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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.

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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.

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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.

Photo credit: Wiki Media Commones

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3 Responses to “How does addiction treatment differ between the UK and the U.S.?
Jen Wilford
2:21 pm May 8th, 2014

It’s a shame to see Obamacare being bashed by a foreign government. I wonder if you only get FOX news over there? I work at a rehab, and as a result of Obamacare we have been able to admit (and be paid for) many more people than in the past- last year this would not have been possible. Often we were taking people for free. We are grateful for Obamacare. Or, as it is properly known: The Affordable Healthcare Act. Higher end rehabs also benefit, through my own health plan (through Obamacare) I would have great options to choose from.

lisbeth
3:07 am May 10th, 2014

I think it’s so sad that horrid fearmongering like this can still be presented like it’s got some relationship with science. What are the rates of recovery in Britain as opposed to the US? What are the mortality rates from addiction related causes? How many families in Britain are driven into bankruptcy trying to pay to get their loved one better? Where did you find those many interesting statistics you cited, I wonder?

“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”
I’ve long wondered why Britain leads the world in the percentage of its citizens who have been committed to prisons, especially considering the vast majority of Britain’s prisoners are low level, first-time, non-violent drug offenders who have never been offered treatment of any kind and who are overwhelmingly people of color despite the fact that people of color use drugs at the same rate as the white population, and who (the convicted, obviously) are thereafter forever banned from voting, subsidized housing, rental assistance, financial aid programmes for college to help them no longer need things like subsidized housing, even food assistance programmes because once convicted of a drug related crime Britain rightfully recognises that after serving one’s debt to society one should then starve–oh no, got confused with America for a minute.

“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.”
…I’m sorry you are afraid of this. Let me reassure you: the Affordable Care Act does nothing like the NHS does. This is too bad for Americans, since Britain consistently delivers better healthcare outcomes than does the US across pretty much every metric, including fun things like longer life expectancies, lower overall mortality, and better pregnancy outcomes–all the while doing it at a fraction of the cost! The NHS is also wildly popular, unlike any American insurance I can think of. In addition to being better and well-liked, it’s also free. Don’t worry–the ACA only offers free healthcare (Medicaid) to the very poorest of the poor, and only in some states, and Medicaid recipients still have significantly poorer health outcomes than those with private insurance, who have poorer health outcomes than Britons. The ACA won’t even begin to change that, because it does very little to ensure quality improvements in the widely-known-as-deplorable US healthcare system. The ACA is not at all socialist, never fear, you won’t face the trauma of free, quality healthcare that Britons have enjoyed for years.

“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.”
This sort of sentiments terrifies me. Statistics? Statistics will trump quality? Statistics like… what? Patient outcomes? Recovery rates? Improvement in life quality and function? Statistics like that? Statistics like: methadone consistently and dramatically offers statistically better outcomes, as well as reduced crime recidivism and higher job retention rates and significantly lower mortality and a statistically lower cost than traditional Minnesota Model treatment facilities? Addiction treatment, in the US, is a tremendously expensive proposition. If someone can deliver the same outcome at a lower cost, patients should be sent there! From a cost perspective, patients wouldn’t be sent to a lower-quality facility because multiple bouts of treatment would increase costs. If only treatment facilities in the US had a vested interest in making sure their patients got well quickly and didn’t require multiple rounds of treatment, because there was government oversight, or some sort of regulatory system to ensure that patients were getting quality care… well, then the US’s treatment system might approach Britain’s.

I am so disappointed in this article! I was hoping to see something thoughtful that indicated some real understanding of the two systems, and actually compared the merits of the UK system against 12-step, instead I got this ridiculous, ascientific, poorly articulated and incompetently argued dreck.

Nina
3:32 pm June 15th, 2014

I think you need to do more research into what is on offer in the UK. You seem to have made an assumption that if the treatment is not ‘Minnesota Model’, there is no treatment. There is free, widely available treatment avaialbel in the UK that is not all about AA, although AA is there in the mix. The UK recognises that it is not ‘one size fits all’, and if you need treatment, your GP can refer you to your local community alcohol team, or you can go out and find any of a number of independant/charity based treatments, either in the communtiy or online.

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