Academic journal article Contemporary Drug Problems

Brief Overview of the Social Model Approach

Academic journal article Contemporary Drug Problems

Brief Overview of the Social Model Approach

Article excerpt

Social model programs (SMPs) were developed by non-medical, non-academic practitioners, most of whom were in recovery; thus there is little published academic literature on their approach. Much of the writing that does exist has been "fugitive," such as unpublished conference papers and reports published locally by California state agencies or SMP associations (the California Association of Alcoholic Recovery Homes, CAARH, for example). Little is known in professional circles about "social model" as a discrete paradigm, and what is known is often confused with other models of treatment and recovery. In order to clarify just what is referred to in this special issue as "social model," this article briefly reviews key available literature and the social and political milestones that shaped the development of SMPs in California. A brief description of the qualitative observation and analysis methodology underlying all of the papers in this issue is also included.

Defining the social model approach

The Institute of Medicine singled out the California social model approach as "the most prominent example of the use of the sociocultural model in formal treatment" (Institute of Medicine, 1990), and it recommended that SMPs be further evaluated to legitimize the approach. Social model philosophy as expressed in SMPs, in keeping with the sociocultural perspective, holds that alcohol problems are the consequence of a lifetime socialization in a social context that in some way encourages the drinking of alcohol. Treatment thus focuses on the social environment as well as the individual, and attempts to lead participants not only to personal abstention from alcohol and drug use, but also to cultivation of a sober lifestyle and community.

Although there are variations between programs, the social model expression of this philosophy focuses on program environments staffed by nonprofessional or paraprofessional staff who are themselves in recovery. Solidly founded in both the 12 steps and the 12 traditions of Alcoholics Anonymous, the programs seek to instill in participants a sense of responsibility for their own recovery and for the larger task of bringing recovery to the community of which they are a part. At the programmatic level, SMPs rely heavily on peer helping techniques (both staff-to-participant and participant-to-participant practices), and also refrain from institutional or hierarchical structures that would encourage staff oversight or discourage participant responsibility for their own recovery. As much as possible, SMPs encourage residents to run their own programs (see Borkman, 1998b, in this issue).

Since other approaches also acknowledge the role of the environment in treatment and recovery, there has been much confusion about what is the essence of the social model approach in comparison not only to medically oriented programs but also relative to other sociocultural programs such as the Oxford House movement, the prototypical "halfway house," or the therapeutic community. Thus it is important to distinguish SMPs from their sociocultural brethren at least superficially.

Briefly, halfway houses and therapeutic communities (TCs) differ from social model with respect to their funding mechanisms, their degree of professionalization, and the amount of freedom and control that program participants have in the program. For example, halfway houses generally employ professional staff to diagnose and provide case management services (Borkman, 1998a), quite unlike social model, and also do not routinely offer recovery groups on site (Schonlau, 1990). Therapeutic communities also use professional, credentialed staff, unlike social model. Although they do offer groups on site, unlike SMPs' the community's focus is internal rather than on the community at large (Borkman, Kaskutas, Room & Barrows, 1998). Oxford Houses are established using federal set-aside funding that allows recovering individuals to establish drug- and alcohol-free, democratically run, self-supporting houses (Jason et al. …

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