“No big shots or little shots here”: staffing principles and roles at medical and social model substance abuse treatment facilities

This paper discusses staff roles and staff-client interactions in three substance abuse treatment and recovery programs (two social model, one medical model). The paper argues that medical staff, drawing on culturally supported physician-patient roles, tend toward interactions discouraging clients’ responsibility for/involvement in their own care. Structures of medical service provisions encourage professional distance, and expectations of staff guidance, among clinical program staff. Conversely, staff in social model recovery programs expect participants to take primary responsibility for their own care; social model programs are characterized by structures/practices supporting peer model staff-resident interactions. This paper identifies six categories into which social model and medical model staff role differences divide: (1) staff hierarchy and specialization; (2) role modeling and experiential learning; (3) patient documentation; (4) medicalization of patients; (5) program administration and upkeep; and (6) personal, behavioral, and vocational responsibility. Social model recovery programs practice an alternative staffing model that affects staff composition and style (1 and 2), program infrastructure (3 and 4), and expectations that are placed on program participants (5 and 6).