The author defines "medical treatment" as a "formal intervention directed by one or more persons with recognized expertise and training in an explicit therapeutic modality as a means of curing or controlling a diagnosed disease or disorder with results that are orderly, predictable, and specific." When a medical practitioner uses a treatment strategy, the assumption is that the strategy will produce results specific to that intervention; however, the effects of substance abuse intervention are anything but specific. Influences unrelated to the intervention technique, commonly referred to as nonspecific factors, apparently have a far greater impact on outcome than an intervention's presumed therapeutic benefit. Different drug abuse counselors using the same technique produce widely divergent results; whereas, counselors who use dissimilar techniques often achieve similar outcomes. Unlike medical treatment, there is apparently little specificity in how people desist from substance abuse. Using the medical concept of a therapeutic milieu as justification for placing substance-abusing offenders in separate facilities or units serves to isolate these individuals from natural reservoirs of social support and learning opportunities. The proposed alternative to the medical model for substance-abuse treatment views the "helper" as facilitating the natural change process that exists in all people. There are four principal goals that guide this alternative model: responsibility, empowerment, meaning, and community. 23 references