based analysis helps define the terms of the discussion, clarifies what it means for a program to be model, and also describes the methodology for qualitative observation at the three programs. …