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The Minnesota Model

5 hours - 1 comments






















Imagine for a moment that it is 1949, and that someone you love is alcoholic. As you struggle with this fact, you quickly learn about three prospects for this person's future: One is commitment to a locked ward in a mental hospital, sharing facilities with people diagnosed as schizophrenic. Another is that alcoholism will lead to crime, which could mean years in prison. And third is a slow sinking into poverty and helplessness -- perhaps life on "skid row."

In all three cases, your loved one's condition will be denied, ignored, or denounced as evidence of moral weakness.

The year 1949 is significant because it marked Hazelden's beginning. What started then as a guest house for alcoholic men has flowered into the prevailing method of treating addiction: the Minnesota Model. More importantly, this historic innovation offered alcoholics a new alternative to jail, mental wards, or homelessness.

It's easy to forget that the Minnesota Model represents a social reform movement. The model played a major role in transforming treatment wards from snake pits into places where alcoholics and addicts could retain their dignity.

Hazelden began with the idea of creating a humane, therapeutic community for alcoholics and addicts. Once this idea was ridiculed; today it is seen as commonplace. The story of how this change has evolved is in large part the story of the Minnesota Model.

The model began humbly. During Hazelden's first year of operation in Center City, Minn., the average daily patient count was seven and the staff numbered three. The treatment program was equally bare-boned, resting on a few expectations of patients: Behave responsibly, attend lectures on the Twelve Steps of Alcoholics Anonymous, talk with the other patients, make your bed, and stay sober.

It would be easy to dismiss such a program. Yet behind these simple rules was a wealth of clinical wisdom. All five rules focused on overcoming a common trait of alcoholics--something the founders of AA described as "self-will run riot." People addicted to alcohol can be secretive, self-centered, and filled with resentment. In response, Hazelden's founders insisted that patients attend to the details of daily life, tell their stories, and listen to each other. The aim was to help alcoholics shift from a life of isolation to a life of dialogue.

This led to a heartening discovery, one that's become a cornerstone of the Minnesota Model: Alcoholics and addicts can help each other.

Throughout the 1950's, Hazelden built on this foundation by adopting some working principles developed at another Minnesota institution, Willmar State Hospital. Among them were these:

    Alcoholism exists. This condition is not merely a symptom of some other underlying disorder. It deserves to be treated as a primary condition.
    Alcoholism is a disease. Attempts to chide, shame, or scold an alcoholic into abstinence are essentially useless. Instead, we can view alcoholism as an involuntary disability--a disease--and treat it as such.
    Alcoholism is a multiphasic illness. This statement echoes an idea from AA--that alcoholics suffer from a disease affecting them physically, mentally and spiritually. Therefore treatment for alcoholism will be more effective when it takes all three aspects into account.

These principles set the stage for a model that expanded greatly during the 1960s, one that has been emulated worldwide and has merged the talents of people in many disciplines: addiction counselors, physicians, psychologists, social workers, clergy, and other therapists. These people found themselves working on teams, often for the first time. And what united them was the notion of treating the whole person--body, mind and spirit.

Bummed Out....No More!

Apr 15, 2014 - 0 comments




6 weeks ago I had a lipid panel that revealed my Triglycerides were 305. My bad cholesterol was also high and my good cholesterol low. My doc prescribed Fenofibrate that I was supposedly going to have to take the rest of my life....

I didn't take the Fenofibrate. Instead, I did my due diligence and researched. Come to find out that not just fat but high carbs and sugar adversely effect ones Triglycerides. So I changed my diet. No more soda, fruit juice, Doritos, red meat, white rice, white bread, eggs, white potatoes, Luck Charms, Pizza, butter, and sugar. I started going heavy on the veggies, red potatoes, green tea, lean turkey, multi-grain bread, REAL oatmeal, benocol spread, fish, chicken, egg beaters, and brown rice. Oh yeah...I also took 3 grams of Krill oil every day.

In 6 weeks my Triglycerides went from a very high a cool in range 98  (<150 is in range) My Bad cholesterol VLDL was a high 61 but is now in range at 20. My good cholesterol is off by 5 points but I will fix that.

Oh the process I lost 9 lbs.

A Relapse Prevention Plan: The Tools of Recovery

Apr 09, 2014 - 5 comments

relapse prevention









The Stages of Relapse

Relapse is a process, it's not an event. In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse. There are three stages of relapse.(1)

    Emotional relapse
    Mental relapse
    Physical relapse

Emotional Relapse

In emotional relapse, you're not thinking about using. But your emotions and behaviors are setting you up for a possible relapse in the future.

The signs of emotional relapse are:

    Mood swings
    Not asking for help
    Not going to meetings
    Poor eating habits
    Poor sleep habits

The signs of emotional relapse are also the symptoms of post-acute withdrawal. If you understand post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.
Early Relapse Prevention

Relapse prevention at this stage means recognizing that you're in emotional relapse and changing your behavior. Recognize that you're isolating and remind yourself to ask for help. Recognize that you're anxious and practice relaxation techniques. Recognize that your sleep and eating habits are slipping and practice self-care.

If you don't change your behavior at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.

Practice self-care. The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.

For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse. (Reference:
Mental Relapse

In mental relapse there's a war going on in your mind. Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely thinking about using.

The signs of mental relapse are:

    Thinking about people, places, and things you used with
    Glamorizing your past use
    Hanging out with old using friends
    Fantasizing about using
    Thinking about relapsing
    Planning your relapse around other people's schedules

It gets harder to make the right choices as the pull of addiction gets stronger.
Techniques for Dealing with Mental Urges

Play the tape through. When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.

A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when your addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.

Tell someone that you're having urges to use. Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.

Distract yourself. When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.

Wait for 30 minutes. Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.

Do your recovery one day at a time. Don't think about whether you can stay abstinent forever. That's a paralyzing thought. It's overwhelming even for people who've been in recovery for a long time.

One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.

Make relaxation part of your recovery. Relaxation is an important part of relapse prevention, because when you're tense you tend to do what’s familiar and wrong, instead of what's new and right. When you're tense you tend to repeat the same mistakes you made before. When you're relaxed you are more open to change. (Reference:

Physical Relapse

Once you start thinking about relapse, if you don't use some of the techniques mentioned above, it doesn't take long to go from there to physical relapse. Driving to the liquor store. Driving to your dealer.

It's hard to stop the process of relapse at that point. That's not where you should focus your efforts in recovery. That's achieving abstinence through brute force. But it is not recovery. If you recognize the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you'll be able to catch yourself before it's too late.

Addiction: Classical Conditioning

Apr 08, 2014 - 5 comments











Mental Health







Excerpt from Harvard Mental Health Letter

Classical Conditioning

Operant conditioning accounts for repeated use when a drug is available. Classical or Pavlovian conditioning is said to explain the relapses that often occur after long periods of abstinence. When a neutral stimulus or cue is consistently associated with a stimulus that causes an unconditioned response (food or an addictive drug, for example), the neutral stimulus eventually brings about a conditioning response on its own. A person is more likely to return to using a drug when exposed to cues that have been reliably associated with its use or its effects in the past. Many types of external and internal cues or conditioned stimuli may cause an addict to relapse: the sight of the bar where he used to drink, a needle of the type used for injection, even the onset of a mood in which she was accustomed to taking the drug.

Classical conditioning also helps to determine patterns of tolerance and withdrawal symptoms. Tolerance originally develops because the brain because adapted to the new chemical environment created by the drug and no longer responds to it with the same intensity. Presumably neurotransmitters are depleted, or the number or sensitivity of nerve receptors for the drug decreases. This homeostatic or compensatory reaction is the body's way of returning to a relatively normal state. Almost all addictive drugs produce some tolerance and a person or animal that is tolerant to one drug will also be tolerant to others in the same class--sedative, stimulant, or opioid.

Withdrawal symptoms are another form of compensatory response. Drugs that produce a certain intense withdrawal syndrome, especially sedatives and opioids, are sometimes said to cause physical dependence. But the physical intensity of the withdrawal reaction is rarely one of the most important reasons why a person goes on using a drug. Many researchers believe that the brain mechanisms producing these reactions are unrelated to the reward system. People who take large doses of morphine for the relief of pain in a hospital, even when they suffer a withdrawal reaction afterward, are unlikely to look for opiates on the street.

Simple unconditioned compensatory responses to the immediate presence or absence of a drug are not the only source of tolerance and withdrawal symptoms. By way of classical conditioning environmental cues can stimulate similar responses long after drug use has stopped and the chemical is no longer exerting direct effects on the body and brain. An addict may start to develop mild withdrawal symptoms on returning to the old neighborhood or simply anticipating an injection. Formally addicted rats are most likely to survive a high dose of heroin or cocaine if they are kept in the cage where they were originally addicted, apparently because the familiar environment excites a compensatory tolerance. If the experimenter substitutes a placebo for the drug in that environment, the conditioned tolerance will eventually by eliminated (extinguished).

Patterns of conditioned tolerance and withdrawal are much more complicated than any straightforward automatic response to an internal state of the body or brain. A rat that presses a level to inject heroin will develop more tolerance and more severe abstinence symptoms than another rat that is simply attached to the same machinery and absorbs the drug passively. Rabbits develop tolerance to the effect of alcohol on motor activity and coordination faster if they take it before rather than after they are required to work for food. Rats become tolerant to the appetite reducing effects of amphetamine more quickly if they are given plenty of sweetened milk at the same time. The presence of food or the need to work apparently provides the cue for a compensatory reaction.

The language of behavioral conditioning does have words for desires, urges, and cravings, or even for purpose of intention. Behaviorists regard these concepts as scientifically valueless, because they refer to subjective states that are not consistently or clearly associate with distinct physical symptoms or patterns of drug use. In fact, addicts usually do not say they relapse because of cravings or urge; instead they talk about moods and situations that provoke drug use. But there is another way to think about craving. Repetition of any activity tends to make it automatic, a uniform response to a uniform stimulus. Urgings and cravings can be seen as the result of complicated nonautomatic processes that are activated in the brain either to oppose the automatic process or to overcome an obstacle to it (such as unavailability of the drug). In other words, craving is a sign that the addict is either trying to obtain a drug that is temporarily unavailable or trying to resist the temptation to use a drug that is available. This view of craving is compatible with the DSM-III-R definition, which describes unsuccessful attempts to stop as one of the symptoms of drug dependence.