Link Christin, JD, MA, LADC Advisor, Hazelden s Legal Professionals Program

Transcription

1 The Minnesota Model of Addiction Treatment: Could it Possibly be Even More Relevant Today? Link Christin, JD, MA, LADC Advisor, Hazelden s Legal Professionals Program The Original Minnesota Model New alternative to jail, mental wards, or homelessness No more snake pits Abandonment of psychoanalytic and moral views of addiction Brief History of the Model

2 Brief History of the Model Context Pat C. gets sober: AA comes to MN (1940) NCEA s 5 Kinetic Ideas & 5-point strategy Synergy of 3 Programs Pioneer House (1948) Hazelden (1949) Willmar State Hospital (1950) Key Elements of the Original Minnesota Model Key Elements of the Original Minnesota Model Addiction is a disease multiphasic Abstinence is prerequisite 12-steps provide optimal solution Blending of professional and recovering staff around AA principles and belief that addiction is a physical, mental, and spiritual illness

3 Key Elements of the Original Minnesota Model Individual treatment with active family involvement in 28-day inpatient setting AA participation/group affiliation is agent of change (fellowship) Complete multidisciplinary assessment and treatment Key Elements of the Original Minnesota Model Spiritual experience: personality change or change in basic thinking, feeling, acting Acceptance, surrender, action addicts have inherent ability to change beliefs, attitudes, and behaviors Key Elements of the Original Minnesota Model Began at Willmar State Hospital and Hazelden in 1949, called Minnesota Model by the 1970 s Rooted in existential philosophy

4 Key Elements of the Original Minnesota Model True recovery can only start with addicts admitting they need help from others Patient education Holistic model that flexes to needs of the individual Respect, dignity, and understanding of each patient Quality of life improves The Impact of the Model Early On Neo-Freudian psychology No need for professional training on research Confrontational style High rate of discharge Personal experience necessary Results not tabulated

5 Early Treatment Innovations Use of Multidisciplinary Team Introduced Counselor on Alcoholism role into addiction treatment (1954) (adaptation of earlier lay therapist role) Introduced Pastoral Counselor as key role Use of patient, AA and alumni volunteers Philosophy of Respect/Choice Unlocked the inebriate wards Early Treatment Innovations Patient education via introduction of lectures (possibly adapted from Ray McCarthy s work at Yale) AA participation during treatment AA viewed as essential framework for longterm recovery Nature of MN Model Adaptations Expanded view of etiology, e.g. historical trauma (Brave Heart, 2003; Durant, 2005) Cultural adaptation of Twelve Steps, (Red Road to Wellbriety, 2002; Coyhis & White, 2006) Use of empowerment-focused alternatives to Twelve Steps (Kirkpatrick, 1986; Kasl, 1992; Williams, 1992) Patterns of co-attendance (White & Kurtz, 2006) Integrating indigenous therapeutic practices into MN Model (Jilek, 1974; Abbot, 1998)

6 Nature of MN Model Adaptations Multidisciplinary team expanded, e.g., outreach workers, recovery coaches, primary care physicians Emphasis on multiple levels of professional care Emphasis on post-treatment recovery environment, e.g., recovery homes & community development efforts (e.g., community resurrection in Tampa) Some Statistics Criticisms of the Model Too narrow Not just genetic Lots of ways to get sober

7 Criticisms of the Model Ignores medicine Disease model not evidence based Cultural psychosis Contrary to common sense Criticisms of the Model Requires change of behavior (not like other chronic diseases) Renders addicts helpless rather than empowering them Inappropriate for women, adolescents, people of color, disenfranchised Others Alternative Treatment Models

8 Alternatives to the Model Alternatives to the Model Education/rehabilitation Cognitivebehavioral therapy regarding disease Psychoanalysis/ Therapy Therapeutic communities Harm reduction Methadone maintenance Pharmaco therapies/medication Alternatives to the Model Alternatives to the Model Contingency Management Community Reinforcement Approach Motivational Enhancement Therapy Multisystemic Therapy Matrix Model Family Behavioral Therapy Multidimensional Family Therapy Alternatives to the Model Alternatives to the Model Brief Strategic Family Therapy Functional Family Therapy Adolescent Community Reinforcement Faith-based Malibu Model Florida Model Supportive-Expressive Therapy

9 How the Model Has Adapted to Changes in Medical, Scientific, and Social Addiction Research How the Model Has Adapted to Changes in Medical, Scientific, and Social Addiction Research Transcends single dimensional care models with its focus on mind, body, and spirit Not stagnant, but evolving No ONE way Integrates AA with educational and technological advances Model is Consistent With: Psychotropic medication monitoring Individual psychotherapy Family therapy Medication-assisted treatment Maintenance therapy Other addiction problems Other special populations

10 The Model in 2013 An Example Confronting the Opioid Crisis Prescription Opioid Dependence Four-fold increase in treatment admissions (U.S ) Overdose deaths have increased dramatically (3,000 in ,500 in 2011) Drug overdose is the No. 1 cause of accidental deaths, fueled by the increase in opioid overdoses Over 125,000 opioid overdose deaths have occurred in the U.S. in the past decade

11 Hazelden s Experience Increased admissions for opioid dependence Problems with ASA discharges, treatment retention Unit milieu issues Use of opioids during treatment Increased incidence of death following treatment Remember! Recovery itself is not treatment Discussion: Why Has the Minnesota Model Continued to be Effective After a Half Century?

12 Link Christin, JD, MA, LADC Advisor, Hazelden Legal Professionals Program Patrick Krill, JD, MA, LADC Director, Hazelden Legal Professionals Program