What is the Minnesota model?

Background and Treatment Philosophy

The Minnesota model (MM) was established in 1948 as a new form of drug treatment. The first MM residential program, known as Pioneer House, was established in an old warehouse in Minnesota and was modeled after the principles of Alcoholics Anonymous (AA). The treatment centers Hazelden and Willmar State Hospital, both in Minnesota, adopted a similar model in 1949 and 1950, respectively. Collectively, these three programs constitute the origins of MM. Pioneer House is now the Hazelden Center for Youth and Families. MM was initially designed as a residential treatment program, although outpatient variants of the model exist today and the model itself is amenable to a variety of delivery settings.

The principles and philosophy of AA and the disease concept of addiction, a central element of AA, are essential parts of the MM treatment philosophy. The disease concept of addiction views addicts as having an incurable or chronic disease. Addicts are believed to be biologically different from nonaddicts. They are not blamed for their addiction, but they are considered responsible for facing their disease. The program emphasizes that addicts can change their beliefs, behaviors, and lifestyles and can become well, but only through complete abstinence from all chemical substances.

The typical residential stay ranges from three to six weeks, with a common twenty-eight-day program of inpatient treatment and lifelong aftercare, primarily through AA, to manage the disease. Aftercare may also include family counseling and extended care. The residential treatment program comprises many dimensions of care, including individual counseling, group therapy, family counseling, working the AA twelve-step program, attendance at AA or Narcotics Anonymous meetings, daily reflection and readings (usually of AA’s “big book”), and lectures.

MM-based programs are staffed by different professionals, a central feature of the model’s multiprofessional and comprehensive approach to treatment, and include nurses, clergy, professional social workers, psychologists, and counselors. Counselors are recovering addicts themselves and have trained through the residential program.

The client is treated as a whole person with professional attention devoted to the mind, body, and spirit, a focus sometimes referred to as the physical-psychological-spiritual model of treatment. Clients are treated with dignity by staff and other residents. Although there are no standard guidelines as to what a treatment center must do to officially claim the MM concept, the common elements discussed here make up a typical program of treatment. The Betty Ford Center and Hazelden are among the larger and more recognizable residential treatment programs based on MM today.

MM is similar to concept houses and therapeutic communities in their emphasis on mutual aid, the peer community, and treating the whole person. The heavy emphasis on AA philosophy—the belief in the disease model of addiction instead of the moral shortcomings of addicts—and shorter durations of residency are two of the primary differences between MM and other therapeutic communities. Some clients of MM may participate in a therapeutic community, or extended care, after completing a program of inpatient care.

Criticisms and Successes

Criticisms of MM often focus on aspects of the treatment philosophy instead of on the whole model itself. A common basis for criticism is found in the tenets of AA, such as the insistence on complete abstinence over controlled drinking; the emphasis on spirituality and a higher power, which may not resonate with all addicts; and the rigidness of the AA philosophy, resulting in an inflexible program. Addicts who do not wish to seek help from AA have few helpful exit strategies because of the intolerance of AA members to treatment alternatives.

Other criticisms are directed toward the disease concept of addiction, which some argue relieves the addict of too much responsibility for his or her addiction and which can reinforce self-indulgent behavior and undermine treatment. Despite criticisms, research suggests that the multiprofessional approach to treatment grounded in the principles of AA is a successful form of treatment for many addicts.

Although there are challenges in studying the success of treatment programs, and although many studies have methodological flaws, evidence shows that MM graduates do as well as, and possibly better than, graduates of other treatment programs. Completion of the program results in long-term abstinence for many addicts and shortens periods of repeated drug use for persons who may fail to maintain abstinence. There are documented improvements in the psychosocial well-being of graduates, improvements involving self-esteem, family relationships, and employment, and in overall physical health.

At the same time, Hazelden began incorporating the use of anti-addiction drugs, such as Suboxone, into its program in 2013. Professionals at the facility hoped that this move—which mainly targeted those suffering from opioid addictions—away from the program's foundation in abstinence would help patients having difficulty adhering to the MM.

Bibliography

Cook, Christopher. “The Minnesota Model in the Management of Drug and Alcohol Dependency: Miracle, Method, or Myth? Part I. The Philosophy and the Programme.” British Journal of Addiction 83 (1988): 625–34. Print.

Cook, Christopher. “The Minnesota Model in the Management of Drug and Alcohol Dependency: Miracle, Method, or Myth? Part II. Evidence and Conclusions.” British Journal of Addiction 83 (1988): 735–48. Print.

Spicer, Jerry. The Minnesota Model: The Evolution of the Multidisciplinary Approach to Addiction Recovery. Center City: Hazelden, 1993. Print.

Szalavitz, Maia. "Hazelden Introduces Antiaddiction Medications into Recovery for First Time." Time. Time, 5 Nov. 2012. Web. 29 Oct. 2015.