Hazelden, a treatment center whose treatment plan is based on the Twelve Steps, becomes extremely successful. As Hazelden grows, it replaces a strictly Big Book approach to treatment and with the multidisciplinary approach that will come to be known as the Minnesota Model. The Hazelden version of the Steps becomes increasingly psychological. As the influence of the Minnesota Model grows in the United States , it has an influence on Step practices within AA and other organizations.

Hazelden begins in a small farm house in Center City , Minnesota . Its treatment program is based on the Twelve Steps, and only requires four things of its clients:

When Hazelden officially opened its doors on 1 May 1949 , the program expectations were few and simple. The patients were expected to:

practice responsible behavior;

attend the lectures on the Steps;

associate and talk with the other patients; and

make their beds.

Hazelden A Spiritual Odyssey
Damian McElrath

Each client is given a copy of both the Big Book and the Twelve Steps and Twelve Traditions. Treatment is administered by lay-therapists, recovering alcoholics who got their sobriety in AA. Treatment is focused solely on the first five of the Twelve Steps. All clients are encouraged to associate with one another, as identification of one drunk with another is seen as central to recovery.

As Hazelden grows, its board decides to expand Hazeden’s campus and treatment program. Several elements are adapted from the program developed at Wilmar State Hospital . Among these elements are the assumption that initial motivation is not related to treatment outcome and the multidisciplinary approach to treatment.

The assumption that initial motivation is not related to treatment outcome means that, unlike in Twelve Step organizations, at Hazelden the desire to stop using is not required to participate in treatment. You don’t have to want to get sober; you just have to check in. This policy means that many of Hazelden’s clients enter treatment with a high level of resistance to recovery. In order to compensate for this resistance, Hazelden places a great deal of emphasis on the First Step, where various forms of intervention are used to convince the client of his or her powerlessness and need for help.

Adopting the multidisciplinary approach means that Hazelden will now have psychiatrists working alongside the lay-therapists. This means introducing conflicting perspectives on how treatment should be carried out. Among Hazeden’s staff there is some resistance to the multidisciplinary approach:

[Lynn Carrol, longtime lay therapist at Hazelden] believed that the professionalization of treatment at Hazelden threatened the purity of the A.A. approach to recovery, and he resisted the integration of professional members and the ideas they brought. Tension between the old and new schools at Hazelden continued and escalated, resulting in Lynn C.’s departure from Hazelden in 1966.

Lynn C.’s exit confirmed the evolution of Hazelden’s treatment regimen from “pure A.A.” to one that integrated multiple disciplines and multiple treatment modalities, still bound together within an A.A.-oriented treatment philosophy.

Slaying the Dragon
William L. White

Many of Carroll’s disciples also became disillusioned at what they considered the betrayal of Carroll and the abandonment of A.A. principles on behalf of psychology. It was a time of serious crisis for Hazelden.

Hazelden: A Spiritual Odyssey
Damian McElrath

As a result of the introducing of psychologists and psychological treatment at Hazelden, Hazelden’s approach to the Steps becomes more psychologically oriented and changes over time with the trends in psychological theory.

For example, Hazelden’s most recent Fourth Step guide suggests a model of inventory that is influenced by Cognitive-Behavioral thought. It assumes that the troubles in an addict’s life are caused by the addict’s mistaken beliefs.

Mistaken beliefs cause us to think irrationally and act in self-defeating ways…One of the benefits of a personal inventory is that you have an opportunity to see in print all of the damaging statements you have been telling yourself over the years and decide if you think they are valid or not.

Step 4: Getting Honest

As Hazelden grows larger, and its influence on recovery thought expands, Hazelden’s psychological style of Stepwork grows in popularity. Hazelden’s version of the Steps effects not only Stepwork within a treatment setting, but in the growing diversity Twelve Step fellowships. The introduction of psychological interpretations of addiction and recovery cause some controversy within AA.

12-step treatment has caused marked disagreements about how much psychological explanation and interpretation should go into an AA meeting. The disagreements concern the importance of ‘getting in touch with your feelings’ and the role of psychodynamic vocabulary in the recovery process…many traditional members feel uncomfortable with ‘treatment psychobabble,’ but the dissatisfaction is reciprocal.

Alcoholics Anonymous as a Mutual-Help Movement:
A Study in Eight Societies
The Nordic Council for Alcohol and Drug Research

The Nordic Council for Alcohol and Drug Research also finds that in countries where Minnesota Model treatment preceded the widespread presence of AA, the practice of Twelfth Step work is impacted significantly.

Institutional treatment based on the 12-step program also may have reduced 12th-step work…Twelve-step treatment programs usually require the completion of Step Five before discharge. Where Step Five is completed in an institutional setting, there is no compelling reason for a newcomer to take a sponsor or share their Step Five with another AA member. The basic symmetry in taking Step Five and the resulting strong social bond is also lacking at most treatment institutions.

Alcoholics Anonymous as a Mutual-Help Movement:
A Study in Eight Societies
The Nordic Council for Alcohol and Drug Research

Hazelden and its style of treatment have promoted a form of Stepwork that is both professional and psychological. This style of Stepwork is also less thorough, with a strong emphasis on the First Step, no presentation of the last seven Steps, and a decidedly negative impact on the practice of the Twelfth Step.

The fact that Hazelden’s Stepwork shifted toward the first five Steps is representative of both the psychological character of Hazelden’s development, as the first five Steps are all focused on the internal state of the Stepworker, and the limits of in-patient treatment, as the amends process and sponsoring others are not practical tasks for an in-patient setting. To Hazelden’s credit, its Minnesota Model pioneered professional Twelve-Step treatment. The popular success of this model will go a long way toward legitimizing the Twelve Steps to the American public, and this will be one factor leading to the Twelve Step Boom.

3 Comments so far
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My sponsor told me years ago, “You don’t really ‘get’ this thing until you move from being a ‘taker’ to a ‘giver’. Success at permanent sobriety goes ‘way up’ when 12th step work is done on a regular basis,(my personal observations). To quote the book, “..intensive work with other alcoholics. It works when other activities fail’.

Comment by Nodge Adams

I have had a 24 year relationship with both prisons and treatment centres particularly The Bridge.I have opinions on both these institutions but i keep these to myself.I try to carry the message directly from the Big Book as if you read the foreword to the 2nd edition that after 15 years A.A.50% recovered immediately,25% recovered after a few relapses and those who did not stay started to come back and practice the program.We do not have that success rate today,so when i take people through this program i stick strictly to what is in the Big Book,not what i think,not what i do but what the clear cut directions that are only in the Big Book and wow what an amazing experience,we are starting to get great results,we educate them on what this illness as described in the Drs opinion(What a saint Dr.Silkworth was).

Comment by Paul

I’ve had 40 plus years of sobriety so far. I got sober by being “12th Stepped,” ironically by a person who was in training at Hazelden. Looking back, the Hazelden” approach with interventions was good for those who needed prodding to look at their drinking. The rest of their approached was badly flawed in thinking this is some sort of a psychological process to long term sobriety. It’s a spiritual program, not a psychological one. Though we need to get our thinking straight with steps 1 through 9, its the practice of the spiritual steps that keeps people sober and happy.

So the trainer at Hazelden died at drunk in his garage. Sad. The others I knew from there always thought they could think their way to a better life. The antidepressant drugs and therapy sessions they attended may have helped them psychologically but it never seemed to keep them sober or happy.

So as the Big Book says, “Abandon yourself to God as you understand God. Admit your faults to Him and to your fellows. Clear away the wreckage of your past. Give freely of what you find and join us. We shall be with you in the Fellowship of the Spirit, and you will surely meet some us as you trudge the Road of Happy Destiny.”

Comment by Joe

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