Deep Dive with Dr D
Discussions on life and living with Dr D. A man who has risen from the lowest depths of life to the amazing life he has now.
Deep Dive with Dr D
Beyond the Minnesota Model: Reimagining Addiction Treatment
What happens when the dominant approach to addiction treatment hasn't fundamentally changed since the 1950s? Drawing from personal experience both as a patient and professional in the field, I take you behind the curtain of America's addiction treatment system to reveal why our current approaches often fail those who need help most.
The standard 28-day treatment model represents just the tip of the iceberg when it comes to effective recovery support. Research clearly shows that sustainable recovery typically requires approximately two years of consistent support—yet our systems are designed to provide intensive care for less than a month before essentially cutting people loose. This disconnect creates a revolving door where individuals cycle through treatment repeatedly, often blamed for failures that are built into the system itself.
Perhaps most troubling is how socioeconomic factors determine who receives timely help. Those with financial resources or quality insurance typically access treatment immediately, while those relying on public funding face weeks-long waits despite being in active crisis. This waiting period virtually guarantees continued substance use, potentially lost motivation, and deepening health concerns. Meanwhile, the Minnesota Model—a treatment approach developed during the rise of Alcoholics Anonymous—continues dominating the field despite being just one of many potential pathways to recovery. When individuals express that this approach doesn't resonate with them, they're often met with accusations that they "aren't ready" or "don't want recovery badly enough" rather than being offered alternatives better suited to their needs. The treatment world needs to embrace multiple pathways to recovery, truly individualized care, and extended support models that match what research tells us actually works. Until we fundamentally change our approach, we'll continue seeing the same disappointing outcomes that have characterized addiction treatment for decades.
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Today I'm going to talk about the topic that hits close to home for me. It's also a topic that I'm very passionate about in a lot of different ways, and it's the history of treatment in our society. This podcast is all about helping people to see that they have it within them to do amazing things, and one of the ways that I've been able to drastically improve my life is educating myself, and so I've educated myself on topics that I'm passionate about, and this is for sure one of them. So I'm going to read from my journal to start this one off, and it's dated Wednesday, march 28th 1996. Well, I'm back at Olala. Things went well today, just a day of readjusting to the treatment atmosphere. Hopefully tomorrow I'll meet my counselor. That would be day one of my second time in inpatient treatment for a substance use disorder, or better known as addiction, and this podcast is going to talk about the history of treatment in our society.
Speaker 1:Most people, the average person, hears some general things about treatment, and where do we learn this information from? We learn this information from watching the news or talking to friends or family, or watching movies, and there have actually been movies made about treatment, and so most people know treatment to be, and you'll hear other terms used use. I'm all about using non-stigmatizing language. I'm going to do a whole podcast on the use of non-stigmatizing language, because this is the one health condition substance use disorders that carries with it the most stigma and shame and guilt than any other health condition. So a lot of people you'll hear it called rehab, right right, and that's actually a negative term. It's treatment, it's treatment for a health condition, and so most people when you think of treatment, you think of a 21 or 28 day. You go away, you go to some facility and then you come back and everything's great right. And in our society, you come back and everything's great right.
Speaker 1:And in our society, we've been pretty good at giving what is called that subacute treatment for addiction. And what is subacute treatment? That's initial treatment for addiction, initial treatment for a substance use disorder 21 or 28 days and then the person leaves that treatment episode and the expectation is okay go live your life. And resources in a lot of cases are cut off. And what am I talking about when I'm talking about resources? Well, access to ongoing counseling, access to ongoing counseling for mental health and substance use disorders, access to housing, access to jobs, access to a plethora of resources that an individual needs to stay in recovery, to have that sustained recovery. The research is pretty clear on how someone can be successful in a life in recovery and what the research says is it takes approximately two years of sustained support for a person to really turn things around.
Speaker 1:Yet in our society and insurance companies and government entities insurance companies are atrocious about this. They will approve a 28, 21 day treatment episode, but beyond that they're like, oh no, go live your life and good luck, and they won't approve anything beyond that. In fact, here's a fact In fact, treatment centers have staff whose entire job get this, whose entire job is to stay on the phone with insurance companies to get approval for someone to stay in treatment. Like, literally this happens is someone will be in treatment for, say, a week and their insurance company will call and say, hey, we're calling about Joe, how's he doing? And the person on the phone will say, well, he's doing, great, you know, and treatment's 21, 28 days, and they'll do this assessment and they're called reviews, different insurance reviews, and the insurance company will say, well, you know, they haven't used drugs or alcohol for seven days, so we think we're good, we're not going to approve any more treatment. That actually happens For someone who probably has had an addiction issue for a lot of years. Insurance companies, in this arena specifically, will say no more than yes for that treatment Right. So the 21-28 day treatment episode, of which I've experienced two times in my life, can be super helpful. But that's not enough.
Speaker 1:I remember this, this treatment episode that I left, when I left there successfully after 21 or 28 days. I remember leaving that treatment episode and I didn't have a place to live. My sister was allowing me to stay at her house and I left. And I came home and I was just like really anxious, really nervous, I had a lot of anxiety, I had a lot of stuff going on. And I remember calling my caseworker because I was state funded. Many people are state funded for treatment and that's a good thing, we want to support that. Because I was state funded, many people are state funded for treatment and that's a good thing, we want to support that.
Speaker 1:And I remember calling my caseworker and saying, hey, I'm really nervous, I'm on shaky ground here. And she's like well, you know, I can try to get you some more treatment, but you're going to have to get put on a wait list, and this happens all the time, especially for state funded treatment, because there's so many people and there's only so much money. What's the first things that lawmakers want to cut? When they need to cut money, they cut social services right. So this is an arena that there's always more demand than there is supply, meaning bed dates. Long story short, when I was at my sister's, I called my caseworker and I said I need, I need more treatment, I'm really nervous, I don't want to return to use, I'm just like you know. I got really lucky and she called me right back and she says I don't know what's going on, but you, you need to make a decision today because I can get you a bed date, meaning a place to go to for treatment, for a next level of care. But you have to go today and I went and I was really fortunate for that, for having that extended time to be in treatment, which I needed, which a lot of people need.
Speaker 1:I believe that treatment shouldn't necessarily and I say shouldn't necessarily have time attached to it. It should be when the person's ready, when the counselor and that person have had a conversation and all the resources they need access to when they leave treatment are in place and ready to go. But that's not what happens. Now it's 21, 28 days and boom, you're going out into the world and in a lot of cases, in many cases, people leave treatment. They don't have a place to live, they don't have an income source, they don't have a lot of family support. In fact, many people, especially youth, end up going back to very dysfunctional situations. They actually go back to homes that have active use in them. And then who do we blame when that person returns to use? We blame the person. Well, you must not have been listening in treatment, you must not have been paying attention, when the reality is that the levels of support that they had when they left that treatment were very low at best. So it shouldn't be a surprise that someone doesn't have success at staying abstinence or reducing use or being successful in their recovery.
Speaker 1:Right, let's talk about for a minute the modalities used in treatment centers. This is one where it's interesting to me that we have a treatment system that is still today, one where the main method or modality of treatment is out of the 50s, and it's called the Minnesota Model of Treatment. And what is this? Well, this was created out of an era when 12-step groups, specifically Alcoholics Anonymous, were gaining a lot of traction in society. And 12-step groups don't get me wrong are very successful for a lot of people work really well they. But as with anything right, it doesn't work for everyone. But treatment centers when they started becoming a thing, they basically adopted this 12-step model and they put it into the treatment environment. I've been to treatment twice, the same place twice, and this is what they use. And so the Minnesota model of treatment is this at its core. It's teaching the 12-step model.
Speaker 1:While you're in treatment, you read out of the book of Alcoholics Anonymous, you read out of the 12 by 12. Some places now use Narcotics Anonymous. You can pick or choose which 12-step program you want to learn from. You use it in your group settings. You go to meetings while you're in treatment. So you do that, and with that the Minnesota Model of Treatment also has with it therapy, right. So you do individual counseling, you do group counseling and you also get some education. And the education can be surrounding nutrition, it can be surrounding exercise. Family involvement is a part of a lot of treatment centers. That, in a nutshell, is the Minnesota model of treatment. That is still, to this day, the main method of treatment in most treatment centers, the Minnesota model of treatment.
Speaker 1:Now some might say, well, that's great, what's wrong with that? If it works, let's keep using it. Well, here's my thing. It, yes, it works for some and in fact it worked for me for a while. I personally don't use the 12-step model in my life right now, today. I haven't for a long time. It worked for a while and then it's just not my thing. Right? I think of it like this the Minnesota model of treatment.
Speaker 1:And if you go to your doctor, or if you go to your healthcare provider, or if you go to a mental healthcare professional, or if you get any kind of treatment right for an ailment, if you go to your doctor and you get a treatment and that treatment doesn't work, what are you going to do? I'll tell you what you're going to do. You're going to go back to your doctor or your provider, whatever health condition it is, and you're going to say, hey, you gave me a treatment. That treatment's not working, we need to try something else. And any good doctor, mental health, therapist if you're going to a therapist, they're going to say all right, you know what? Let's try these different things, or let's try that same treatment and let's add in some other things.
Speaker 1:Alas, here's what happens in the substance use disorder field and with the Minnesota Model of Treatment to individuals who go to treatment centers. The Minnesota model of treatment doesn't work for them. As I said, it's a great model for some, but is it going to work for all? We have how many people in the world and we're all different people and we all take in different information in different ways.
Speaker 1:When someone goes to treatment and they say they, they verbalize, you know what this? This just isn't for me. I remember it's like well, you know, you, you must not be ready, or you must need to hit rock bottom, or you, you just must not want to hear you might, you must not want to have a higher power. It's like, no, that's not it. I just this doesn't work for me. Is there another method of treatment? And here's where the struggle is there's not, there's. In fact, there are many who won't even allow entertain that as an option, because they're so ingrained into that Minnesota model of treatment that anything outside of that they view as that person just doesn't want recovery, that person is just in denial, right, which can be true in some cases, for sure, but not all right. Can we lump everyone into that one model of treatment? Absolutely not, just like we wouldn't lump every person into every other model of treatment for anything else.
Speaker 1:Why do we do it here? And here's what happens. Here's what happens in our society. If someone goes to treatment, they get that model of treatment, they leave and it doesn't work. They return to use and they even may search for a different method of treatment, but because that method of treatment is so prevalent in our society, it's really difficult to find something outside of that. So what happens? They end up back in the same treatment center getting the same method of treatment.
Speaker 1:And then this is where I get really upset, because this is what happens they get a lot of, they get a lot of shame and they get told well, you must not want it bad enough. So you better listen this time. And here's what happens, my friends with that. Here's what we know. Guilt and shame never work right. Just in general, if you're trying to get someone to change behavior, guilting and shaming them to change, that's not going to work. But that's what happens.
Speaker 1:Someone will go back to treatment and get that same method of treatment, the same person that said, hey, is there another method of treatment? Is there another way? I can try? And it's not them not wanting to find a path to recovery, it's them asking an honest question. They get told no, and this is it. So you better like it, right? I have a huge struggle with that.
Speaker 1:Now here's the good thing is, in some treatment centers there are some, we actually have one in central washington that is called, I believe, the chance for change up in wenatchee they use the choice theory. It's a completely different theory and a completely different model of treatment for people who want to find a path to recovery. That's a beautiful thing. There are other treatment centers that are using mixed modalities. Right, they're allowing for truly individualized treatment, and that's what I'm all about. Truly individualized treatment, because a lot of treatment centers have shiny pamphlets and great websites. I can go look at some now that say, yes, we offer individualized care. And here's why they say that Because by state law they're required to. But even the state buys into archaic method of treatments Our own governments, when people are required to go to support groups. There are some. They won't say this out loud, but they won't even allow any other type of support group verification other than 12-step group. I have a huge issue with that right Like why wouldn't you, why wouldn't you let someone go to Celebrate Recovery or Buddhist Recovery? Or there's the Phoenix, which is an exercise recovery group. Right, allow it all, alas.
Speaker 1:Back to that treatment situation where a person goes through treatment, makes a full faith, honest effort. It doesn't work. They don't buy into the 12-step model. Should they? Should they have to, should they try it? Maybe, sure, but it doesn't work for everyone. And then they go back to treatment, to the same treatment, and then they're guilted and shamed into believing that it's their fault, that they must not want it bad enough. And I have a huge, huge issue with that. There are, as a society we're now especially in the recovery arena, there are many inside the recovery arena that are completely defensive about any other path of treatment other than the one that they completely believe in. And it's like what? No, we have to be open to multiple ways for an individual to get to and stay in recovery.
Speaker 1:So back to the beginning. What is our society doing as far as treatment for individuals with addiction issues? Well, it's still primarily that sub-acute model where someone can get access to that 21 or 28 day treatment. In some cases and not all it's a financial issue. If you have good insurance, you can get in pretty quickly. If you have cash money, you can get in pretty quickly. If you have cash money, you can get in right now.
Speaker 1:But if you, like me, have significant issues with addiction and you've lost jobs and you don't have insurance and you rely on state funding, here's what happens you get told to wait. Let me describe this for you. So we know and I didn't say this at the beginning I've been a substance use disorder professional in my past. I have tons of education in the arena, I have friends and family who work in this arena. So and this is still the case for treatment right now, today, in our local community, in our state and across the country.
Speaker 1:So we know that the best time for someone to get help is when they say they want help, right, like if your friend comes to you and says, hey, you know what I'm struggling with addiction. The best time to get them to treatment is right now. Because what's going to happen if you tell that person oh well, you know, let's talk about it next week or let's talk about it. You know, tomorrow or whatever, what's going to happen. They're going to return to use. So let's say that's the case. Someone comes and they've been in trouble with the law or whatever the case may be. They've had a lot of issues and they walk into our local treatment center it's really good. They do offer same day assessments, right. It's like, yes, that's great, that's progress.
Speaker 1:But if they don't have insurance, if they don't have cash money, that counselor will make a full faith effort. It's not the counselor's fault for this. They'll call an inpatient treatment center and they'll say, hey, I've got Joe here. Joe wants to go to treatment, can I send him down? And they're going to go oh, wait a second. Does he have insurance? Does he have have? How's he gonna pay? And oh, he's state-funded. Oh, okay, well, we're happy to take him, but he's gonna have to wait. Oh okay, about how long? Three weeks.
Speaker 1:So here's what happens. So that person is told they have to wait and that outpatient treatment center will likely say, hey, let's keep you engaged. Why don't you check in with us a couple times a week while you're waiting for that bed date? Right, but outside of that, that's pretty much it. And maybe go to some meetings. They'll tell them to go to meetings or find some support, right, but they're basically told to wait. What's gonna happen when a person is told to wait? They're gonna return to use. And then this happens they get cut off from resources because they're even told hey, if you don't have abstinence while you're waiting for treatment, you're going to be pushed to the back of the line or some other nonsense.
Speaker 1:We know that the time to get a person to treatment is when they say they want help.
Speaker 1:But in our society, depending on your socioeconomic status, that is dependent on that, on whether you have access to health insurance or cash money.
Speaker 1:If you don't have two of those things, you're going to get told to wait, and it can also depend on how much money you have or how good your insurance is. But that's the reality of treatment in our society and that access to treatment. I'm very much a proponent of helping someone find access to treatment and I'm very much a proponent of those treatment centers truly providing individualized care. Not just you know a pretty name on a pamphlet saying we do not just something in a file saying it's individualized care, but it's really cookie cutter but truly providing individualized care. That is a short history of treatment in our society. I'm very passionate about the topics I talk about and I want you to become educated yourself in the arenas that you want to learn about, and one of mine is for sure substance use disorders and people having access to quality, innovative ways to find their own path to recovery. I hope everyone has a great day and a great week.