A Medical Model for Today

In the March Open Forum, Barber suggests that recovery has become the basis for a modernized definition of the medical model in mental health (1). This shift would indeed align psychiatry to emerging science and practice, and it is strengthened by both practice and understanding in other areas.

In February, 18 leaders in substance use policy, research, practice, and recovery gathered at the Betty Ford Institute to share their ideas about further exploring the value of recovery supports in substance abuse treatment, co-occurring disorders, and addiction. Although we did not have the Open Forum commentary, I believe that this group would have been very supportive of Barber's conclusions. In particular, the group would have embraced her overarching perspective that a recovery-focused framework mirrors the actual evolution of the medical model while reflecting attitudes about mental health (and about substance use by proxy) held by consumers and their families. Barber's proposed approach to addressing each person's clinical recovery, illness management, and personal recovery would also have been welcomed.

Unique aspects of recovery from mental illness and from substance use disorders are evident. For example, although progress has been made in medication treatment of mental disorders and substance use disorders, many people seeking recovery from the latter continue to be concerned that some will use medications to avoid fuller treatment, sustaining their dependence and not attaining wellness and recovery. This is the nature of addiction. Accurate epidemiological differentiation of the presenting illness and the derived various pathways to its remission can also lead to unique considerations in substance abuse treatment. However, for the most part, similar approaches to those suggested by Barber are evolving in the treatment of substance use disorders, with associated improved outcomes (2,3). There are also more opportunities for improved outcomes via recovery supports that are brought to bear earlier on problematic substance use, suicidality, trauma, pain management, and so forth.

White and Davidson (4), who have sought to strengthen the conceptual bridge between the mental health and addictions fields, have noted that “a recovery revolution now is occurring within and across the addictions and mental illness problem arenas that challenge practice within both of these fields, as well as their historical segregation.” They noted that the evolving system is more culturally competent, trauma informed, evidence based, inclusive of families, based on strengths, and connected to communities served. When clinical practices such as these (2,3) and the new practices described by Le Boutillier and colleagues (5) are implemented, improved ownership of personal health and the health of families has been noted, along with increases in treatment completion, personal hope, and community service.

Barber points the way to improved practice through a recovery framework that encompasses the individual, family, and community and the best science and practice and that recognizes the value of addressing both the illness and recovery from it. Although her commentary is grounded in her work in the mental health field, this person-centered medical model has great relevance not only for mental health but also for substance use and each community's health in general. It should be the basis for a new medical model.