The reluctance to combine

The shifting of substance abuse in this country away from a pattern of single substance dependence toward multiple substance abuse has been accompanied by renewed interest in the possibilities of so-called combined treatment and its ideological base, a generic conceptualization that encompasses and integrates into a unitary theory all types of substance abuse. This view maintains that many of the differences separating alcoholic persons from other substance abusers have more to do with factors like age, ethnic, social and cultural background--and prejudice--than with real differences in the addictive processes or therapeutic needs. Some careful studies of combined treatment have found it no less effective than substance segregated treatment. Some persons are helped, others are not. Until we have reliable ways to select out those who would benefit form combined treatment from those who would not, the method remains experimental, not yet to be advocated for mass use. What is needed at once is a generic concept of substance abuse. This would prepare the way for planning, legislation, program organization, national data systems, and research that could be designed for the most effective response to today's needs and problems. An especially pressing need is for generic training and credentialling of workers in the alcohol and drug fields. As the many questions raised by a generic viewpoint are considered, one can observe that much of the resistance to this concept among professionals is attributable to fear of the unfamiliar, protection of vested interest, misapprehension about consequences and, not least, prejudice reflecting the stereotyped ideas of the general population.