by Kitty S. Harris, Ph.D.

There is perhaps no better time than the present to be in the field of addiction counseling, treatment and research. As someone who has worked with individuals struggling with the disease of addiction for almost three decades, I am happy to see the field transitioning to recovery-oriented systems of care. I know that recovery can and does change the lives of individuals and families impacted by addiction. I also know that recovering people are one of our greatest assets in the battle against the epidemic of addiction facing our country.

As we make this transition, it is helpful to see how far we have come in our understanding of both addiction and recovery and how this understanding has influenced our profession and practice. The idea of alcoholism as a disease was first introduced in the United States in 1784 by Dr. Benjamin Rush, a signer of the Declaration of Independence. His observations and subsequent writings first introduced the idea of abstinence as the only effective cure for alcoholism. However, the idea that alcoholism was a disease would not resurface in the American mainstream again until the creation of Alcoholics Anonymous in 1935. Though Bill Wilson, a co-founder of AA, intentionally refrained from using the word "disease" to describe the alcoholic condition, the primary text of this group includes a prologue written by Dr. William Silkworth in which individuals suffering from alcoholism are described as having a "physical allergy" to alcohol.

It is now a widely accepted notion, that alcoholism is a disease; though it was not until the 1956 classification of alcoholism as a disease by the American Medical Association (AMA) and the 1960 publication of E.M Jellinek's The Disease Concept of Alcoholism that the "disease concept" coalesced into a scientific paradigm for looking at addiction. The formation of the disease concept moved the field forward in many areas including the medicalization of addiction treatment. The trend emphasized the neurobiological underpinnings of addiction and served to counter the belief that addiction is the result of immorality or weak character.

From this early conceptual work, our field was given the bedrock on which we now base much of our profession and practice. We still adhere to the ideas of Dr. Benjamin Rush that abstinence is the most effective cure for alcoholism. The ideas put forth by Alcoholics Anonymous offered us the Minnesota model of addiction treatment which has become the basis of our modern treatment industry. Furthermore, Dr. Silkworth's "physical allergy" has lead to scientific investigations into the metabolic processes related to the consumption of alcohol and drugs and has prompted the brain science of addiction that is offering us better understandings of the production and reuptake of neurotransmitters as they relate to addiction and recovery.

With all of this information readily available, you must be asking many of the same questions that I am. Where are we going now? What will our legacy look like to future generations? How will the profession look back on our decades of addiction counseling, treatment, and research? I hope they will see that our contributions have advanced the field as much those of our predecessors.

We have offered the rigor of scientific inquiry into evidence-based practice. We understand the importance of individualized treatment and we will have advocated tirelessly for underserved and disadvantaged populations. We have invited adolescents and young adults into the realm of recovery and have designed counseling and treatment interventions expressly for them. We have worked with the criminal justice system to get incarcerated addicts the help they need to decrease recidivism. Most importantly, however, we have pushed for the continuum of care and recognized recovery as an equally critical part of this system.

Recovery-oriented systems of care will be our greatest contribution. Our counseling, treatment, and research focus is moving away from a triage model. Instead, we now understand that addiction is a chronic disease necessitating a lifetime of change. Instead of a goal of simply abstinence, we are advocating the goal of a totally transformed life. A life free from addiction filled with opportunities for full and complete participation in society.

The greatest by-product of our contribution will be the reduction of stigma associated with addiction. Recovery oriented systems of care integrate families, communities, employers, faith-based organizations, and our governments into the process of treating the addicted person. By involving the entire system, we teach society that recovery is a reality and that it benefits everyone when a recovering addict rejoins his/her community.

I do not know what the future will hold in the decades to come, but I do know that I am proud of the work we have accomplished in the decades that I have been a participant in this field. Our predecessors moved us from addiction as a moral flaw to the disease concept. We have taken that mantle and moved from the treatment of a disease to systems of care that promote, enable, and advocate for a lifetime of recovery. We have moved out of judgment, to healing of an illness, to the restoration of lives. The evolution of recovery is something that we call all be proud of for generations to come.