A Hundred Flowers

It is not every day that one is inspired to turn to the work of Chairman Mao when discussing the status of addiction treatment. On the other hand, these are not ordinary times. When addiction treatment in the United States was in its infancy, one philosophy predominated. Treatment centers were staffed almost exclusively by those in recovery, whose experience of personal redemption through immersion in self-help programs inspired them to promote the philosophy of Twelve Steps. With little empirical research to guide the field, a consensus emerged that there was one way, and only one way, to recover: by practicing the principles of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) “in all our affairs.” This, in turn, led to a zealousness that soon morphed into dogmatism; a “one size fits all” rigid insistence that any treatment approach not firmly grounded in Twelve Step principles and attendance at Twelve Step meetings was doomed to fail; that clients who could not find it in themselves to embrace the philosophies of AA and NA were in need of aggressive confrontation to break through the wall of denial; and that those who used medications responsibly to treat comorbid psychiatric conditions were violating the fundamental tenet of abstinence. Interestingly, this was not the case in other countries, who from the start embraced a more eclectic approach to treatment. Nor was it consistent with Twelve Step literature, which urged recovering members to inspire others through their experience, strength and hope, and which understood that aggressive persuasion would only undermine internal motivation. In the words of the AA Big Book, “When a man is presented with this volume, it is best that no one tell him he must abide by its suggestions. The man must decide for himself ” (p. 144). Many things have changed. The workforce has become increasingly professionalized. A wealth of outcome studies have convincingly demonstrated the efficacy of other approaches, such as Motivational Interviewing and Cognitive-Behavioral therapies, and have documented the fact that many who recover do so without any treatment or Twelve Step involvement whatsoever. There is no question that a commitment to science and critical inquiry has broadened the field and brought it into the mainstream in a way that can only be healthy for the field and for our clients. However, we are now at a point where a new orthodoxy is threatening to prevail. Professional organizations are amassing lists and registries of evidence-based