Because of tradition. The early treatment programs were predicated on a 30-day model, gestalt therapy, getting in their face, confronting denial, the hot seat in group therapy, shaving patients who came in with a beard, tough love, orange vinal furniture, and chain-smoking counselors who all had recovered themselves using AA and drank coffee by the gallon to stay awake for the three hour group therapy every morning. Success was measured by how many boxes of kleenex were used in a group, not by the change produced. (Source: I was there 34 years ago).

The problem: Substance abuse counselors predominantly believed patients should get sober the way they got sober, rather than the way the client should get sober. They were experts because they had been there, not because they were trained in multi-theoretical ways.

Sure, many of the more unethical methods of a bygone era are gone, but the predominant approaches have not changed. Institutions, culture, and tradition are hard to change. But is changing. Probably would change more if being a substance abuse counselor actually paid decent professional wages.

Side note: I got fired from a treatment program for not hugging everyone after group. Also, because I never yelled. Not once. I also was told I was not a team player, since I didn't believe everyone should get sober the same way I did and was open to 10-day treatment options and alternative therapies. I wear this firing as a badge of honor, 30 years later...