Social work has historically balanced commitments to both individual care and collective reform. Over the last century, the field’s integration into health and behavioral-health systems has emphasized clinical treatment over social reform. This article argues for reclaiming macro-level systems innovation as central to contemporary social work. Drawing from the field’s historical foundations and emerging research, it examines the growing phenomenon of aging in recovery—a population of older adults with long-term substance-use recovery histories—through both national and preliminary New York State data. Results from an exploratory survey of over 200 adults in long-term recovery reveal significant anticipated service needs, including daily living assistance, healthcare navigation, and social reconnection. The findings highlight a growing service gap and call for community-based, systems-level responses grounded in social work’s historical reformist tradition.