The Minnesota Model is described by McElrath in 1997 as being “inextricably interwoven with the program, practice and philosophy of Alcoholics Anonymous (AA)”. The AA movement conferred the belief that alcoholism is a physical, mental and spiritual illness and developed the Twelve Steps, which outline a spiritual solution, and the concept of a fellowship where recovery can take place.
The Hazelden Foundation was established in 1949 as an environment in which respect, understanding and acceptance of the dignity of each patient was promoted. The belief developed that time spent in association with other alcoholics, talking with one another and sharing life experiences, was central to recovery. Alcoholism was conceptualized within the disease model as a complex, existential condition of “dis-ease”, which could be relieved by sharing experiences. Furthermore, there was a fundamental belief that addicts have an inherent ability to change their beliefs, attitudes and behaviors to restore health.
Two long-term treatment goals of the Minnesota Model are total abstinence from all mood-altering substances and an improved quality of life. Consistent with the philosophy of AA, the objectives for the individual are to grow in transcendental, spiritual awareness, to recognize personal choice and responsibility, and to develop peer relationships. The resources for recovery, then, lie primarily within the addict with treatment providing the opportunity to discover and use those resources and the therapeutic atmosphere conducive to change. This approach is by nature client-centered.
Much of the work done by clients toward achieving those goals is done within the context of group therapy. Engaging with counselors and members of the peer group, the alcoholic / addict is encouraged to develop meaningful relationship experiences and clarify feelings and definitions of reality. Success of the process is characterized by relief, peace, increased sense of self worth, acceptance by self and the group, and the existential restoration of meaning to life.
The success of the Minnesota Model stems from it addressing the fundamental existential issues of addiction. Common to AA, it is rooted in existential philosophy and incorporates a treatment philosophy and treatment approach that addresses the core issues of addiction. This existential philosophy allows for a caring, nurturing, client-centered environment where the Twelve Steps provide direction and patients suffering from addiction can find healing.
Patients with co-morbid mental health conditions receive concomitant treatment for both conditions within a co-therapy concept. A common mental health diagnosis among chemically dependent patients is borderline personality disorder (BPD), a pervasive pattern of instability of interpersonal relationships, self-image, and affect along with impulsivity. About 40% of chemically dependent subjects are also diagnosed with BPD. Those with BPD seem especially prone to the use of substances in order to cope with unwanted affective states.
The frequent co-occurrence of addiction with other mental health problems is of relevance and importance to chemical dependency (CD) counseling. For example, patients with BPD are likely to evoke strong and often negative responses among CD professionals. There is a risk that patients presenting with symptoms of BPD may be negatively stereotyped and treated inappropriately. There may be the tendency for staff to describe the patient in vivid and dramatic terms that can set negative expectations even before the patient arrives on the treatment unit. There may be a tendency to react to self-harming or suicidal acts with horror and/or anger. The CD counselor needs to understand this behavior in the context of the patient’s underlying pain and distress and their inability to express or process those feelings. Counselors need to be educated to understand the etiology and manifestations of disorders such as BPD in order to appreciate the worldview of patients with dual disorders and enhance empathy and respect shown all patients.
Thus, while the Minnesota model has become recognized as the gold standard of chemical dependency residential care across North America, it has some inherent limitations. The disease concept, while introducing scientific rigor and a conceptual framework for conducting research and assigning treatment, is limited by the tendency to label clients as ‘sick’, risking breeding stereotypical views and treatment approaches by clinical staff. Viewing the problem as being the ‘disease’ tends to shift the focus from the individual, manifested within the model by the tendency to conduct group therapy to the relative exclusion of individual attention and therapy.
The next generation of addiction treatment must be more holistic in nature, addressing the whole person as an individual with a problem, rather vice versa. The potential for sterile, text book approaches to diagnosis and treatment must be tempered with compassion, accurate empathy, behavioral modification, growth of interpersonal relationships, and spiritual development. It is time to accept the advances and learning of the Minnesota model with gratitude, and move forward with a more humanistic and loving approach in a less clinical setting, such as a home setting that is warmer, safer, and more client focused and outcome oriented.