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"Minnesota Model" Outpatient and Inpatient Treatment

Moyers talking to former patients

Bill Moyers talks to former clients at Ridgeview, a Minnesota Model residential treatment program, at a picnic celebrating their recovery.

The so-called Minnesota Model of addiction treatment is one of the best-established treatment modes. It is based on the philosophy that addiction is a disease but continuous, life-long abstinence is possible. Programs usually include counseling aimed at behavior modification, group therapy, 12-Step meetings, and intensive education on the nature and causes of addiction, the importance of peer support and sharing, and principles of long-term recovery and relapse prevention.

Says Tim Sheehan, Ph.D., vice president of recovery services at Hazelden, one of the oldest and best-known Minnesota Model treatment programs, "If you have an illness that has multidimensional causes and impact, you need a multidimensional approach for treating it. We use teams of counselors, with a chemical dependency specialist, clergy, a psychologist, and other recovering addicts and alcoholics."

The best programs are also highly individualized. "While the disease of addiction is predictable in terms of its symptoms and progression, it's superimposed, in individuals, on different personality structures, possible mental health complications, different sociocultural backgrounds, and different learning styles," Sheehan says. "Our counseling team tailor-makes a treatment plan for each patient. We evaluate the person's spiritual status -- i.e., existing values and beliefs -- and the person's psychological functioning in terms of capacity to learn. Because our treatment model is holistic, we also identify and address potential blocks to recovery. These may include mental health problems such as depression, dysfunctional family relationships, or issues of diversity based on sexual identity." If the patient is initially reluctant to give up his or her addiction (as may be the case with court-ordered or other compulsory treatment), "We use two methods to ready people for abstinence," Sheehan says. "We talk about the realistic consequences of their disease, and we help them build a vision of what recovery could be like."

Such programs may be outpatient or inpatient. In outpatient programs, patients undergo at least four hours of treatment daily. Although treatment duration varies, most run for several months. Patients who are successful with the outpatient approach tend to be those who are ready to pursue abstinence, have good family support, and are employed. The inpatient model is similar, except that the patient lives at the center. Formerly, 28 days was a standard length of stay, but the shift to managed care has often significantly cut patient length of stay, to 7 to 10 days.

Although this treatment model has been highly successful, it is expensive and thus remains almost exclusively available to the privately insured and/or affluent.

Therapeutic Communities

Therapeutic communities are sometimes-controversial residential programs aimed at the socially troubled, hard-core addict who has trouble with rules and responsibilities. The goal of these programs is for drug and alcohol addicts to completely change their lifestyle by abstaining from drugs, eliminating antisocial or criminal behavior, developing employable skills, and learning how to be honest. Staffed by former addicts as well as professional counselors, these communities tend to place strict limits on the patient's behavior and social interactions, such as the amount of communication they can have with the outside world. Each member of a TC is given a job and is expected to carry out that responsibility. Much of the treatment is accomplished through highly confrontational encounter groups, aimed at breaking down denial and rationalization, in which addicts talk frankly about their own and each other's behavior. Most of these programs require a commitment of at least 15 months (18 months is the average), although some programs are as short as three months.

Recovery Homes

These are residences for people who need to leave a dysfunctional or drug-saturated environment to stay clean and begin living independently. These homes are cheaper than traditional inpatient treatment. They usually have a counseling staff available, but many are in houses in which groups of recovering addicts participating in 12-Step programs live together without any professional supervision.

-- Janet Firshein

-- Additional reporting by Maia Szalavitz and Sue Young Wilson

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