The Minnesota Model As A Response To Problem Drug Use
Outline and discuss your understanding of the Minnesota Model as a response to problem drug use.
Student No: 109495185.
Introduction
Addiction is a chronic disease, and can be progressive, relapsing and fatal (Heyman, 2009). There are many models of addiction theories. The disease model, which sees addiction as a medical condition along the same lines of diabetes and arthritis, is the most widely known in the public due to its depiction in media and film as a result of the popularity of Alcoholics Anonymous (AA). It is also the most dominant treatment model in the USA (Rasmussen, 2000).
The aims of this piece are to outline and form an understanding of the Minnesota model (MM), which incorporates the disease model, as well as its use as a response to problem drug use. Linking to the Irish perspective throughout, The MM will be looked at in three different contexts, the origins of the MM and its development in both America and Ireland, an outline on the elements used within the MM and lastly, a critique of the MM in its response to drug users. Firstly, I will put forward a definition of a problem drug user for the purposes of …show more content…
the piece.
Problem drug use
The problematic-recreational models of drug use developed in the 1990’s. The Drug Treatment Centre Board defines problem drug use as: “the illegal or illicit drug taking or alcohol consumption which leads a person to experience social, psychological, physical or legal problems related to intoxication or regular excessive consumption and/or dependence” (Bellerose et al, 2011). Problem drug use is characterised generally with the use of heroin and crack and other intravenous injection substances. In contrast, recreational drug use is associated with using drugs such as ecstasy or cannabis, known to be more “weekend drugs” (Rasmussen, 2000). The reason behind the distinction is because of the fact that injecting drugs carries more potential harm and risks. Risks associated include HIV/AIDs and hepatitis C.
It is suggested that problem drug users make up 5% of illegal drug use, with recreational use amounting to 95% (Paylor et al, 2012). Concerns with regard to this model were that the 5% of problem drug users are the focus of much of the policies, and were the main focus of justice, medication and media (Butler, 2002). It is assumed that all use of crack and opiates is problematic and thus treatment is normally focused towards these groups. Treatment for problem drug use in Ireland is delivered by statutory and non-statutory services, which include residential centres, community-based addiction services and more (Bellerose et al, 2011).
The Disease model, Alcoholics Anonymous and the Origins of the Minnesota Model
The disease model The Minnesota model is based upon the disease model of addiction. The idea of addiction as a disease is prevalent within media as well as among researchers and clinicians. However, although the disease concept is widely accepted, drug offenses are still punishable by law (Heyman, 2009). There are seemingly two responses to problem drug use and addiction: medical treatment or punishment. The disease approach is the less punitive option and allows the addict to adopt the sick role (Hussein Rassool, 2011).
The main concept of the Disease Model is that addiction is a medical issue, or progressive illness. Researchers have said that addiction should be grouped with diseases such as Alzheimer’s, diabetes and arthritis (Rasmussen, 2000). Within the model, there is no cure for addiction as such and the addict is in recovery for life. Due to the inability of the addict to control their consumption, the only treatment aim is total abstinence, a voluntary restraint from the acts of addiction (Denzin, 1987). Research suggests that there is a scientific basis for the disease model, stating that addiction is in our genetics, or biological make up. The role genes have to play is hard to ignore and gives the disease model rationale for approach to addiction. Much of the research done on this topic of disease was done on alcoholics, and findings indicated that alcoholism runs in families even if they don’t live together. A finding in a large scale study in Sweden found that an adoptees biological father’s drinking pattern was more of a predictor of alcohol abuse in the adopted child than their adoptive father (Hussein Rassool, 2011). Many other studies found the same correlation between genes and addiction.
Alcoholics Anonymous and the Minnesota Model
The Minnesota makes use of the philosophy of Alcoholics Anonymous (AA).
The AA was established in Ohio, USA in 1935 by Bill Wilson and Dr. Bob Smith. Both had identified as being drunks and found by reaching out to each other they could stay sober. By 1939, AA had reached out to many other states within America and other countries overseas. The founders created a model of twelve steps to form sobriety (appendix 1). The first AA meeting in Ireland took place in late 1946. Following this first meeting, AA grew within Ireland steadily. It is important to say that, although AA had religious roots, it wasn’t as readily accepted by the Catholic Church as one would expect. Instead it was seen as a threat to the role of the Catholic Church (Butler, 2002). Since its introduction, many similar models of treatment based upon AA have been
created. The MM evolved in the state of Minnesota in 1940’s and 1950’s. Started by two young men, Dr. Dan Anderson, a psychologist, and Nelson Bradley, who was to become a psychiatrist, the MM evolved from AA and is a variant of the disease model also. It incorporated a synergy of three programs, Pioneer House, Hazeldon, and Wilmar State Hospital (Miller et al, 1998). Pioneer house used recovering AA members, and employed an informal atmosphere. Hazeldon made use of clergy and past AA members and was said to be introduced for the business class before they lost their jobs. Its target was upper and middle class. Wilmar State Hospital looked at these models and formed their treatment around these (Borkman, 2007). The MM was based upon the philosophy of the AA, but differed in its advocacy, as well as being highly structured. It represented a professionalisation of the AA model (Gossop, 2001). In the 1940’s, it was common in the USA, as well as in Ireland under the Mental Treatment Act 1945, for people with addiction problems to be taken in to psychiatric wards without their consent (Butler, 2002). The concept of the disease model, coupled with the introduction of the MM and AA lead to a less stigmatised reaction to addiction. The MM started as an all male inpatient treatment centre. It is fair to say that the MM was introduced for the middle and upper classes of society and, at a time where insurance did not cover the treatment, it meant that only those who could afford it would go (Butler, 2002). As previously stated, Ireland was slow to accept the model of AA; however it was very fast to promote the Minnesota model. It was priests and nuns who initially promoted the model. This was at a time in Ireland that pastoral work was taking more form in communities and this was seen as a very appropriate form of pastoral care (Butler, 2002). The first centre in Ireland was the Stanhope Social Service Centre in 1976. This was an outpatient centre. It was in 1978 that the Rutland centre was formed in Ireland and this had a much greater impact on the treatment scene within Ireland. The Rutland centre soon became a pilot project and the minister for health provided funds towards the costs of the program. This was the first in a line of MM centres introduced to Ireland, including Arbour house and Tabor Lodge among others (Butler, 2002).
MM: a response to problem drug use.
Elements of the MM
The MM is based on a therapeutic philosophy and made use of the AA’s twelve step approach. The main differences between AA and MM are that the MM uses an inpatient rehabilitation treatment model, incorporating lengthy aftercare. As previously stated, the MM also views addiction as a disease and recovery from the disease is constringent upon abstinence (Borkman et al, 2008). Recovery from addiction is achieved through the use of the twelve steps, adopted from the AA. It has a multidisciplinary approach to addiction, employing both professionals from fields such as psychology, counsellors, clergy and recovering addicts themselves (Rasmussen, 2000). The approach of the model is that the clients are treated within a community of respect and dignity. It claims to be holistic in its approach and include many dimensions of the person’s life. The multidisciplinary approach is very important and is something a lot of other models had ignored (Borkman et al, 2007). The use of past addicts in treatment is beneficial and gives the client hope and strength.
There is a need of people entering residential treatment to be clean of the illicit substances, and thus a detoxification treatment is administered before entry, but kept separate from the facility. This is purposefully done in order to separate the drugs and withdrawal symptoms from the treatment centre. Further adaptations of the model incorporated halfway house, a high support unit and family focused care (Butler, 2000).
Critique
The main criticisms of the model are that it is inflexible and that a one size fits all approach is employed (Harrison et al, 2001). There is no distinction between types of drugs and types of treatment administered and as such, even though evidence shows that the harm associated with the use of opiates contrasted with the harm associated with alcohol use is astronomically different (Bellerose, 2011). The MM also has nothing to say on prevention and health aspects of addiction and focuses entirely on recovery through the twelve steps. (Butler, 2002). This deflects attention away from the wider context of alcohol and drug consumption (Butler, 2002).
Regarding the response to problem drug use, the main and most predominant element of the MM is the use of the twelve steps. There are many arguments against the use of these. It has been said that the twelve steps have a religious basis which in today’s more secular society, is getting less relevant (Butler, 2002) The are also very weakness based. The first step to recovery is admitting that one is powerless to the alcohol (or other substance) and that their lives have become unmanageable. This in itself is very disempowering for the user. The second, third and eleventh steps are about turning one’s self over to the “care of God”, who will restore the sanity of the addict, through prayer and meditation. There are arguments that passing off the responsibility of the drug user to themselves can be detrimental. The fourth step calls on the addict to develop a moral inventory of one’s self. This is interpreted as one finding faults, and ties in with step six, which requests god remove the character defects the addict has (Gossop, 2001). This has a culture of self-blame. Steps one to five are to be completed in the inpatient set up before one is released. Step eight and nine requires clients to make a list of people they have harmed, and make amends with them all, so far as to not injure or harm them. The clients are also requested to continuously take personal inventory of themselves and admit when they are wrong. This again leads to disempowerment and focusing on ones negative attributes. Finally the twelfth step requires the client to carry these messages, of their spiritual awakening and pass them on to other addicts. While step twelve can be seen as a positive one, there is an overtly negative feel to the majority of the steps. From the outside in, the Disease model, and Minnesota Model looks to be an ideal model, and is one of the most popular forms of treatment within Ireland (Butler, 2002). It is praised in media and the treatment outcome studies conducted within the centres have very positive outcomes. However it is worth noting that these studies have been labelled by some an exaggerated (Harrison, 2001). Having conducted research on the treatment outcomes of a MM centre in Cork, I can conclude that, while there are some very positive outcomes, this is not always the case. The outcomes are also constringent upon the gender, age, types of drugs used, among many more. (Dunne, et al, 2014). The study conducted had a sample of 180 participants, and of these, 84% were male. Patients were tracked at three intervals over an 18 month period, and those who were in for alcohol addiction fared the best, with success rate at 62%. Though the opiate users were the smallest group within the sample, none of them had remained abstinent after the 28 day programme. Outcomes for adolescents and younger people were also a lot poorer (Dunne, 2014 & Harrison, 2011). This leads one to believe that although the MM has a long standing reputation with treatment of alcoholics; it is not the best treatment for those using opiates and similar drugs. More research on this is needed. As stated earlier, expecting one to surrender to a disease and remove any sense of self reliance is very disempowering to the user. It is this notion of irreversibility, and lack of cure, and the emphasis on accepting powerlessness, which other professionals seem to have the biggest problems with in regards to this treatment model.
Closing arguments and conclusions “Disease Conceptions have come to represent all our fears. We also have no hope for total cure, for even if we have not taken a drink for years, we still call ourselves alcoholics.” (Blessing, 1990, p.19)
The fundamental issue with this model is the concept of the disease model. It represents a total lack of power for the “sick” addict. Within this piece, we have discussed the origins of the MM in Ireland and its use for the treatment of addiction and problem drug use. Evidenced in this piece, the Minnesota Model has a long tradition of treatment, but its criticisms far outweigh the praise. The outcomes with regards to alcoholics are positive however, the treatment with regards to treating problem drug users is inconclusive. One such model I believe would be more suited to problem drug users would be harm reduction (HR) model. This incorporates teaching and policies on reducing the harm resulting from use of drugs (Gossop, 2001). Introduced following the HIV/AIDS epidemic of the eighties, measures introduced include needle exchange programs as well as methadone replacement is. Although the MM cannot be ignored entirely as it has an impressive track record, and it definitely has its place for different types of addicts, it is my opinion that HR is a more focused and better aimed treatment for problem drug users. HR is viewed as a continuum of behaviours including excess to moderation to abstinence (Paylor et al, 2012). This is done in steps from excess towards abstinence rather than expecting absolute and total abstinence as the MM does. The overall aim of HR is moving clients away from their behaviours towards less harmful consequences. Although the abstinence model has its pros for recreational drug use and alcohol problems, a step away from this in order to treat problem drug users would be much more beneficial as it allows more scope for treatment other than merely abstinence.
Appendix 1
“The Twelve Steps
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”
(AA, 1961, p.7)
Bibliography
Alcoholics Anonymous (1961) Members of the Clergy Ask About Alcoholics Anonymous. New York, Alcoholics Anonymous Grapevine Inc.
Bellerose, D., Carew, A.M and Lyons, S. (2011) Treated Problem Alcohol Use in Ireland. HRB Trend Series. 11, pp. 1-24.
Blessing, S.R. (1990) 12 Steps Down: The Road from Recovery. Off Our Backs: A Woman’s News Journal. 20(4) p. 19.
Borkman, T., Kaskutas, L.A. and Owen. P. (2007) Contrasting and converging Philosophies of Three Models of Alcohol/Other Drugs Treatment. Alcoholism Treatment Quarterly. 25(3), pp. 25-38
Butler, S. (2002) Alcohol, Drugs and Health Promotion in Modern Ireland. Dublin, Institute of Public Administration.
Denzin, N.K. (1987) Treating Alcoholism: An Alcoholics Anonymous Approach. Beverley Hills, Sage Publications.
Dunne. S., Hughes. P., and Devine. M. (2014) A longitudinal outcomes study on the effectiveness of abstinence based residential rehabilitation as experienced by clients and their families in Tabor Lodge. Unpublished.
Gossop, M. (2001) Drug Addiction and its Treatment. Oxford, Oxford University Press.
Harrison, P.A. and Asche, S.E. (2001) Outcomes Monitoring in Minnesota: Treatment Implications, Practical Limitations. Journal of Substance Abuse Treatment. 21, pp. 173-183.
Heyman, G.M. (2009) Addiction: A Disorder of Choice. New York, Harvard University Press.
Hussein Rassool, G. (2011) Understanding Addiction Behaviours: Theoretical & Clinical Practise in Health and Social Care. London, Palgrave Macmillan.
Miller, W.R. and Heather, N. (1998) Treating Addictive Behaviours. New York, Plenum Press.
Paylor, I., Measham, F. and Asher, H. Social Work and Drug Use. Berkshire, Open university Press.
Rasmussen, S. (2000) Addiction Treatment: Theory and Practise. California, Sage Publications.
Student No: 109495185.
Introduction
Addiction is a chronic disease, and can be progressive, relapsing and fatal (Heyman, 2009). There are many models of addiction theories. The disease model, which sees addiction as a medical condition along the same lines of diabetes and arthritis, is the most widely known in the public due to its depiction in media and film as a result of the popularity of Alcoholics Anonymous (AA). It is also the most dominant treatment model in the USA (Rasmussen, 2000).
The aims of this piece are to outline and form an understanding of the Minnesota model (MM), which incorporates the disease model, as well as its use as a response to problem drug use. Linking to the Irish perspective throughout, The MM will be looked at in three different contexts, the origins of the MM and its development in both America and Ireland, an outline on the elements used within the MM and lastly, a critique of the MM in its response to drug users. Firstly, I will put forward a definition of a problem drug user for the purposes of …show more content…
the piece.
Problem drug use
The problematic-recreational models of drug use developed in the 1990’s. The Drug Treatment Centre Board defines problem drug use as: “the illegal or illicit drug taking or alcohol consumption which leads a person to experience social, psychological, physical or legal problems related to intoxication or regular excessive consumption and/or dependence” (Bellerose et al, 2011). Problem drug use is characterised generally with the use of heroin and crack and other intravenous injection substances. In contrast, recreational drug use is associated with using drugs such as ecstasy or cannabis, known to be more “weekend drugs” (Rasmussen, 2000). The reason behind the distinction is because of the fact that injecting drugs carries more potential harm and risks. Risks associated include HIV/AIDs and hepatitis C.
It is suggested that problem drug users make up 5% of illegal drug use, with recreational use amounting to 95% (Paylor et al, 2012). Concerns with regard to this model were that the 5% of problem drug users are the focus of much of the policies, and were the main focus of justice, medication and media (Butler, 2002). It is assumed that all use of crack and opiates is problematic and thus treatment is normally focused towards these groups. Treatment for problem drug use in Ireland is delivered by statutory and non-statutory services, which include residential centres, community-based addiction services and more (Bellerose et al, 2011).
The Disease model, Alcoholics Anonymous and the Origins of the Minnesota Model
The disease model The Minnesota model is based upon the disease model of addiction. The idea of addiction as a disease is prevalent within media as well as among researchers and clinicians. However, although the disease concept is widely accepted, drug offenses are still punishable by law (Heyman, 2009). There are seemingly two responses to problem drug use and addiction: medical treatment or punishment. The disease approach is the less punitive option and allows the addict to adopt the sick role (Hussein Rassool, 2011).
The main concept of the Disease Model is that addiction is a medical issue, or progressive illness. Researchers have said that addiction should be grouped with diseases such as Alzheimer’s, diabetes and arthritis (Rasmussen, 2000). Within the model, there is no cure for addiction as such and the addict is in recovery for life. Due to the inability of the addict to control their consumption, the only treatment aim is total abstinence, a voluntary restraint from the acts of addiction (Denzin, 1987). Research suggests that there is a scientific basis for the disease model, stating that addiction is in our genetics, or biological make up. The role genes have to play is hard to ignore and gives the disease model rationale for approach to addiction. Much of the research done on this topic of disease was done on alcoholics, and findings indicated that alcoholism runs in families even if they don’t live together. A finding in a large scale study in Sweden found that an adoptees biological father’s drinking pattern was more of a predictor of alcohol abuse in the adopted child than their adoptive father (Hussein Rassool, 2011). Many other studies found the same correlation between genes and addiction.
Alcoholics Anonymous and the Minnesota Model
The Minnesota makes use of the philosophy of Alcoholics Anonymous (AA).
The AA was established in Ohio, USA in 1935 by Bill Wilson and Dr. Bob Smith. Both had identified as being drunks and found by reaching out to each other they could stay sober. By 1939, AA had reached out to many other states within America and other countries overseas. The founders created a model of twelve steps to form sobriety (appendix 1). The first AA meeting in Ireland took place in late 1946. Following this first meeting, AA grew within Ireland steadily. It is important to say that, although AA had religious roots, it wasn’t as readily accepted by the Catholic Church as one would expect. Instead it was seen as a threat to the role of the Catholic Church (Butler, 2002). Since its introduction, many similar models of treatment based upon AA have been
created. The MM evolved in the state of Minnesota in 1940’s and 1950’s. Started by two young men, Dr. Dan Anderson, a psychologist, and Nelson Bradley, who was to become a psychiatrist, the MM evolved from AA and is a variant of the disease model also. It incorporated a synergy of three programs, Pioneer House, Hazeldon, and Wilmar State Hospital (Miller et al, 1998). Pioneer house used recovering AA members, and employed an informal atmosphere. Hazeldon made use of clergy and past AA members and was said to be introduced for the business class before they lost their jobs. Its target was upper and middle class. Wilmar State Hospital looked at these models and formed their treatment around these (Borkman, 2007). The MM was based upon the philosophy of the AA, but differed in its advocacy, as well as being highly structured. It represented a professionalisation of the AA model (Gossop, 2001). In the 1940’s, it was common in the USA, as well as in Ireland under the Mental Treatment Act 1945, for people with addiction problems to be taken in to psychiatric wards without their consent (Butler, 2002). The concept of the disease model, coupled with the introduction of the MM and AA lead to a less stigmatised reaction to addiction. The MM started as an all male inpatient treatment centre. It is fair to say that the MM was introduced for the middle and upper classes of society and, at a time where insurance did not cover the treatment, it meant that only those who could afford it would go (Butler, 2002). As previously stated, Ireland was slow to accept the model of AA; however it was very fast to promote the Minnesota model. It was priests and nuns who initially promoted the model. This was at a time in Ireland that pastoral work was taking more form in communities and this was seen as a very appropriate form of pastoral care (Butler, 2002). The first centre in Ireland was the Stanhope Social Service Centre in 1976. This was an outpatient centre. It was in 1978 that the Rutland centre was formed in Ireland and this had a much greater impact on the treatment scene within Ireland. The Rutland centre soon became a pilot project and the minister for health provided funds towards the costs of the program. This was the first in a line of MM centres introduced to Ireland, including Arbour house and Tabor Lodge among others (Butler, 2002).
MM: a response to problem drug use.
Elements of the MM
The MM is based on a therapeutic philosophy and made use of the AA’s twelve step approach. The main differences between AA and MM are that the MM uses an inpatient rehabilitation treatment model, incorporating lengthy aftercare. As previously stated, the MM also views addiction as a disease and recovery from the disease is constringent upon abstinence (Borkman et al, 2008). Recovery from addiction is achieved through the use of the twelve steps, adopted from the AA. It has a multidisciplinary approach to addiction, employing both professionals from fields such as psychology, counsellors, clergy and recovering addicts themselves (Rasmussen, 2000). The approach of the model is that the clients are treated within a community of respect and dignity. It claims to be holistic in its approach and include many dimensions of the person’s life. The multidisciplinary approach is very important and is something a lot of other models had ignored (Borkman et al, 2007). The use of past addicts in treatment is beneficial and gives the client hope and strength.
There is a need of people entering residential treatment to be clean of the illicit substances, and thus a detoxification treatment is administered before entry, but kept separate from the facility. This is purposefully done in order to separate the drugs and withdrawal symptoms from the treatment centre. Further adaptations of the model incorporated halfway house, a high support unit and family focused care (Butler, 2000).
Critique
The main criticisms of the model are that it is inflexible and that a one size fits all approach is employed (Harrison et al, 2001). There is no distinction between types of drugs and types of treatment administered and as such, even though evidence shows that the harm associated with the use of opiates contrasted with the harm associated with alcohol use is astronomically different (Bellerose, 2011). The MM also has nothing to say on prevention and health aspects of addiction and focuses entirely on recovery through the twelve steps. (Butler, 2002). This deflects attention away from the wider context of alcohol and drug consumption (Butler, 2002).
Regarding the response to problem drug use, the main and most predominant element of the MM is the use of the twelve steps. There are many arguments against the use of these. It has been said that the twelve steps have a religious basis which in today’s more secular society, is getting less relevant (Butler, 2002) The are also very weakness based. The first step to recovery is admitting that one is powerless to the alcohol (or other substance) and that their lives have become unmanageable. This in itself is very disempowering for the user. The second, third and eleventh steps are about turning one’s self over to the “care of God”, who will restore the sanity of the addict, through prayer and meditation. There are arguments that passing off the responsibility of the drug user to themselves can be detrimental. The fourth step calls on the addict to develop a moral inventory of one’s self. This is interpreted as one finding faults, and ties in with step six, which requests god remove the character defects the addict has (Gossop, 2001). This has a culture of self-blame. Steps one to five are to be completed in the inpatient set up before one is released. Step eight and nine requires clients to make a list of people they have harmed, and make amends with them all, so far as to not injure or harm them. The clients are also requested to continuously take personal inventory of themselves and admit when they are wrong. This again leads to disempowerment and focusing on ones negative attributes. Finally the twelfth step requires the client to carry these messages, of their spiritual awakening and pass them on to other addicts. While step twelve can be seen as a positive one, there is an overtly negative feel to the majority of the steps. From the outside in, the Disease model, and Minnesota Model looks to be an ideal model, and is one of the most popular forms of treatment within Ireland (Butler, 2002). It is praised in media and the treatment outcome studies conducted within the centres have very positive outcomes. However it is worth noting that these studies have been labelled by some an exaggerated (Harrison, 2001). Having conducted research on the treatment outcomes of a MM centre in Cork, I can conclude that, while there are some very positive outcomes, this is not always the case. The outcomes are also constringent upon the gender, age, types of drugs used, among many more. (Dunne, et al, 2014). The study conducted had a sample of 180 participants, and of these, 84% were male. Patients were tracked at three intervals over an 18 month period, and those who were in for alcohol addiction fared the best, with success rate at 62%. Though the opiate users were the smallest group within the sample, none of them had remained abstinent after the 28 day programme. Outcomes for adolescents and younger people were also a lot poorer (Dunne, 2014 & Harrison, 2011). This leads one to believe that although the MM has a long standing reputation with treatment of alcoholics; it is not the best treatment for those using opiates and similar drugs. More research on this is needed. As stated earlier, expecting one to surrender to a disease and remove any sense of self reliance is very disempowering to the user. It is this notion of irreversibility, and lack of cure, and the emphasis on accepting powerlessness, which other professionals seem to have the biggest problems with in regards to this treatment model.
Closing arguments and conclusions “Disease Conceptions have come to represent all our fears. We also have no hope for total cure, for even if we have not taken a drink for years, we still call ourselves alcoholics.” (Blessing, 1990, p.19)
The fundamental issue with this model is the concept of the disease model. It represents a total lack of power for the “sick” addict. Within this piece, we have discussed the origins of the MM in Ireland and its use for the treatment of addiction and problem drug use. Evidenced in this piece, the Minnesota Model has a long tradition of treatment, but its criticisms far outweigh the praise. The outcomes with regards to alcoholics are positive however, the treatment with regards to treating problem drug users is inconclusive. One such model I believe would be more suited to problem drug users would be harm reduction (HR) model. This incorporates teaching and policies on reducing the harm resulting from use of drugs (Gossop, 2001). Introduced following the HIV/AIDS epidemic of the eighties, measures introduced include needle exchange programs as well as methadone replacement is. Although the MM cannot be ignored entirely as it has an impressive track record, and it definitely has its place for different types of addicts, it is my opinion that HR is a more focused and better aimed treatment for problem drug users. HR is viewed as a continuum of behaviours including excess to moderation to abstinence (Paylor et al, 2012). This is done in steps from excess towards abstinence rather than expecting absolute and total abstinence as the MM does. The overall aim of HR is moving clients away from their behaviours towards less harmful consequences. Although the abstinence model has its pros for recreational drug use and alcohol problems, a step away from this in order to treat problem drug users would be much more beneficial as it allows more scope for treatment other than merely abstinence.
Appendix 1
“The Twelve Steps
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”
(AA, 1961, p.7)
Bibliography
Alcoholics Anonymous (1961) Members of the Clergy Ask About Alcoholics Anonymous. New York, Alcoholics Anonymous Grapevine Inc.
Bellerose, D., Carew, A.M and Lyons, S. (2011) Treated Problem Alcohol Use in Ireland. HRB Trend Series. 11, pp. 1-24.
Blessing, S.R. (1990) 12 Steps Down: The Road from Recovery. Off Our Backs: A Woman’s News Journal. 20(4) p. 19.
Borkman, T., Kaskutas, L.A. and Owen. P. (2007) Contrasting and converging Philosophies of Three Models of Alcohol/Other Drugs Treatment. Alcoholism Treatment Quarterly. 25(3), pp. 25-38
Butler, S. (2002) Alcohol, Drugs and Health Promotion in Modern Ireland. Dublin, Institute of Public Administration.
Denzin, N.K. (1987) Treating Alcoholism: An Alcoholics Anonymous Approach. Beverley Hills, Sage Publications.
Dunne. S., Hughes. P., and Devine. M. (2014) A longitudinal outcomes study on the effectiveness of abstinence based residential rehabilitation as experienced by clients and their families in Tabor Lodge. Unpublished.
Gossop, M. (2001) Drug Addiction and its Treatment. Oxford, Oxford University Press.
Harrison, P.A. and Asche, S.E. (2001) Outcomes Monitoring in Minnesota: Treatment Implications, Practical Limitations. Journal of Substance Abuse Treatment. 21, pp. 173-183.
Heyman, G.M. (2009) Addiction: A Disorder of Choice. New York, Harvard University Press.
Hussein Rassool, G. (2011) Understanding Addiction Behaviours: Theoretical & Clinical Practise in Health and Social Care. London, Palgrave Macmillan.
Miller, W.R. and Heather, N. (1998) Treating Addictive Behaviours. New York, Plenum Press.
Paylor, I., Measham, F. and Asher, H. Social Work and Drug Use. Berkshire, Open university Press.
Rasmussen, S. (2000) Addiction Treatment: Theory and Practise. California, Sage Publications.