The Future of Addiction Treatment Revisited

“The best way to predict the future is to create it.” –Peter Drucker

In 2003, Dr. Tom McGovern, the distinguished Editor of Alcoholism Treatment Quarterly, and I published an article offering some predictions on the future of alcoholism treatment in the United States. In spite of our long tenure as students of addiction treatment history, we did so with the full realization that those who have risked making such predictions in the past often made fools of themselves. A dozen years later, it seems a good time to revisit those 22 predictions.

 Infrastructure and Cultural Context

 Prediction 1:  The federal/state/local partnership created by the Comprehensive Alcoholism Prevention and Treatment Act of 1970 (known as the Hughes Act) will be challenged by the growing restigmatization, demedicalization and recriminalization of severe alcohol and other drug problems. 

 Prediction 2: The federal investment in an alcohol problems research infrastructure will reap significant rewards in the coming decades. 

 Organization

 Prediction 3:  The integration of the treatment of alcohol and other drug problems–arguably one of the major professional achievements or (according to some) the worst mistake of the past 25 years–will progress in the next decades with a full integration of the treatment of nicotine addiction alongside the treatment of other drug addictions. 

 Prediction 4: The categorical segregation of the treatment of alcohol problems will be severely challenged in the next two decades as alcohol treatment programs are absorbed into larger umbrellas of “behavioral health” and “human services.” 

 Problem Definition

 Prediction 5: Multi- pathway models of understanding and intervening in alcohol problems will replace more traditional, single-pathway models. 

 Prediction 6: The next two decades will witness attempts to integrate the emerging public health and medical/clinical models of understanding and responding to alcohol problems. 

 Changing Characteristics of Treatment Consumers

 Prediction 7:  Differences between community and clinical populations will widen with the multiple problem client/family (greater problem severity and psychiatric co-morbidity and fewer recovery assets) becoming the norm within publicly funded treatment programs.  

 Prediction 8: Escalating life expectancies and the demographic aging of the “war babies” will spark growing concern about the problem of late-onset alcohol problems. 

 The Professionalization of Treatment Providers

 Prediction 9: The recognition of addiction medicine as a recognized specialty will continue, but will be offset by greater involvement of primary physicians, physician assistants, and nurse practitioners in the treatment of alcohol problems. 

 Prediction 10: The continued professionalization of the role of the addiction counselor (e.g., the licensure movement) will be balanced by new roles (recovery coaches, recovery support specialists) that will bring greater numbers of recovering people back into the field. 

 Prediction 11: Professional roles in the field, dominated by men when the first issue of ATQ was published, will be increasingly filled by women. 

 Treatment Technology

 Prediction 12: The organizing mantra of the next decade will be the call to bridge the gap between clinical research and clinical practice in the resolution of alcohol problems. 

 Prediction 13: The next decade will witness the widespread application of disease (recovery) management technologies from primary medicine to the treatment of severe and persistent alcohol problems. 

 Prediction 14: Research findings will compare and contrast explicitly religious and spiritual frameworks of recovery from explicitly secular frameworks. 

 Prediction 15: There will be a movement to push the breakthroughs in knowledge about special populations of clients from the enclave of the demonstration project to the mainstream of the field. 

 Professional Ethics

 Prediction 16: There will be a significant movement in the next decade to get the treatment field ethically re-centered. 

 Prediction 17: New roles that focus on harm reduction, pre-treatment/engagement, and sustained recovery support will call for a re-evaluation of traditional definitions of appropriateness related to ethical conduct, particularly those governing relationship boundaries. 

 Recovery and Community

 Prediction 18:  The treatment field will face in the next decade what it has never faced in its history: a strong consumer/constituency movement. 

 Prediction 19: The locus of treatment will expand beyond the institutional/office environment to the natural environment of each client. 

 Prediction 20:  There will be increased demands for the field to shift its research focus from one of pathology to one of resilience and recovery. 

 Prediction 21: The growing “varieties of recovery experience” will continue to manifest themselves within the growing diversification of mutual aid structures. 

 Achilles Heel: The Aging of the Field

 Prediction 22: The rapidly approaching loss of long-tenured clinical and administrative leaders will constitute one of the most significant challenges to the future integrity and existence of the field. 

 I will leave it to the reader to judge the accuracy of these predictions now that years have passed since they were formulated.  What would your predictions be for the future of addiction treatment and recovery during the next 20 years?