For 28 years, an important part of my professional identity has been “addiction professional.” Over that 28 years, addiction professionals have never been a very harmonious group. There have always been disagreements about things like policy, the best treatment models, credentialing, and many other controversies. Despite these disagreements, I never really questioned whether we all belonged to the same general classification–addiction professionals. We often divided up into different camps within the profession and there was plenty of disagreement, but they felt like disputes internal to a coherent professional category because there was enough agreement about things like the risk of harm associated with alcohol and other drug use, the targets for intervention, and endpoints.
In recent years, I’ve grown increasingly concerned about addiction treatment and policy becoming a front in the culture wars. I still believe there’s truth to that, with one-wayers or self-promoters of various types (12-step, harm reduction, medication) often becoming the loudest and most influential voices in the space.
However, another frame is becoming clearer to me. As we have more engagement from public health, harm reduction, and medical providers, there is a growing number of professionals working with addiction, but not recovery. This is an observation, not criticism. Many of these professionals are doing essential work with very high severity, high chronicity, and high complexity cases for whom, in many cases, the treatment system has no real place for. My contact with them made me realize that they are addiction professionals. I’ve worked as something else, a recovery professional or an addiction and recovery professional or a treatment professional, I suppose.
Further, we also have professionals working in this space whose primary concern is drug use, rather than addiction or recovery. I suppose the proper title for them is something like substance use professional?
None of this is to criticize or rank these areas of practice. They are all necessary. The problem is that too many people in each area seek to delegitimize the others.
There’s plenty of room for disagreement about which interventions make sense in which context, what policy should look like, the nature of addiction, and more.
However, there ought to be broad agreement that we need systems that respond to the needs of people who use drugs, AND respond to the needs of people in addiction, AND offer a pathway to full, stable recovery. And, we shouldn’t sacrifice one for another. And, the system ought to be responsive to changes in needs and preferences. And, directionally, it ought to recognize flourishing as the ideal.
Once we agree on that, we can commence with disagreeing about how integrated that system should be, how specialized the workforce in each should be, etc.