The Minnesota Model is a treatment method used in many rehabs around the world. It is based on the twelve-step program and philosophy of Alcoholics Anonymous (AA). The 12-Step Model is known as the Minnesota Model because its use originally took hold in Minnesota at the Hazelden Foundation, one of the most renowned addiction treatment pioneers. The twelve-step model is by far the most popular method used globally due to its over-riding success rates. This is beginning to change as a new updated form of treatment, CBT, or Cognitive Behavioral Therapy is now being added. (Note: not usually replaced) CBT is very similar to the 12-Step method addressing impaired thinking and behaviour change. Addicts can use CBT tools to change their self defeating thinking patterns.
The Minnesota method adheres to the disease model of addiction. The disease model treats addiction as an illness, which is chronic and progressive, with alcohol or drugs as the causal and sometimes medication agent. The inability to control drinking or drug use is seen as a symptom, compulsive behaviour, and complete abstinence from alcohol or drug consumption is the long-term means of managing the illness.
It is worth mentioning at this point that The American Society of Addiction Medicine (ASAM) in 2011 released the new definition of addiction after a four year process involving more than 80 experts, defining addiction as a disease involving many brain functions, mainly an imbalance in the reward circuitry. This creates a problem experiencing pleasure and compels people to seek ways to boost their pleasure related brain chemistry, using substances and in some cases excessive behaviour like food and gambling. In other words they put an official stamp on what AA had been saying for decades.
While the Minnesota model embraces the disease model, it also uses the AA old-fashioned terminology, e.g. ‘making amends’, ‘defects of character’, ‘personal inventory’, ‘confessing the nature of our wrongs’ that modern professionals don’t approve of. Additionally, it is thought that recovery only comes with a ‘spiritual awakening’ which is also outside the realms of the many professionals, especially modern psychologists or general counsellors.
These recovery support groups were started by two Alcoholics desperate for help having exhausted every possible medical, psychiatric, charitable and religious support offered at the time in 1930’s USA and Europe. They formed what we now know as Alcoholics Anonymous (AA), and it quickly grew internationally, a non-professional self-help group, based on mutual support “one alcoholic can best understand and help another”.
The twelve-step program of AA seems old-fashioned compared to modern forms of psychological interventions. However, the main principals are quite scientific if you investigate them, such as “Powerless” meaning Compulsive or “Unmanageability” meaning Consequences. Even the so-called spiritual aspect can be translated into a form of positive psychology or adopt a spiritual problem-solving style:
Find meaning in what happened
Attending the meetings is a rapid way to build a support network, make new friends and deal with loneliness if an issue. Some feel this is a life-support network which is now spread across the globe helping hundreds of millions of people who are trying to break free of many types addictions – not just alcoholism. It is said that social interactions increase the probability of success due to collective emotions, energy and common aims releasing brain chemistry during active engagement meetings, producing feelings of contentment naturally. Analysis has found that by participating in groups, the individual members’ beliefs matched those of their support group possibly similar to a supporter attending his team’s football matches.
We use the term “In Recovery” to identify being abstinent as opposed to being in relapse or active addiction. Most addiction experts agree that it’s a disease of some sort, usually chronic and progressive, so abstinence is the safest way to manage. In 12-Step recovery we understand the paradox that “self-knowledge avails us nothing”. This means no matter how much we learn about addiction theory we still need to commit to treatment and practice basic recovery rituals to stay abstinent, knowledge is meaningless without the action.
AA always suggested 90 meetings in the first 90 days, why? This is an important question for those involved in recovery work, wether as psychologists, therapists, life coaches, or as individuals wanting to change. In a recent article by B. Koerner on AA, he explores some of the elements of how AA creates long-term positive behavioural change:
It may seem like a lot of meetings and overwhelming to the beginner but think of it as medicine. If you are sick or have any other disease, you take your medication, exercise and eat well; it’s no different for alcoholism and addiction, it’s a disease, and it’s only 7 hours per week, plus it’s a great time to decompress, think and reflect on what’s happened. One day at a time…and it’s free.
Step 1: Admit powerlessness over addiction and the unmanageability it causes.
Step 2/3: The so called “spiritual” steps. We accept outside help to restore control of our lives. We learn to “let go” of difficult emotions,” Using the phrase “Helping Power” instead of “Higher Power” can benefit some.
Step 4/5: Work through our significant life events, hurts and fears that cause us anxiety and conflict.
Step 6/7: List our dysfunctional behaviour and personality traits.
Step 8/9: Make amends to those we hurt and change our behaviour.
Step 10/11/12: Daily maintenance steps, checking our behaviour regularly, meditation and helping others.
A spiritual program not religious: One of the biggest blocks for many is the use of the word God in the AA literature, although it’s always qualified with “as we understand him” more recently the word Higher Power (HP) is being used. Taken in its original context, written 80 years ago by recovering alcoholics in America they were only trying to convey the message that much of the solution is best described as spiritual. The reason being is to find and nurture hope, faith and optimism, or a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks to remain clean and sober. Many do this by accepting a form of what we now call spirituality or psychologists call positive psychology. Developing a sense of meaning and overall purpose is said to be equally important also.
The Minnesota Model Principles and the 12 Steps are heavily influenced by the Judeo-Christian worldview, but the wisdom of this path is not confined to one religious or philosophical system. The fact that there are so many similarities between Buddhism and the 12 Steps can be viewed as evidence for the universality of this wisdom. There is no conflict or contradiction between Buddhism and the 12 Steps. Instead, the systems complement each other.
The founders of Alcoholics Anonymous broke away from the Oxford Group (an evangelical Christian sect) because they realised that their program did not require any specific religious beliefs. This approach to recovery can work for atheists, Muslims, Jews, Christians, Hindus, Jains, and Buddhists. Although it is not a religious program, it is open to people of all religions and non-religions.
Many people find that combining their 12-step work with their religious or philosophical beliefs strengthens their sobriety. This is a sensible approach. The 12 Steps are an important piece of the jigsaw, but it might be a mistake to treat them as the only piece. The Minnesota Model principles are not limited.
Buddhism is sometimes referred to as an atheistic religion because followers are not required to believe in a supreme deity. The Buddha did actually talk about gods, but he did not promote the idea of a single creator God. The fact that God is mentioned so often in the Big Book might make it seem as if the 12 Steps are incompatible with Buddhism, but this is not the case. The program only asks that people believe in a God ‘as we understood him’ and Buddhists have no real problem with the idea of a higher power.
The Buddhist four noble truths would be the equivalent to the 12 steps and these are: