Breaking Free From Addiction | Mental Health | Hudson Valley | Chronogram Magazine
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Breaking Free From Addiction 

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The Science Approach

Mark Willenbring has been on a mission to change addiction care in this country since he was director of the National Institute for Alcohol Abuse and Alcoholism (NIAAA)—and saw a lot of good research about addiction sitting on a shelf, unused. "The most common treatment, which is based on what's called the Minnesota Model, or Twelve Steps, was developed in the 1950s, when there wasn't any science and there wasn't any treatment," he says. "Because this model is based on people in recovery who are sharing their stories, these folks don't look to science as a way to advance treatment outcomes." Willenbring finds the rehab model equally unscientific, comparing it to the 1920s sanatorium "cure" of fresh air and sunshine for people with tuberculosis. Moreover, he says, rehab has become a standard treatment when it's really meant for extreme cases—the sickest 10 percent, or those with the most refractory addiction. "Saying that everyone [with an addiction] needs rehab is the equivalent of saying that everyone who has asthma needs to be put in the ICU on a ventilator."

Earlier this year, Willenbring opened Alltyr clinic in St. Paul, Minnesota—"to basically demonstrate what 21st-century addiction treatment looks like." The goal is to provide a scientifically based model that looks, sounds, and feels like other medical specialties. Designed as an outpatient clinic with low-intensity care that's individualized and extended over time, Alltyr offers every evidence-based treatment available, says Willenbring. That includes medications for drug or alcohol relapse, which he recommends to just about everyone who comes in—but it's not just about pharmaceuticals. A team of psychiatrists, psychologists, social workers, counselors, and recovery coaches also offer individual and group therapy, cognitive behavioral therapy (i.e., coping skills), and treatment for coexisting disorders such as anxiety and depression. The program is not authoritarian, but rather all about the patient's free choice—what Willenbring calls the cafeteria model. "It's like saying, okay, there's chicken, there's pork, there's tofu—take your pick [of treatments], take what you like. The emphasis is on engagement, retention, and working with people as long as it takes."

And sometimes it takes a long time. "When abstinence is a goal, it usually isn't so mystically achieved all of a sudden," he says. Most often, people need to struggle and make a persistent effort over a protracted period of time, with multiple quit attempts, until they get it. The last thing he wants people to do is stay away from him or his staff if they have a recurrence because they're embarrassed or ashamed. Because addiction is a brain disease, he explains, there are forces at work beyond sheer will and discipline: The mechanisms that control intake of a particular substance get disregulated. "People literally watch in horror as they behave in a way that's going to destroy them," he says. The aim is to catch it at earlier and milder stages of illness—and to address it in primary care. "It turns out that for opiates and alcohol, and tobacco or smoking, we already have medication treatments that are pretty good," he says. "It really depends on the severity and complexity of the disorder."

The Spirit Approach

When Kevin Griffin set out to recover from a drug and alcohol addiction three decades ago, he was happy to discover that AA encouraged meditation. Even before he got sober, Griffin had a spiritual side, a longing, which led him to explore Buddhism. So he already had a meditation practice—which is part of AA's Eleventh Step—under his belt. As his practice progressed, he was eventually asked to teach at Spirit Rock Meditation Center in California's Marin County. Says Griffin, "My own experience of working a Twelve Step program naturally seeped into my teaching." He wrote a two books—One Breath at a Time: Buddhism and the Twelve Steps (Rodale, 2004) and A Burning Desire: Dharma God and the Path of Recovery (Hay House, 2010)—and built a following. Some of his students want to learn meditation to help them with recovery, yet Griffin's views also appeal to many people who struggle with AA's theistic orientation. "The Twelve Steps obviously talk a lot about God," he says, "so a lot of people who have those difficulties with the Steps are drawn to my work. They have trouble with the language and want to find an alternative approach to it."

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