1 The Minnesota Model & Integrative Medicine© David Moore, PhD CDP

THE MINNESOTA MODEL OF TREATMENT & SOCIAL SUPPORT

“An Old School Approach supporting a client’s involvement in the 12 Step Community; with New School Methods of parallel professional services.”

David Moore, Ph.D. CDP Merrill Scott Symposium; August 26, 2010

AN ADDICTION SERVICES MODEL

The Three Foundations of Moore & Associates

Our methods are the New School of Integrative Addiction Medicine. We combine the knowledge of Addiction Professionals with an interdisciplinary team of [as needed] Psychologists, Physicians, Attorneys, Nutritionists, and Exercise-Mindfulness facilitators. This method, called an Integrated Medicine approach, is at the cutting edge of supporting clients in managing their own, comprehensive, lifestyle change—at home, at work, during leisure-recreational time and when connecting with the community of recovery.

The most successful model of recovery is the 5-year model of the Physicians’ Assistance Program. Five-year addiction treatment programs for physicians represent the most effective treatment model for any professional. Recent national field research of these Physicians Health Programs indicate that their 51-75% recovery rates, over five years, could serve as a model for any professional treatment [N=904 physicians studied]. Moore & Associates believes that adding a confidential client-centered team to balance any external monitoring team provides an improvement to maintain, or exceed, a 75% rate. Moore & Associates’ Integrated Medicine approach has been developed to advocate for the overall wellness and recovery [Wellbriety1] of recovering persons who have re-entered their home and community after intensive addiction treatment. This builds on their first stage of treatment, during structured residential care, where a treatment team at their rehabilitation center utilized a multi-dimensional therapy plan to apply counseling strategies so that the patient would accept their addiction and a lifetime of recovery.

The four dimensions of holistic recovery, used by the Executive Health Team, is based on the Medicine Wheel Model of Wellbriety—which embraces all the 12-Step Programs and can best be addressed in a renewal setting conducive to evidence-based lifestyle restructuring used by Integrative Medicine Programs2---housed at the established Cedar Springs lifestyle renewal center:

1-3: Joining the community of recovery, 4-6: Taking personal responsibility for a recovering lifestyle, 7-9: Restoring oneself with family and community, 10-12: Committing to a lifestyle of growth, strengthening recovery and

giving back to the community.

1 Don Coyhis; www.whitebison.org. 2010. 2 Research into practice examples are the multi-site models of the Dean Ornish Cardiac Recovery Program; or extensive individual programs, such as Scripps Health’s Integrative Medicine Center founded by Dr. Mimi Guarneri, MD, FACC [Scripps Health serves 27% of San Diego’s health care.]

2 The Minnesota Model & Integrative Medicine© David Moore, PhD CDP

HISTORY AND PRACTICE OF THE MINNESOTA MODEL

Historical Introduction

The Minnesota Model of support group therapy integrated with professional behavioral health services is a term given to chemical dependency treatment strategies developed in the Minneapolis St Paul area in the 1960s3. It reaches back into the roots of the first 12 Step program of Alcoholics Anonymous to what emerged as a string of case studies emanating from the therapeutic work of Carl Jung. Jungian Psychology, at that time, was a blend of indigenous symbolism integrated around a relatively generic spiritual concept of synchronicity. Jung guided his clients to an inner self-evaluation and reconstructing their life experiences around a sense of balance and insight. Unsuccessful with individual therapy, he suggested that one of his alcoholic clients attempt to practice his principles within a religious group experience of his choosing. This led to a series of three prominent historical case studies that spanned the Atlantic, from Jung’s Europe to the Alcoholic Sanitariums of New York: Rowland H, Edwin “Ebby” T and then Bill W. Bill Wilson [a stockbroker] and Dr. Robert Smith [a physician] used the spiritual group principle to found Alcoholics Anonymous which evolved around two separate groups in Ohio. The Cleveland Group, led by Clarence Snyder and Attorney Abby Golrick, focused on developing a secular approach to the 12 Steps of AA—where spirituality was left to the individual [“God as you understand him”]. The Akron Group, led by Bill Wilson and Dr. Robert Smith, maintained a strong religious focus modeled after the Oxford Group. The integration of this history is seen in many ways:

The self-reconstruction inventory steps [4-10] that come forward from Jungian Psychology; An eclectic spirituality from the Cleveland Group [Clarence Snyder was always known for

his avowed agnosticism]; Methods of group spirituality found in many religions and brought forward by the Akron

Group, such as a search for spirituality as a foundation to recovery, a belief in the power of verbally acknowledging and atoning for wrongs, and a community perspective and group service which led to AA’s on unique traditions of doing things as a group; and

A concept of Fellowship and need for ongoing self-reflection, meditation and life balance which sustained the 12 Step Groups’ membership beyond simply achieving abstinence.

The Emergence of a Parallel Professional Health Care Model

The “Minnesota Model” was a name coined in the first articles in the Journal of the American Medical Association that described the new health care field of addictions treatment pioneered by the Johnson Institute in the Minneapolis—St. Paul MN. In the Minnesota Model, the 12 Steps of social support were seen as so important to the ongoing recovery of chemically dependent persons—that behavioral health professionals developed a series of parallel therapeutic approaches that maintained a consistency with the steps themselves. This consistency allowed chemically dependent persons to move from treatment to social support with a seamless “transfer of training.”

As the 12-Step social networks have broadened to include people who have different addictions or are experiencing childhood risks [CODA, ACOA] or even non-chronic emotional disorders [Emotions Anonymous], the Minnesota Model has gained a broadened applicability. Whether an activity is counseling, dietary assistance, pastoral therapy, case management, recreational therapy or 3 The Origins and Evolution of the Disease Concept of Treatment; Journal article by Daniel Yalisove; Journal of Studies on Alcohol, Vol. 59, 1998.

3 The Minnesota Model & Integrative Medicine© David Moore, PhD CDP

a myriad of other professional and para-professional strategies—the Minnesota Model allows for a consistent service model that offers a transfer of training to the national 12 Step programs , recovery clubs and connected recreational or social events.

The Integrative Medicine Path of Moore & Associates’ Minnesota Model Paradigm

In the past 40 years, the numbers of clients treated by the addiction field has grown by ever-earlier professional and non-professional interventions on the addict. This follows the classic use of threatened painful consequences to get through the addict’s denial so they will enter treatment. However, the unfortunate effect is that the treatment resources, family and community support has, on an increasingly expanding basis, been linked to intervention monitoring processes that extend far beyond the point where the addict’s denial and delusion have been largely or fully removed.

As the patient re-enters the community, the Minnesota Model is compromised by inserting monitoring persons and institutions throughout addict’s recovery. Even such a simple act as the traditional “signed” AA attendance slip indicates where the person was, if the meeting was a specialty meeting such as one for the GLBT community, if it was a smoking meeting, if he has changed meetings, what time of day he is in what part of town and the list goes on.

In order to maintain the integrity of the Minnesota Model, the M&A Team would never be part of a monitoring system[ unless required by a Court Order]. To further avoid even that remote possibility, and safeguard the addict’s disability rights, one of the first tasks, if the recovering person is on a monitored treatment plan, will be to refer the person to a disability lawyer separate from M&A—which does not provide any legal advice. The addict will also be encouraged to meet with that lawyer to make final decisions on the restorative justice plan developed during therapy [see Step 9 in chart, below]. While M&A supports the need for the monitoring activities, which also safeguard community safety, their Integrative Team model is committing to filling the separate role of a fully confidential Minnesota Model support program to the addicts themselves.

The Minnesota Model of the Executive Health Team

Generic Step of 12-Step Group

Professional Counterpart to the Step [“Minnesota Model”] Used by the Executive Health Team of Moore & Associates

1 “We admitted we were powerless over [ ] and our lives had become unmanageable.”

Self-assessment tools, strategies and Motivational Interviewing allow the person to evaluate the compulsive behavior and its consequences. They arrive at their own understanding of the disease of abuse, dependency or addiction.

2 “Came to believe that a Power greater than ourselves could restore us to sanity”

The client receives group therapy based on the Johnson Institute model of leveling and feedback by peers. A transfer-of-training occurs where the client is coached into a homogenous community support group that represents interpersonal connections and empathy to use the recovery skills [i.e. restore us to sanity=recover from our behavioral health disease].

3 Made a decision to turn our will and our lives over to the care of God as we understood God [original and most use the phrase “.as we understood Him”]

The client develops a personal recovery contract, with an abstinent base, that has enough empowerment for the person to make a personal commitment or pledge, in the most meaningful way to that person, to take actions to sustain abstinence as a lifestyle.

4 The Minnesota Model & Integrative Medicine© David Moore, PhD CDP

4 Made a searching and fearless moral inventory of ourselves

The client conducts a paper and pencil review of their entire life in a manner where they can identify emotionally uncomfortable points--for them or another person[s] they interacted with. They reconstruct this narrative with a recall of the event, specific actions, the emotional content of the event and the sensory elaboration they remember [e.g. sight, sound, smell, touch, hearing]. This is often done in a simple 3 column format of: Event, Actions, and Feelings.

5 Admitted to God, to ourselves and to another human being the exact nature of our wrongs

After the client conducts a thorough timeline, or portion of the timeline, that person then adds a fourth column to each event that states what they should have done instead, from a moral [Golden Rule and empathy] perspective. In cases where any cause of their pain is from another, the person would develop the most moral avoidant/survival behavior based on what they know now. In order for a cathartic effect, the counselor works with the client to identify the most person-centered environment/person[s] to verbally share their information. The written columns are then used by the counselor and client, except for those parts that the client selects to remain confidential, to create a relapse prevention plan parallel to Steps 6 and 7.

6 Were entirely ready to have God remove all these defects of character

The program helps the client identify common themes throughout the fourth column of the events timeline. This identification is often of two types: 1) A Cognitive Therapy approach for faulty belief systems; and 2) the ABCs of ineffective social/life skill responses to interpersonal situations that led to emotional stress. [“defects of character”=behavioral traits and cognitive schemas]

7 Humbly asked God to remove our shortcomings

The client develops a relapse prevention plan with professional and/or community group support that targets a change in faulty beliefs and learning new interpersonal behaviors. [“humility”=re-affirming a need for support]

8 Made a list of all persons we had harmed, and became willing to make amends to them all

The client reviews interpersonal and social damages that have occurred within the timeline of events. This includes preparatory work to understand the behavioral impact on others and therapeutic work on interpersonal empathy [the emotional impact]. This includes a community reconstruction plan based on the four principles of Restorative Justice.

9 Made direct amends to such people wherever possible, except when to do so would injure them or others

The program assists the client to implement, evaluate, and revise the reconstruction plan: Encounter: Create opportunities for victims, aggressors and community members who want to do so to meet to discuss the crime and its aftermath Amends: Expect aggressors to take steps to repair the harm they have caused with specific actions Reintegration: Seek to restore victims and aggressors to whole, contributing members of society Inclusion: Provide opportunities for other parties with a stake in a specific wrong to participate in its resolution [e.g. family]

5 The Minnesota Model & Integrative Medicine© David Moore, PhD CDP

10

Continued to take personal inventory and when we were wrong promptly admitted it

A case manager assists the client navigate real-life learning experiences over the next five years. Navigation includes use of inventory skills in decision-making, use of self-monitoring skills from the relapse prevention plan and ongoing refinement of community restoration--including volunteer work in the social support network they used to learn their recovery skill]. [“wrong”=interpersonal conflict or an emotional imbalance; “admit”=address others directly to restore relationship or consult with empowerment network to identify and resolve the emotional imbalance.]

11

Sought through prayer and meditation to improve our conscious contact with God as we understood God, praying only for knowledge of God's will for us and the power to carry that out

The client receives psycho-education and support in developing an internal and external balance. The internal balance uses the principles of integrative medicine of nutrition, meditative mindfulness and stress management. The external balance uses the principles of Wellbriety to identify a personal spirituality with the goal of a sense of emotional harmony with the surrounding world, both seen and unseen, that is connected to our thoughts and beliefs, both conscious and unconscious.

12

Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs

Through case management and use of the client’s empowerment network of professional and social support, a state of conditional* recovery is achieved based on 3 outcomes: 1) integration of skills in Steps 10 and 11 to a holistic lifestyle, 2) an enduring commitment to community restoration through participatory volunteerism in the community of recovery, and 3) an ongoing transfer of training from the world of professional services to the empowered client world of self-monitored growth and development. [*based on maintaining the 3 outcomes and maintaining access to an effective medical plan that can be immediately used if relapse occurs.]