The Minnesota Model

Creating a humane, therapeutic community for alcoholics and addicts

Imagine for a moment that it is 1949, and that someone you love is alcoholic. As you struggle with this fact, you quickly learn about three prospects for this person's future: One is commitment to a locked ward in a mental hospital, sharing facilities with people diagnosed as schizophrenic. Another is that alcoholism will lead to crime, which could mean years in prison; and third is a slow sinking into poverty and helplessness—perhaps life on "skid row."

In all three cases, your loved one's condition will be denied, ignored, or denounced as evidence of moral weakness.

The year 1949 is significant because it marked the beginning of the Hazelden Foundation. What started as a "guest house" concept for alcoholic men has grown into the prevailing method of treating addiction: the Minnesota Model. More importantly, this historic innovation offered alcoholics a new alternative to jail, mental wards, or homelessness.

It's easy to forget that the Minnesota Model represents a social reform movement. The model played a major role in transforming treatment wards from abysmal pits into places where alcoholics and addicts could retain their dignity.

Hazelden began with the revolutionary idea of creating a humane, therapeutic community for alcoholics and addicts. Once this idea was ridiculed; today it is seen as commonplace. The story of how this change has evolved is in large part the story of the Minnesota Model.

The model began humbly. During Hazelden's first year of operation in Center City, Minnesota, the average daily patient count was seven and the staff numbered three. The treatment program was equally bare-boned, resting on a few expectations of patients: behave responsibly, attend lectures on the Twelve Steps of Alcoholics Anonymous, talk with the other patients, make your bed, and stay sober.

It would be easy to dismiss such a program. Yet behind these simple rules was a wealth of clinical wisdom. All five rules focused on overcoming a common trait of alcoholics—something the founders of AA described as "self-will run riot." People addicted to alcohol can be secretive, self-centered, and filled with resentment. In response, Hazelden's founders insisted that patients attend to the details of daily life, tell their stories, and listen to each other. The aim was to help alcoholics shift from a life of isolation to a life of dialogue.

This led to a heartening discovery and one that's become a cornerstone of the Minnesota Model: alcoholics and addicts can help each other.

Throughout the 1950's, Hazelden built on this foundation by adopting some working principles developed at another Minnesota institution, the Willmar State Hospital. Among them were the following:

Alcoholism exists. This condition is not merely a symptom of some other underlying disorder; it deserves to be treated as a primary condition.
Alcoholism is a disease. Attempts to chide, shame, or scold an alcoholic into abstinence are essentially useless. Instead, we can view alcoholism as an involuntary disability—a disease—and treat it as such.
Alcoholism is a multiphasic illness. This statement echoes an idea from AA—that alcoholics suffer from a disease affecting them physically, mentally and spiritually. Therefore treatment for alcoholism will be more effective when it takes all three aspects into account.

These principles set the stage for a model that expanded greatly during the 1960s—one that has been emulated worldwide and has merged the talents of people in many disciplines: addiction counselors, physicians, psychologists, social workers, clergy, and other therapists. These people found themselves working on teams, often for the first time. And what united them was the notion of treating the whole person—body, mind and spirit.
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