How does addiction treatment differ between the UK and the U.S.?
By Deirdre Boyd
The Minnesota Model was developed in the 1950s and started out as a social reform movement; it was the first addiction treatment approach which regarded the patient as a sick person, who needed help to heal, rather than someone with a moral weakness who should be punished. Before, that an alcoholic only had three options: sharing a locked ward with psychotics; prison; or homelessness.
In 1949, the steps of the Minnesota Model were to: “behave responsibly, attend lectures on the Twelve Steps of Alcoholics Anonymous, talk with the other patients, make your bed, and stay sober”. The aim was to help alcoholics shift from a life of isolation to a life of dialogue. This remains true but the model has become more sophisticated and is now interwoven with the “talking therapies” such as CBT (Cognitive Behavioural Therapy), Gestalt, group therapy and the creative therapies (art, drama, music and writing).
Two different approaches
The Minnesota Model became the main residential treatment model in the U.S. long before it came over to the UK. The long-term treatment goal is total abstinence from all mood-altering substances. In the U.S. the aim was to get people sober and then, only if that failed, to use harm reduction methods.
In the UK the opposite approach was taken – treating symptoms rather than the causes of addiction. It was only in 2010 that the UK’s coalition government recognised the failings of the old approach, and the goal of being drug free became the core of Drug Policy 2010. Unfortunately implementation has not followed policy.
Adopting evidence-based treatment models
There are thousands of rehab clinics in the USA that use the Minnesota Model. The model is accepted by the U.S. medical community. Americans are often referred into rehab by the criminal justice system as well as by company managers whose right to do so is protected by labour law. The situation in Britain is very different: AA and the 12-Steps tend to be ignored by the medical community; it is rare for a judge to consider rehab as a valid option to incarceration; very few company managers refer their employees into addiction treatment (they either ignore the problem or fire the addict). As a result, there are less than 50 rehab clinics in the UK that use the Minnesota Model.
Viewing addiction recovery through two different lenses
When it comes to stigma against addicts the situation in the USA is very different to how it is in the UK. In the USA there is a sense of pride about recovery and an estimated 23 million Americans are in long term recovery — in other words they are abstinent from all mind altering drugs. In the UK there is a furious stigma against recovery and proponents of abstinence-based treatment tend to be accused of being elitist and misguided — all of which is rather difficult for our American friends to understand.
Socialization can reduce treatment quality
I fear that Obamacare will reduce the quality of addiction treatment in the U.S. to the low level it’s at in the UK. Money and statistics will become more important than quality. Patients will be sent to cheaper and lower quality centres. Prescribing substitutes like methadone, to address symptoms rather than root causes, will prevail. And residential rehab clinics will close.
I hope this prediction turns out to be inaccurate. The Hazelden and Betty Ford clinics have merged in order to face this future. More mergers are likely as governments prefer to deal with a few big organisations.
About the author: Deirdre Boyd is the CEO of the Addiction Recovery Foundation, founder of UKESAD (UK/European Symposia on Addictive Disorders) and consultant to Castle Craig Hospital.
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