People wonder what happens in chemical dependency
treatment. What is it about treatment that can transform
the life of an addicted person?
John P. entered residential primary treatment at
Hazelden more than two years ago. Like most first-time
patients, he didn't know what to expect.
"I had a vague idea that treatment might include
group sessions and counseling," he said. "But
otherwise, I had no clue. A lot of people entering
treatment have been in denial and they have never
thought about what treatment might be. If they had an
idea, they might have gone sooner. But you don't want to
know and you really have no experience to base it
Once a person gets to treatment, whether it's
inpatient or outpatient care, the staff and setting
there must instill a sense of hope. "If you
demonstrate care--if you show that you know they're
hurting--then that helps patients believe there is hope
and they have the ability to change," said Bruce
Larson, supervisor of Counselor Training at Hazelden.
Incoming patients need to be stabilized medically and
emotionally. "They need to be distanced from their
drug of choice," said Phil Kavanaugh, supervisor of
a men's inpatient unit at Hazelden. "Some will need
to go through physical withdrawal. A mental withdrawal
also needs to take place. Some people can't stop using
as long as their drug is accessible."
Once patients reach a calm state--in which they can
think clearly, without feelings of anger and fear--they
are given the space and time to look at their lives
realistically. They are given a respectful, supportive
environment in which they can make some life changes.
Under the widely used Minnesota Model of treatment,
each patient receives a thorough assessment in the first
few days of treatment. A holistic, team approach is
taken and every aspect of a patient's life is evaluated:
physical, emotional, spiritual, social and intellectual.
The information, including chemical-use history, is
pooled to form a patient profile; an individualized
recovery plan is developed. Key issues such as low
self-esteem, anxiety and grief will be addressed. Some
patients may have coexisting problems, such as clinical
depression or sexual abuse, that need to be addressed as
Treatment varies. At Hazelden, for instance, the new
patient joins a unit of about 20 patients. It is usually
a diverse group in terms of age, race and economic
status. The mix includes patients who are well along in
their recovery, those just starting to make progress,
and new--often skeptical--patients. In this setting the
peer group becomes a critical therapeutic element.
"One human being sharing and becoming vulnerable
with others and then sharing that back--that's a big
reason treatment works," said Larson. "In that
process people find hope that they're not alone, they're
not unique and terrible, but that they're experiencing
the consequences of an illness. They find they can talk
about their hopes and dreams and share their pain and
struggles in a safe, supportive setting."
Education about the disease of chemical dependency,
through lectures and reading, is another key part of
treatment. As with any chronic illness, it's critical
that patients understand the implications of their
disease and how to manage it. They need to be educated
about what has happened and what can happen if they
continue to drink. They learn that when they drink they
can't build trusting relationships. They realize they
have to become honest and move from the self-centered
life of an alcoholic to one that cares for others.
In the Minnesota Model approach, the Twelve Steps of
Alcoholics Anonymous form the spiritual core for a
recovery program. The Twelve Steps provide principles
for living, and in an inpatient setting patients get AA
education every day for the duration of treatment.
Patients concentrate on "doing" the first
five steps in treatment. Admission, understanding and
acceptance of Step One--"We admitted we were
powerless over alcohol--that our lives had become
unmanageable."--is crucial. Step Two is recognizing
the need for help from "a Power greater than
ourselves," and Step Three is the changing of
behavior and attitudes based on acceptance of that help.
Steps Four and Five lead to improved self-esteem as a
result of attitude and behavior change.
In essence, treatment represents "a time for
healing that sets the stage for recovery and self-help
groups such as AA," said Larson. "It offers an
opportunity for patients to connect with self, others
and a higher power."
John P. found that bonding with peers was invaluable
to his treatment experience. "What surprised me is
that so much of your recovery is based on your own
initiative and the contacts and bonds you form with
peers," he said. "You can't sit back and let
it happen; you can't rely on a counselor to provide a
magic solution. You often hear that recovery takes place
around a coffee table after the counselors have gone
home; there's a lot of truth to that.
"Successful treatment requires rigorous
self-examination and a lot of work digging up all the
old stuff and sharing it with peers. The key is
interaction, and that's really no more than learning how
to ask for help, which for me and a lot of others is the
cornerstone of recovery."
The Hazelden Report is a chemical health column
that addresses the prevention and treatment of chemical
dependency and other related addictive behaviors. This
Report was originally published Sept. 14, 1993 in the Star