(00:00:00) Alcohol beverages are illegal and accepted part of American society. But when alcohol is abused, it's a threat to health and safety family life and employment this month. Minnesota Public Radio is examining the price we pay for alcohol abuse today here on. Midday. We're going to focus on various treatment programs that are available in the state Our Guest this our include Patricia Owen a clinical psychologist at the well-known Hazleton Institute at Center City a Pioneer in the development of the so-called Minnesota model of treatment Robert mascola chemical dependency counselor who's developed an alternative Pro treatment approach called the chemical health concept works as an advisor to a group called rational recovery of Minnesota and Pat Harrison. She evaluates chemical dependency programs for the State Department of Human Services, but first of all, we have a report from national public radio's Frank Browning on two very different approaches to treatment And and Ruby are both alcoholics. Both are in recovery programs and both have also gone through numerous other treatment programs before and failed to stop drinking the big difference between them. Is that while Ruby is a penniless single mother and is (00:01:09) Rich. I was raised in a pretty wealthy home with very respectable family and I was on the street. My family wouldn't take you back in they had had enough. They had had an absolutely enough of me being in crisis and not having any place to go and breaking up with one boyfriend and moving out of one apartment into another and constantly calling them. Can I have some money will you send me to treatment again this time and (00:01:33) parents and her personal trust fund paid thousands of dollars to the Hazelden Foundation. The world's most prestigious alcohol treatment center. Meanwhile Ruby who has been through 15 previous treatment programs leads a very (00:01:47) different life when we get done here. Then (00:01:55) Ruby is wrestling with her alcohol troubles through a city funded outpatient counseling and (00:02:00) support system (00:02:01) called Basics that helps her cope with housing and raising four kids on welfare (00:02:06) payments. The biggest problem I'm having right now is dealing with with four children and being a single parent. So it's kind of like when the stress builds up real high the way I I guess I'm used to coping with it is to drink (00:02:22) money isn't the only thing that separates how Ruby and are facing their drinking problems. The approaches of their programs are also radically different and lives on the bucolic 400-acre Hazelden treatment compound which requires a 28-day residency based on the 12 step recovery in absolute abstinence principles of Alcoholics. Anonymous. Hazleton Central precept is the patient's confession of helplessness and submission to a higher power that an says has been her key to (00:02:52) sobriety one needs to have some trust in some faith and gain some inner strength from a power greater than oneself some choose to call it God some choose to call it their alcoholics anonymous group or see it through other people some may call it AA some you I can't help but look out here at this beautiful campus in the lake. Nature and and know that there's something at work within us humans. There's more than just our skins and our bodies there's a soul involved but I've also been known to use the group as my higher power to take a problem to the group and let them help me with the answer rather than trying to tackle it all on my own when in the past I finally learned that my way doesn't work anymore. (00:03:50) Hazleton is recognized worldwide as the finest Exemplar of the so-called Minnesota model for treating chemical dependence unlike AAA, which is a free voluntary Association Hazelden is a lavish expensive program $8,500 for the initial one month visit which provides an average of five professional staff per patient offers a library gymnasiums of bookstore with its own Daily Devotional books even meditation paths and chapels all of this says Hazelden president Jerry Spicer is necessary to address the complexity of alcoholism. We believe that alcoholism is what we say is is multi-phase eek mean. It has a lot of different consequences. It not only affects the person physically emotionally psychologically socially employment. And so we talked about a (00:04:41) rehabilitation model where you need to have a team of (00:04:46) people who are able to work with the patient on all of those different (00:04:50) areas Spicer speaks of (00:04:52) lifelong rehabilitation in which the initial residency starts a patient like hand on a never-ending battle for growth and sobriety people don't leave Hazel and as we often say being cured, they leave Hazelden being started on the recovery process, if the combination of spiritualism professional counseling and serenity has worked for an the 12-step approach was a complete turnoff to Ruby (00:05:16) or less. It was a lot of people telling what it was. When they were drunk and I know what it was like to be drunk. You know what I'm trying to get past that point and try to figure out what I need to do to stay sober, you know socializing with people that were not using was good, but it wasn't enough to keep me sober. working the steps You know admitting that I was powerless over alcohol. I know that I accept that. But that doesn't really help with the reality of everyday (00:05:44) life at Basics counselors. Help Ruby and other alcoholics reorganize their home in personalized to alleviate the stress has that led them to drink Karen Ganley who has spent the last 20 years working with drug and alcohol abusers founded Basics. She says that 12-step Minnesota model programs fail to address the Practical problems that bush people like Ruby to use drugs and (00:06:08) alcohol. We know what the using is about. It's a stress release her it's what happened who came over the family came over. I got so overwhelmed it was there. I had the money who knows what the reason is people use drugs because it works there's no mystical thing about that. So what did you need it to work for what was happening in your life indeed as Ganley sees it the very (00:06:30) idea of lifelong abstinence. So Central to 12-step programs (00:06:34) is a mechanistic (00:06:36) bureaucratic approach that gets in the way of helping people sort out their (00:06:39) problems if you choose to use again and it To news to cause you problems you better make a serious thinking deal here. You better figure out maybe I shouldn't drink it all because every time I do it creates major problems for me. That's how I think we need to look at substance abuse. If I use 15 years from now or 4 months from now or 10 years from now and it's not a problem who says it is. Who says it (00:07:07) is? Beyond these differences over recovery techniques a tougher question remains what actually works to that question. There's very little good news earlier this year reporters for the Minneapolis Star Tribune spent months combing through State records in an attempt to assess the effectiveness of the hundred million dollar a year Minnesota treatment industry, which altogether handle some 30,000 people annually while the industry claims a recovery rate of 60 to 70% State records show that fewer than half the people who enter the program still abstain from alcohol and drugs even six months after graduation worse, the Star Tribune reported long-term abstinence the formal objective of most programs fell to less than a third and in some programs was as little as 10% In addition a 1990 study conducted by The Institute of medicine found no intrinsic advantage to inpatient residency programs over much less expensive outpatient counseling the real challenge for health policy planners and treatment Specialists will be finding which programs promise the most hope for a diverse and desperate array of abusive drinkers. That report prepared by a national public radio's Frank Browning. Of course, he filed it late last year. That's the reference to the Star Tribune series, which actually ran in July of last summer. Well today we're going to take a closer. Look at what programs are available to people in the state of Minnesota Pat Harrison. I'd like to start with you you work for the state of Minnesota have been evaluating and measuring various treatment programs. Is there a one-size-fits-all solution to this to this problem? (00:08:51) No, and there never is going to be I think there's a variety of people with a variety of problems. It's not only alcohol but it's different drugs as some of the speakers in your earlier report alluded to people get into alcohol and drug abuse for a variety of reasons and many of them are going to need to address and resolve some of those issues. To be able to reduce their alcohol or drug abuse. So I think what we need to look at long term is a variety of approaches in evaluate those individually and begin to learn which approach for which length of time in which setting with which population seems to work for different groups of (00:09:31) people now right now there are what we spending a hundred million dollars is at the correct figure on treatment programs in (00:09:37) Minnesota about half of that as public expenditures about half of that as insurance money private pay (00:09:43) and how many people go through treatment in Minnesota (00:09:45) every year about (00:09:46) 40,000. Most of those are minnesotans are people who come from outside the state (00:09:51) most of those now are minnesotans, but that does include people that go to halfway houses and extended care programs in a whole variety of services. Not just the inpatient program that most people think of when they think of treatment (00:10:05) Patricia Owen you are with Hazelton, which is by far the best known program around here and probably in the country. What kind of trying to determine exact success rates is apparently very difficult, but in general how many people who show up at Hazleton when they leave our sober and remain sober (00:10:28) we've been doing extensive follow-up studies since about 1970 and we follow people up at six months and 12 months. And as you can imagine they're all sorts of difficulties and logistically and doing follow-up but to our best knowledge at 12 months between 51 percent and fifty nine percent at 12 months report abstinence. We also confirm this with significant others in their family members our friends and usually find about 80 percent concordance rate, which is very good actually in terms of matching responses, but I'd like to also add that more than that respond that they have a much improved quality of life meaning that their relationships with their spouse. I'm on the job friends relationship with themselves is vastly (00:11:18) improved that your figure is that is that the cutoff point if somebody makes it that far then they pretty well got it licked or is that just an arbitrary time that you had to pick two to study to the success rate (00:11:32) give two responses to that one is that nobody ever has it licked? We know that that is definitely our philosophy but it is true that if a person is able to maintain abstinence for 6 to 12 months chances are good. They're on a pretty good path. And so we believe that those are those response rather those outcome rates reflect. Some can reflect some pretty long term outcomes as well (00:11:55) Robert mosca. How does your program differ from the traditional 12-step model that we hear so much about Well, I think we've only got an hour for the program. I'm not sure that we could get into all the differences that exist between what has come to be described as alternative treatments of which there are a number of different types that exist out in the community. I think that first of all the idea that that someone is in order to be able to get help and assistance would have to Define themselves as being an alcoholic or refer themselves to being an alcoholic we take great difference of opinion with and we don't require any of our clients or even ask any of our clients to be able to refer to themselves in that way. We talked about their chemical health as being a problem or a particular condition that they have but they are not to the condition themselves anymore than someone should be required to come in and describe themselves as being cancer, but rather describe themselves as having cancer other kinds of differences that I think exists is that Oh, we might have somebody involved in what we would describe as being a treatment regimen maybe over the course of their entire lifetime may be involved in a low structure Outpatient Treatment effort where they may be being seen one to four times a month on a continuing basis without expectation that they're ever going to graduate or complete treatment, but rather we're trying to be able to sustain the quality of their life on an ongoing basis just like a physician would try to be able to do so with somebody who's got a very chronic and difficult and complicated problem. We use other kinds of treatment models and approaches a rational recovery as an alternative to Alcoholics Anonymous. We don't encourage people to confuse the differences between their chemical health and their religious and spiritual preferences, which I think is widespread throughout the entire industry in Minnesota and widespread throughout the entire country in the United States. We would know more encourage our clients to be able to acknowledge that they're powerless then to indicate that there's some kind of a shameful person because we don't think That's a way for them to be able to try to get better and yet that's a central organizing peace and much of traditional conventional treatment in the way that it is constructed. So if there are lots of different ways in which we do things differently, I think another principle one is that we let clients themselves choose what's in their best interests, whether they wish to choose an abstinence orientation or control drinking orientation. We don't impose a particular orientation on them. We will let clients to choose whether they want to engage in a treatment regimen that we design or whether they want to engage in a counseling program that they themselves Design This was absolutely unheard of ten years ago. And in fact was considered by the state to be an illegal practice. We do detoxification of people inside of their homes rather than to require them to have to be able to come to expensive facilities, whether they be outpatient or inpatient do insurance companies pay for all kinds of treatments that are offered all the various different approaches or do they have preferred programs that they pay for. How does that work? (00:14:53) Well, she know that the health industry is changing rapidly. So any answer I give us probably outdated before I'm finished. But the way we work in Minnesota is the publicly funded clients are eligible for all licensed treatment providers that contract with the county and then use a Consolidated funding source for eligibility and that's virtually all but a handful of programs in the state serve publicly-funded clients, which I think is an advantage in Minnesota because we have not developed a two-tier system like much of the country has where poor people can only get services in the public sector programs in the Private Industry goes elsewhere as far as people with private insurance now, I think we're seeing a much greater limitation on Choice than his existed in the past hmos May set up their own programs and requirements preferred provider organizations, May limit your choices, so I don't think that The consumer is often in the position unless he or she can pay out a pocket to choose the service that best meets their needs and I think that's a concern that we need to weigh in the future because I agree very much with Bob's philosophy that a consumer often is the person who best knows what kind of treatment and service they will best respond to (00:16:16) our insurance companies third payers. Are they moving away from the major inpatient kind of program and giving preference to outpatient the less expensive programs is that generally the trend (00:16:29) it is true that many insurance companies will require person for example to quote fail in outpatient treatment before they can move on to inpatient treatment, but we are finding that many funders are becoming more flexible in their approach and are looking more at the individual and what he or she needs and trying to make the best choice the first time so that the person doesn't have To fail in whatever approach that they choose. (00:16:55) We've got a number of callers on the line and I want to get to the callers but a couple of just a couple of basic bits of information. First of all, what is alcohol it? Is this anybody Define an alcoholic for me. Is this somebody who one drink and and they're out of control? What's an alcohol? (00:17:17) I'll take a stab at that recognizing that it it definitely is a controversial and somewhat undefined term. But basically what we would describe as an alcoholic as somebody who has impaired control over their use meaning that they cannot reliably predict when they will quit using once they begin that would be one criteria and the other would be that they have consequences negative consequences in many spheres of their life from using alcohol and this definition is consistent. For example at the sm-3 the standard manual that's used for diagnosis. (00:17:53) How would an alcoholic differ from a heavy drinker? Depends on which program you go to in which counsel you happen to see what kind of language they use how they tend to be able to view the world whether or not you are an alcoholic or not probably says more about the diagnostic standards of the clinician that just had a chance to be able to interview you than it actually says whether you are not so it's not like a cigarette addiction. For example, I mean, you know, even a cigarette addiction is difficult to be able to ascertain some people suffer from actual drug withdrawal symptoms and need to be on nicotine substitutes in order to be able to prevent the nicotine withdrawal process from going on when I make a change in my nicotine or my cigarette patterns. I'm experiencing an addiction as well. And I have a hard time abstaining and refraining from from using but not because I have an addiction to nicotine but more because I've kind of a psychological dependence on cigarette smoking having something in my hand. I kind of miss it. I've used it as a coping device and whether or not somebody's physiologically addicted to a substance or psychologically dependent is hard to be able to ascertain sometimes but sometimes that's used. Way to be able to define whether or not somebody is dependent or alcoholic or whether or not they're suffering from alcohol abuse and could a person be categorized as an alcoholic or a person who's in danger of alcohol abuse who has never had a drink in their life. I mean, is it that kind of a kind of a disease? (00:19:15) I wouldn't say so although you might find people that would disagree. I think that it needs to be assessed in behavioral terms based on the amount and frequency with which a person uses a substance and then the consequences they suffer as a result and then if they still continue to use in the face of those consequences, you have to think there's a problem. I think what you can refer to those people that are probably at higher risk than the average person and we do know but we don't understand totally genetic vulnerabilities where there appears to be some transmission and families. Certainly, if a lot of your relatives are dependent on alcohol and you've witnessed a lot of All related problems. You're probably going to want to be much more cautious about what happens when you drink but I don't think people are alcoholic when they're born and I don't believe their alcoholic when they take their first drink. I think it's a developing problem over time that some people experience and some don't and we don't clearly understand the differences. (00:20:17) That's Pat Harrison who is with the State Department of Human Services. Also joining us. Today is Patricia Owen who's with the Hazelton Institute and Robert mascola who is a chemical dependency counselor in Minneapolis. We are talking about treatment programs in the state of Minnesota. This is part of our special month-long series of broadcasts on alcohol abuse and price that Society pays for it. Let's take a caller. Hi. Hello. Yes. Go ahead. I'm out of car phone. I hope the quality of this call is okay. I've I'm a physician and I've had through contracts with the hospital to do physicals on patients as they come in for chemicals or feet chemical dependency treatment programs. I've had hundreds of patients come through. A base programs and had horrible success rate with the maybe something closer to four percent rather than the numbers we've heard. I know that in other areas of our Medical Care heart disease asthma blood pressure control, we would never get approval for any sort of techniques with a success rate. That's so low and it seems like the reporting mechanisms back to the Physicians and to the insurers is kind of all couched in the secrecy of well, this is chemical dependency and therefore we can't share information and can't talk about it for confidentiality purposes. And as a result, I think it's been easy to bury some of these poor statistics and I guess my question is how can the AA based programs be so successful in Minnesota given my experience with it. I've had instantly I've had a number of patients who have done very well in our although with admittedly much fewer numbers, but I'm wondering how this program can be so successful. For Minnesota despite lack of evidence from almost any of the positions that I talk to that their patients get any success and then one quick follow up after them, then I'll hang up and listen on the radio. I'm interested in the comments from the panel members on the cycling of patients with DWI through treatment programs, even when they're not interested in quitting smoking is giving quitting drinking just in order to get around other sanctions that the court might be ready to impose and now hang up and listen. Thanks a lot. Okay. Thanks the success rates Patricia Ellen Hazelton want to record a comment on (00:22:34) it. Yes. I'd like to respond to that because I think this doctor does point out something that's very important is that when a person does not get into recovery, the effects are dramatic and that unfortunately is what he's seeing and what is so visible oftentimes to society and to Physicians is that when a person does not recover, they're likely to have extreme problems. Now the flip side of that is is that those who do get into recovery. It's often a very quiet recovery. I would bet that he's got a huge number in his caseload who have gone through programs who probably have chosen not to tell him or it simply has not come up and they are leading lives of quiet productivity and health that Society doesn't necessarily (00:23:16) recognize now, what about the practice of sending people through the get picked up for DWI and they automatically get channeled through a chemical dependency evaluation program and the rest that make any (00:23:30) sense. Well, I think it makes sense as part of a dual strategy. I think that people that break society's laws need to have sanctions. So I don't think there's necessarily any reason that they're not be legal sanctions for the illegal Behavior. But the other part of the consideration is if the compulsion to drink and drive is resulting in part from an illness that can be treated. It doesn't make sense not to treat the illness, but I think DWI is a complicated Behavior because it is drinking and driving and treatment May address the drinking but there are certain people in society who do not have a great deal of regard for the well-being of others. And I think the driving piece of the DWI is just a significant and we have a right to I think incarcerate people who repeatedly show that they are not going to stop endangering themselves. Another people (00:24:33) don't take a little crack just for a brief moment about the comment that the physician made in relationship to his concern about seeing a lot of people that seemingly had failed that conventional treatment programs. I'm a little concerned that as a panel. We might have given him the impression that we're going to kind of brush him off in this regard the indicating that he's only seeing the failure rates in that he's not seeing the people that are successful. I think as a registered nurse and trained as a nurse and came to this industry out of concern for how General Medical Practice is implemented in this business. I think it's a widespread phenomenon that a lot of Physicians a lot of psychologists a lot of nurses. A lot of people who are working in Primary. Care are seeing people all over the place that are not being helped by the conventional treatment programs and the conventional treatment programs. I think are unfortunately not taking that into account. I think they don't hear what the real cries are out on the streets, which is we need something different for these folks. They are not attracted to the existing model. They don't want to view them. Cells as being alcoholics. They want to be treated in a different fashion than how they're being treated by the conventional treatment programs. And I guess I want to be able to say that I hear what the physician is saying. I think that the physician psychologist the Mental Health Community the court system almost unanimously are the people who are mostly supportive of alternative treatment models because they're the ones that are seeing the failures on the street. It's not the researchers that are coming to the community and saying we need to develop some alternative treatments. It's the Physicians out there who are seeing the casualties from people who are not doing well on the existing treatment check another caller with a question or comment. Hi. Hi. I have a question here talking about the effectiveness of treatment and I'm really interested. Maybe Pat Harrison can talk about this. I wonder what do the state Regulators look for when they evaluate these treatment (00:26:18) programs. Well, I think there's two aspects of evaluating treatment and one is the licensing aspect which simply is set up as a mechanism to guarantee that people meet basic Professional Standards of care. It cannot really evaluate outcomes what we're trying to do now and we've made quite a commitment to this effort is to be able to collect a great deal of information on patients who consent to participate it all 360 programs throughout the state and what we will do that we haven't done in the past is get a real comprehensive assessment of all of their problems when they come into treatment both from their perspective and the perspective of the clinicians that work with them and then to keep a detailed record of all the services they receive and that's just not the standard counseling that we think about but if they get help with Transportation or they participate in acupuncture, or maybe they get some family counseling to help with some problems. They're having with their Legal help anything that they get while they're involved in the treatment sequence and then we will do the follow-up interviews and talk to them about their satisfaction with the service they got but also look at what got better in their lives not just did they stop drinking or stop using drugs, but did they reduce the other difficulties? Do they feel that their life is improved in any of those other dimensions and analyzing all that? What we hope to be able to do is to set some basic recommendations about how different people have different needs and different packages of services can be put together to respond to those needs and that if that's what works no matter how expensive it is. It will be the most cost effective rate in the future because you will be saving people from a lot of the medical problems in the legal problems that result when people do not receive successful (00:28:18) treatment. We asked adults Question what comes first the drinking or the the problems that people have (00:28:25) I can answer that from a treatment perspective what we see at Hazelden is really both it can happen that a person for example an elderly person who has not had any problems with alcohol or other drugs may all of a sudden in a short period of time face all sorts of losses retirement, perhaps of their spouse perhaps of their own health and find themselves on top of it all having an extreme alcohol problem. So in that case, it can be rather clear that the problems preceded the alcohol problem. In other cases, of course more stereotypically. We see the opposite or person develops problems with alcohol and drugs and then their whole life falls apart they develop problems of the family their kids their job and unfortunate that point they may be still hanging on to the idea. Gee if I can just get rid of all these problems my alcohol use won't be a problem and that's a fallacy. But in treatment, we really start with where the person is at and don't spend a lot of time looking at which came first the chicken or the egg. Certainly we need to help them deal with the stresses in their life and help in the loss and the grief and to get their life back on track but causal factors themselves will not necessarily determine the treatment method. (00:29:41) I think that the causal factors do determine the treatment methodology where I work and that's part of the difference. She's talking about that in the process at Hazelton and I would suggest that probably at 90 to 95 percent of most of the treatment programs in Minnesota, and I hope I don't engender all kinds of hate mail in this regard but I think for 90 to 95% of the treatment programs, I don't think it makes a tinker's damn how the client got there what kind of problems they've got that treatment program was designed long before the client got there and it's going to be operated on the client whether the client likes it or not that may be a bit of an overstatement but to be able to say that for most programs it doesn't really matter. Who the client is or what the nature of their clients problems are because the program is the same for everybody and everybody goes through the same process that's different with regard to the alternative programs. And I would say they're probably three or four programs in the metro area and maybe the out state area that do take into account. How the person developed the problem and what's a realistic kind of outcome or goal to be able to work with them on and and and and does take that into account in the design of the treatment plan. (00:30:43) I have to disagree with Bob on categorizing all the programs as a one-size-fits-all from the state's perspective. We're just putting together directory of all the programs and I think what we're seeing more so than ever in the past is a sincere effort to respond to individual groups of people with different needs. There are many more culturally specific programs programs for person of homosexual orientation. There are programs developed for women who want to live with their kids while they're go through treatment. There's programs from Native American and other specific cultural perspectives, and I think that programs are required to come up with individualized treatment plans and I think less and less we're seeing the standard kind of 40 our program that you put everybody through the same series of lectures in the same. Counseling and what we're seeing instead is an effort to come up with the specific services that that client needs to get their life in order. (00:31:45) That would be good. I mean if there's a change that's going on in the state than she can see that from a state level that would be impressive but that certainly would not have been the case even five years ago. (00:31:54) I would have to say that I agree with Pat certainly from Hazelden. The point of view is that we see people that have far more complex problems now than we did in the past. It's really quite remarkable. The things that people are facing when they return even recovering from an addiction the also need to deal perhaps with an eating disorder history of sexual abuse with a major depression with vast legal problems that they have unfortunately gotten themselves into there's no way that we can ignore those and that's a critical part of their treatment process and ultimately the (00:32:30) recovery, let's just get another caller on the line here and The conversation. Hello. Hi, this is Trent from New Richmond, Wisconsin. Yes, and I was wondering if your panelists could discuss the issue of dry drunks specifically my father-in-law who went to Hazleton. I believe in the late 70s and has now completed over 15 years of sobriety through a a however in both my wife and my eyes he still exhibits a lot of the characteristics that might be included in someone who is proposed who has a preponderance or wants to doesn't want to but goes into alcohol or other drug problems mean so he's not drinking buddies. He's causing everybody as much trouble as if he had been drinking. Yeah, essentially that's that's the idea by doing. Can you say more about what it is that he's actually doing what are the the behaviors that you're noticing her that you're concerned about? Although he's in fact, he's believe it or not. He now is a counselor himself. With double phds and in Psychology and pharmacology. So he's a classic Doctor Who was drunk but he's difficult to be around. He's manipulative, you know things having read this 12-step program myself. He still refuses to acknowledge the pain that he caused his family. He absolutely is in denial about anything that may have happened between him and my wife that kind of behavior. I don't know if being a doctor is an indication of being on a dry drunk but as a registered nurse, I guess I could take a crack at some parts of this. Somebody came to see me one time and said Bob I want you to be able to tell me whether or not I'm an alcoholic or if I'm a jerk and and my family says that that I'm an alcoholic and that's what's causing me to be a jerk. And so we sat down we went through elaborate series of tests and other things we have the whole family together. We call them into the office and we said Jim the findings are in you're an alcoholic and a jerk and it's possible to have both things. I mean, it's possible for people to have problems and difficulties that are just simply unrelated to their difficulties with regard to chemical health. I mean, we're not unit dimensional people and the fact that he's refusing to acknowledge harm that he may have committed to the family and the past related to his drinking. I guess I would see that as being of some concern and and I don't know that the certainly within the a program they would not like that and he would not be viewed as being a successful person if he wasn't able to acknowledge those kinds of Harms and difficulties that he's made in the past. So it's not just a question of whether you've ever you never drink again, but you have to you have to kind of clean the Slate to (00:35:14) absolutely just putting the cork on the bottle is the beginning of a long process and for some people it will be relatively easy because easy comparatively speaking because they've been functioning very well perhaps before their alcoholism or the basic personality style is intact in one that works well in society, but you have other people that are going to have other problems whether it's a personality disorder, whether it's a major depressive disorder clearly a the freeze-dried drunk is not a scientific term, but it's one that's often used in the a a community what it really signals us a hot. This person has some other problems that need some help with that. He needs some help with he or she and in this case this fellow would really benefit from getting a thorough assessment from a psychologist or from somebody else who could help. Come take a look at what else might be going on in seeing if you can't make some other changes its excellent that he's abstinent no doubt about that. But that makes impossible to make other changes in his (00:36:15) life to think sometimes people like this are resistant to being able to go to Mental Health Services or go see a counselor again that kind of say to their families things on the order of Hey, listen, I did this for you before and now I've cleaned my act up and I haven't had a drink in 15 years. What do you guys want me to be perfect or what and some of that resistance is a little difficult for families to be able to contend with but I think that for this gentleman who has concerns about it, even if he were to call a local psychologist in to find maybe some different ways of being able to talk to his father. Is that what I understand about the circumstance maybe even just some telephone calls not necessarily having to set of session himself. He might get some good ideas about what to be able to say. Let's have another caller on the line joining us. Hi. Yes. Hi. Good afternoon. Are you sure of your guests familiar with the in-house treatment program at Ramsey Hospital? (00:36:59) A (00:36:59) lot of blank look on a blank looks (00:37:04) can you talk a little bit more specifically? (00:37:06) Well, it IT addresses chemical alcohol and other areas like mental health lithium in balance that type of treatment kind of a dual disorder clinic of sorts. Well sure all out of whack you go in there knee straighten you out for a while and they let you go on medication. Whatever is required. They recently adopted a no-smoking policy the what you've got our guys that are on the streets, I won't go in because they can't smoke and what they're forcing them to do is not only give up the drugs the alcohol but they also have to give up cigarettes at the same time in those guys. Just coming. You can only give up so much. (00:37:41) Well, that's a very controversial issue and I think that we're going to see it become much more heated debate in coming years. It's it's awkward in one sense for programs that are promoting health or abstinence from alcohol and drugs to be sort of Sanctioning the use of a chemical that causes more deaths in this country than alcohol and drugs combined and interestingly the little research that's been done and it's not a lot has shown that those people that quit smoking at the same time. They give up their Alcohol and Other Drugs are the most likely to stay abstinent from all those substances. So even though I used to believe too that that's asking people to do too much. That's just going to increase the stress. There's the other side to that argument that most people do their smoking when they do they're drinking and there's a lot of psychological connections there in cues that when you light up you drink a beer and so there may be benefits to people to cutting ties with all those behaviors. So I think the jury is out on this but I think health professionals have to really begin to examine this question whether it's appropriate to have people continue to smoke and environments when we know that's a health hazard. (00:38:59) I think inside of our Clinic environment the way that we've dealt with it is he you actually have to write it into your lease. If you are negotiating for a medical office building Etc that you that your particular space will allow cigarette smoking, even though the remainder of the building will be regarded as being a no-smoking facility. I think people need to make their own decisions about when it's appropriate to be able to change their smoking behavior in the very same way that they need to make their own decisions on their own timeframe about when they're going to change their drinking Behavior Etc and for us to be able to impose another layer of a chemical health requirement on them in order for them to be able to get Services. I think keeps them out. I think it does keep them on the streets. I think it makes the program's less attractive. I think it keeps people away from Health Care Providers rather than brings them towards Health Care Providers and generally would not suggest that Ramsey hospital do that, but I would bet you 10 to 1 the Ramsey Hospital probably doesn't have a darn thing to say about it somebody in the legislature decided that they're going to take all existing hospitals and be able to pass a law indicating that they Can't have smoking in those hospitals no matter what so no matter what the clinicians in the chemical health program at Ramsey think might be best for their clients. They may not be able to do anything about it because the legislature may be requiring them to not have smoking there. Let's go back to the phones. Hi your turn. Hi, I'm from Mankato. I of the family (00:40:20) Brooke or other loved ones of those alcohol addicted. I've heard of Al-Anon and I'm wondering what are the alternative treatment (00:40:26) program? Not a darn one in existence anywhere in the country other than Al-Anon for no cost to support group Services, which is a tragedy of immense proportion. So almost all the alternative programs that I am familiar with locally as well as nationally have addressed themselves mostly to the identified patient and not to the involved other if you will or the involved others and it's really a failure on our part. I think as a clinicians involved in this alternative business to do things as substantial for family members we try to do as much as we can inside of our clinic but I think we don't do (00:41:03) enough at a sold and we have a five day residential program for family members, which is certainly based on the principles of alanine, but I would not call it an Al-Anon program per se what it does is it gives a person a chance to take a look at themselves and how they like to make changes in their life as well as cope with somebody whom they love is chemically dependent that is one option, but I it sounds like she's looking for something different than that. It's longer term and in her community and she may look at some of the more General support groups for family members of those with a chronic illness and might find some (00:41:40) commonalities their program like reached its dealing with family members for people that have mental health problems if they would allow her to be able to make some connection there, but she's really without adequate resources. I would suspect and it's it is really a tragedy almost everywhere. That's taken out are a collar with a question. Hi. Hello. I want to say that st. Patrick days has a very good meeting for me. It'll be my ninth year of sobriety. Congratulations. I'm pretty proud of that. I've been thank you very much for the program. I went through a not Hazleton but one similar to it in care patient for 30 days and halfway house for six months and it was I've been listening here the alternative program. I'm wondering what type of Support system. Do you have where Hazelton and the others mostly usually recommend a a I would just like to make one other comment to the car just ahead of me. She might try ACA. I found that really helpful for my codependency. I was that ACA adult children of Alcoholics. It was a very supportive group for me to have in working through some of my codependency programs. All right, and thank you very much for the program. Thanks for call already. I think your question was something on the order of what are we use as ongoing support mechanisms for people and alternative programs that would function as an alternative to what traditional conventional program might use in terms of Alcoholics Anonymous. There has been an attempt to be able to establish some alternative self-help support groups and mutual help support groups that are alternatives to a and the Twin Cities area name of one of the organization's is rational recovery. Unfortunately, even if you call the directory assistance or look in your and the phone book, you will find a listing for rational recovery. It's kind of a hidden thing. We've been supporting it through our Clinic we don't have enough volunteers to be able to make sure that these group meetings are being led in the kind of quality way that everybody wants when for sobriety is certainly has been around for a number of years and two functions as a long-term self-help mutual help but group it's a group now out of Indiana called moderation management for people that are trying a control drinking of activities on an ongoing. This is there's a group that group does not yet exist in Minnesota inside of our Clinic. We've got seven group activities that some people participate in for anywhere from I think the longest running person we've got right now is about six years as a participant in one of the groups and maybe participates for three month time period than drops out for a period of time comes back in for six months at cetera a lot of the alternative based programs in Minneapolis. St. Paul on the Burnsville area have to offer a lot of their own low no cost to support groups associated with their clinics because there are not there's not a big movement like there is in the 12-step Community where you can literally walk down the street and find a meeting almost anywhere. Is it essential that people participate in these these support groups and the rest are there people who just go through the program and leave and that's it. There. They stay clean. (00:44:53) Certainly I did with probably are people who do that. In fact, our research would indicate that's true but in our findings We do in our research rather. We do find that people have a better chance of recovery if they sustain their involvement in a support group on going and like to make a point about support groups are 12-step groups. Certainly that would address also the woman's concern about alanine groups that were very fortunate here in Minnesota and the Twin Cities with the diversity of 12-step groups. So you could go to one 12-step group one night and go to another one the next night and one might fit you in one might seem to be made of people from a different planet. In other words. There's going to be differences within the 12-step groups based on the people who are there the philosophy of course will be the same but people I would recommend that should not give up on a 12-step approach because of their experience with a particular group and instead try several groups and see which one might fit for (00:45:50) them. Let's get another caller and another question from a listener. Hi Hi, how are you? Just one. I have a couple of thoughts one is That I have always been very concerned about what I thought over the last several years was a proliferation of treatment centers in Minnesota at always raised a red flag with me in terms of we seem to have a more treatment centers and we had mon pot walleye resorts at the state and it raised the question of the the element of competition and trying to stay in business as it relates to fingering people. If you will that they're supposedly chemically dependent I happen to think that that we overreacted to all of this strictly from a business standpoint and I'd like to hear somebody comment on the number of treatment centers. We've got in Minnesota and whether or not it's reflective of the actual so-called severity of the problem if you will and whether or not anybody is kind of watching these treatment centers and doing something about them the interventionists and a lot of these other people We seem to be have a vested interest in making sure there's this many people in those places as possible to keep the lights on the last comment. I'd like to make is that I think that if you're looking at agree with your alternative guest there that this is this a a thing which seems to permeate all these places. It's sort of like treating all cancers exactly alike and we know that doesn't work and I would hope we would give some thought to taking a different approach because I think a a sort of borders on the same thing, as you know, religious fanaticism. It seems to me we have rooms full of TV evangelist when we're dealing with all these people. They're all thinking alike. I'll hang up and listen to your comments. Okay. First of all Pat Harrison have we gone overboard here on treatment programs in the state of Minnesota? Are we grabbing people off the streets sending them off to treatment when perhaps they don't need treatment at all. (00:47:51) I think 20 years ago. That was a legitimate criticism. The person could show up at the doors of a treatment. Derp someone there would assess them. And of course there was a huge financial incentive to find that person chemically dependent and admit him to a long-term program that has changed a lot though. We have what people refer to as Gatekeepers are someone that doesn't have a financial incentive to treat or to withhold treatment doing an independent assessment of that person's alcohol and drug related problems in determining whether they need treatment. I don't think that this totally assures us that we're not over diagnosing the problem. I think there's certainly concerns around younger people whose alcohol and drug use May. Well be just one of a dozen problems that they have and does it make sense to put them in an alcohol and drug treatment program rather than deal with the family and other social problems that they're having. So I think it needs to be an ongoing process where we continually do independent assessments of what people need in. Whether they need treatment, but I think the financial incentives can work both ways. You can try to keep people out of treatment to save money or you can try to get them in to make money. And that's why the state in terms of its policy recommendations is moving very much toward the recommendation that the assessment in any National Health Care reform our State Health Care reform be kept independent from the financial incentives to provide a withhold treatment. (00:49:28) Patricia. Ellen is are far too much emphasis on religion and spirituality in the in the AA approach to this problem. I mean, are you where are we talking about a bunch of religious Fanatics? Ultimately, (00:49:40) I would say no, unfortunately, it can be characterized that way and there is a huge difference between religion and spirituality. And in fact in some of the text of a a there's chapters to atheists and and the like you certainly can be an active member of AAA Believing in God or attending church and instead a better one way of thinking about spirituality that works for a lot of people is simply what gives us meaning in life what keeps us connected with other people what adds value to our life and transcends our everyday living some people will find that through religion some people not but you do not have to be a fanatic to in order to grasp and use those Concepts (00:50:26) agree with that. But well, you know, whenever you hear any of the spokespeople from the 12-step programs and and certainly dr. Owen said and not not a spokesperson for The Institute has her own perspective and point of view of the things get kind of clouded and they always give you these kind of murky little answers like there's some kind of difference between religion and spirituality and they kind of talked about how it's not really necessary to have to believe in God in order to be able to become part of the 12-step Community Etc and the kind of disavow that there's really a strong kind of interconnection between religion and spirituality oriented treatment is Man and fashion, which people are in fact treated in Minnesota. I don't think there's any doubt from the people who've been through treatment programs that it's an essential element in the way that people are a talk to in the way that they're treated and what it is that they're required to believe in order to be able to graduate and there may be some variations on a theme that a counselor might be might provide from one place to the next but the language is not on the board that says I made a decision a conscious decision to turn my life and will over to the power of God As I understood him now that's step three in the Alcoholics Anonymous program. You got to get to step for before you can get out of most treatment programs. Now, you can interpret that any way you want to but that's what the language says. I don't like it. I don't think that that should be part of treatment. I think it should have been taken out a long time ago. Unfortunately, not only is it still there? But it's there for the majority of people like we've got time for one more caller. Anyway, let's go back to the phones here. Hi only a couple quick comments. I'm a pest the chairman for a and Southern Minnesota the doctor the called in said that his experience with Hospital based programs using The 12-step recovery method is about 4% Oia is not affiliated with any hospitals. We do a triennial survey and that seems to indicate that about half the people that come to us leave within three months and they don't come back but the other half seem to do pretty well. So maybe 50% in a not treatment centers. But in your two guests said that sobriety wasn't the only measure of success within the A and I think it is what we I've never seen anybody in the a question somebody that sober how they're working the program or how their lifes are going. Now, there are people so Bernie a for 30 years that I don't think are very nice people. But in my opinion if somebody is sober than their successful member of AAA and finally I don't think today is the answer for alcoholism is probably the best thing going now. I don't know if your guess would agree with that but a a certainly is not the answer in the same way that the Salk vaccine. For polio if it was there wouldn't be any alcoholics but seems to be the best thing going for now. I just want to make those points. Thanks and I'll hang up and was thankful. Thank you for your call a very briefly because we were running out of time (00:53:09) here. Well, I'd like to support the gentleman's comments that I hope that in the future we continue to learn and grow and to develop new methods for treatment of alcoholism and chemical dependency. Certainly we do not have the answers any of us sitting here in terms of what really is the best method for everybody who comes to us for (00:53:26) help if people are looking for help or they have a family member who they think ought to get some help. What do they do pick up the Yellow Pages and call the first number they find That's probably the only place that exists in any municipality that gives you some kind of a listing of what the treatment two choices and options are in your local area. And most of those people can give you a can direct you make sure you get to the right resource and (00:53:48) provider. You can try your County's Social Service Agency as well. (00:53:52) Okay. Thanks so much for coming in. Sorry. We're out of time we could talk here for a long time about this subject our guests today. Patricia Owen who is with Hazelton and Robert McCulloch who is an alternative program in Minneapolis has chemical dependency counselor and Pat Harrison is with the State Department of Human Services part of our continuing project this month on alcohol abuse.