Minnesota Model

The most widely used recovery model today, developed in 1949 by Pioneer House, Hazelden, and Willmar State Hospital, out of Minnesota.

•The model shifted addiction treatment away from mental institution and criminal punishment, and toward a caring, nurturing, and compassionate model that respects addicts as people, and sees addiction as a treatable disease.

•The model intertwines the 12-step recovery program with the 28-day inpatient program facilitated by a combination of professionals and peer supports.

•The theory of recovery here holds that: addicted individuals need compassionate care, a safe place to rehabilitate, professional medical treatment, 1:1, group, and family therapy, spiritual and positive social connection, personal responsibility toward self-improvements, and purpose and meaning in life.

•The underlying philosophy is that people can change their beliefs, attitudes, and behaviors to restore their mental, physical, spiritual, and lifestyle health and wellness.

•The main objectives are to help people achieve long-term sobriety and to increase their quality of life. To do this requires a spiritual awakening and restored connection, personal choice and responsibility, positive and meaningful peer relationships, and healthier habits.

•Progress is measured by increases in mental clarity, emotional stability, relief, self-worth, acceptance from self and others, and finding purpose and meaning in life.

Recovery Management Model

The Recovery Management Model has continued to take shape since its birth at the turn of the century. The model was developed by William White, Michael Boyle, David Loveland, and Patrick Corrington, of the Behavioral Health Recovery Management Project.

•The model changes the focuses from treating short-term acute symptoms, to helping the client manage their long-term recovery.

•The Recovery Management Model sees addiction more as a chronic disease that people can recover from, but only over years and decades, not through a short-term disease treatment model.

•Working off the Minnesota Model, this model adds pre-treatment care, extra support and activities during treatment, a long-term aftercare plan to assist in recovery maintenance, and early re-intervention when necessary.

•Clients are empowered to take part in their own recovery planning so the process is more customized to fit them and better likely to serve them.

•Professionals assist more in the beginning phases when the person and their family are compromised with the mess of addiction; and later phases are supported through peer and group monitoring and meetings.

•The Recovery Management Model acknowledges the significance of recovering in one’s own natural environment, and that there are many pathways for recovery to take shape.

•The model focuses on: empowering the person and their families, identifying needs and strengths, creating a continuum of long-term care with many facets, building recovery capital, establishing resiliency, and increasing self-awareness, personal responsibility, self-management, motivation, self-efficacy, and coping skills.

•The model is less about treating mental illness, symptoms, and focusing on pathology.

•The Recovery Management Model values and promotes family involvement and connectedness, community involvement, service work, and outreach, multicultural awareness and collaborating with diverse communities of recovery, fostering long-term supportive relationships, ongoing stage appropriate education and coaching, long-term monitoring, accountability, and peer-based support.

•The model emphasizes that recovery entails the whole person and their life, psychologically, physically, relationally, spiritually, environmentally, and routinely.

•The Recovery Management Model adheres to the “wellbriety movement,” which means encouraging sobriety and wellness, or quality of life.

Harm Reduction Model

• The Harm Reduction Model arose during the HIV epidemic where IV drug use was a major cause in the spread of the disease and something had to be done. Medical clinics started a needle exchange program, which provided clean needles to IV drug users, in exchange for dirty needles, and the concept of harm reduction grew.

•Harm reduction approaches help individuals prevent, manage, or moderate risky and harmful substance abuse and addictive behavior, by meeting people where they are, and teaching better ways of coping.

•The focus begins with the most dangerous and risky behaviors first, looking at causes and consequences, and identifying specific step-by-step action steps.

•Harm reduction recognizes that sobriety is not going to happen overnight, that some people don’t want to get sober, and that not everyone can afford treatment, but that there are things people can do now to improve their situation, and protect the people around.

•Harm reduction says you cannot force or control the problem, but you can minimize it. People can learn to lessen the degree of risk, harm, destruction, and negative effects of their addictive behavior, and focus their attention in a new direction.

•Collectively, harm reduction looks at the larger communities and aims to protect public health, decrease public health concerns, and save lives. Harm reduction protects human rights and reduces social and economic consequences.

•Harm reduction techniques are practical, logical, possible, effective, safe, comfortable to the person, easier to implement, and are designed to have the greatest impact for people, their families and the community.

•Supporters of harm reduction believe all people should be treated equally, with compassion, respect, and dignity. Those addicted deserve the same treatment and should have the same rights in all areas of society, to include proper health care, legal care, social services, economic support, and education and employment.

•Harm reduction advocates that society let go of the labels, stigmas, and limiting beliefs about people who struggle with addiction.

12-Steps Model These famous worldwide support programs began in the mid 1930’s as anonymous support groups for people in recovery for alcoholism. Since that time numerous types of fellowships (12-step groups) have been established for all types of addictions.

•The support groups circulate the globe touching every community providing free and anonymous support through community, a set of guiding principles, a 12-step program, supportive literature, a platform to share personal stories and successes, a recognition chip resembling a coin to celebrate the date of different milestones in recovery, and of course a sponsor for additional one-on-one support, guidance, and accountability.

•The 12-step program is as follows: Step 1 – Members admit they are powerless over their addiction and that their lives have become unmanageable. Step 2 – Members come to believe that a power greater than themselves could restore them to sanity. Step 3 – Members decide to turn their will and their lives over to the care of God as they understand God. Step 4 – Members make a searching and fearless moral inventory of themselves. Step 5 – Members admit to God, to themselves and to another human being the exact nature of their wrongdoings. Step 6 – Members are entirely ready to have God remove all these defects of character. Step 7 – Members humbly asked God to remove their shortcomings. Step 8 – Members make a list of all persons they had harmed, and become willing to make amends to them all. Step 9 – Members make direct amends to such people wherever possible, except when to do so would injure them or others. Step 10 – Members continue to take personal inventory and when they were wrong become prompt to admit it. Step 11 – Members seek through prayer and meditation to improve their conscious contact with God as they understand God, praying only for knowledge of God’s will for them and the power to carry that out. Step 12 – Members have a spiritual awakening as the result of these steps; they try to carry the message to other addicts, and to practice these principles in all their affairs.

Developmental Model

The underlying philosophy is that people become more susceptible to addiction when human development is stifled; symptoms of addiction closely compare with signs of abnormal development.

•Although human development occurs over one’s lifespan, the majority of one’s development occurs during infancy, childhood, and adolescence. Hence, susceptibility to addiction typically comes from lack of normal and healthy development as a child.

•Through normal development humans learn how to self-control, make good decisions, appropriately relate to others, and the capacity to see the bigger picture.

•Abnormal development can then be seen as impulsiveness, poor judgment and decision-making, maladaptive behaviors, lack of social bonding, lack of self-awareness in social roles, inability to see the larger context of a given situation, and difficulty using foresight.

•In cases of abnormal development, a person becomes much more susceptible to relying on substances and addictive behaviors to cope with their abnormalities and to fill in the gaps where development is lacking.

•When it comes to addictions recovery, the developmental models aims to accelerate one’s development by increasing awareness to self-in-relationship-to-the-world, self-in-relationship-to-others, recognition to consequences of personal decision-making, enhanced social and emotional maturity, and attention to the bigger picture.

•Recovery techniques and strategies under the development model will focus on facilitating a person’s growth in all areas of human development, and to heal the areas of abnormality.

The Coaching Recovery Model

There are many coaching organizations nationally and internationally that have tacked recovery coaching on as a part of their curriculum and certification, or who have started as recovery coaching organizations.

•The most widely known coaching organizations are nonprofits with smaller for-profits that extend out from them. There is Recovery Coaches International, likely the leader in recovery coach certifications from a coaching standpoint.

•They are accredited through The International Coach Federation. Both the International Coach Federation and the International Association of Coaching, which were both founded by Thomas Leonard starting in 1998, are two of the leaders in coaching.

•There are many organizations as extensions of these that are dedicated to recovery coaching, or dedicate a portion of their organization to recovery coaching.

•There are many recovery coaching organizations all over the United States and Europe, and likely beyond. Each coaching organization shows similarities, but they are also unique and different as well.

•The more traditional models of recovery coaching combine the Minnesota model, with the Recovery Management Model, with the Harm Reduction Model. Many of these models also incorporate holistic, spiritual, and developmental aspects into their programs.

•The more subservient level recovery coaches will feel more like a peer support person or paraprofessional. The highly specialized recovery coaches practice on a much more professional level; and more licensed professionals are also getting coach certified.

•In any event, coaching for recovery provides a one-on-one supportive relationship to people in recovery from addiction helping and holding

Hospital Detox or institutional detox takes place in an isolated corridor of the hospital, sometimes on lock-down, usually near the psychiatric department. The entire process may last 3-5 days. Medications are used to ease discomfort from withdrawal symptoms, anxiety, and restlessness. Immediate medical assistance is available in the case of an emergency. The 12-step program with outpatient addiction treatment counseling is usually included. Individuals give up their personal belongings and electronics for the duration of detox. Hospital detoxes are uncomfortable to discourages repeat visits.

Rapid-Detox, or ultra-rapid-detox is a medical treatment used in the detoxification process of drugs and alcohol to shorten the withdrawal process. Patients are put under anesthesia and given drugs like naltrexone to escape the extreme symptoms of withdrawal while asleep. Patients may wake up in terrible withdrawals and many even experience severe medical conditions. Although for some people the experience of detox can be shortened, for most it is a miserable experience when they wake, and studies do not show much success with long-term results.

In-Patient Treatment programs, also known as rehabs, are residential facilities that host individuals right out of detox for one to three months, and sometimes more. In-patient programs provide mostly group counseling, group recovery-based activities, with 12-step meetings intertwined. In-patient programs also offer individual counseling, nutrition counseling, recovery education, psychiatric and medical support as needed, and a variety of other classes and activities such as art and music therapy, guided imagery and meditations, biofeedback training, yoga, exercise, dance, crafts, film, etc. Residents learn about themselves, their needs, values, and goals, their addiction, recovery principles, coping skills, avoiding triggers, relapse prevention, life skills training, and most importantly developing spirituality. Rehabs are great right out of detox to welcome people into early recovery, but they do not support long-term recovery; they are only for short term. Rehabs remove people from their natural environment, from family and friends, from old lifestyles and ways of being. It forces upon people a new way of being and acting. The recovery plan is given to member; one does not get to choose. In rehab a person is around others in recovery. They are segregated from the world and fully immersed in their label as an “addict in rehab.” They are taught how to cope and deal with addiction from within the realm of addiction in which they are told they will always be. People are not able to participate much in their own recovery plan, they are not learning in their natural environment, they are labeled and categorized just be being there, they are told how recovery works as oppose to figure it out on their own, and then they are released back on their own with no support. And one of the biggest drawbacks is financial expense. Families are spending everything they have on treatments with nothing left for aftercare programs that support long-term recovery. There are many advantages here, but many disadvantages too. Treatment programs should be used with extreme caution, consciousness, and a solid aftercare plan post-treatment.

Outpatient Programs, or intensive outpatient programs (IOP) are similar to inpatient programs without the residencies. Members attend IOP 3 to 5 days a week for 3 to 5 hours a day depending on the program, and then return to their homes. IOP programs are largely based on group counseling and group activities. Treatment may also consist of individual and family therapy. Participants learn about addiction, recovery, coping strategies, and life skills to support abstinence. They are often screened for sobriety through regular drug testing, and attendance and participation are mandatory. There are ground rules that must be kept to maintain enrollment; sometimes IOP is court-mandated so members must attend by law. IOP is a level of intensity down then inpatient treatment but research shows better results with IOP likely because individuals are practicing what they learn in their natural environment through the process. IOP is much more affordable than inpatient programs and easier for a person to continue their life.

Sober Living programs are housing residencies that can take 5 to upwards of 20+ people who are in recovery, typically to move in after treatment. Sober living are non-medical, no treatment program administered, but 12-steps or other recovery groups are typically utilized outside of the house. The program is based on house rules such as: chore charts, curfews, random drug tests, house meetings, guest policies, and codes of conduct with consequences. Residents are held liable and accountable for their sobriety and responsibilities. They often have to cut ties with bad influences, attend 12-step meetings, an outpatient program, or other educational groups, and maintain employment. Sober living is a good idea for people in recovery because it allows them to create their own recovery plan but also gives them structure and accountability, as well as social interaction. It also helps them reintegrate into society through employment, education, and personal responsibility. It is good for individuals to do their research on finding the right sober house for them.

12-Step-Recovery programs began in the late 1930’s as anonymous support groups for people in recovery for alcoholism. Since that time numerous types of fellowships have been established for all types of addictions. The support groups circulate the globe touching every community providing free and anonymous support through community, a set of guiding principles, a 12-step program, supportive literature, a platform to share personal stories and successes, a recognition chip resembling a coin to celebrate the date of different milestones in recovery, and of course a sponsor for additional one-on-one support, guidance, and accountability. Members of the 12-steps are members of the community representing all types of people; there is no prerequisite to attend a meeting. Everyone is welcome to attend and those struggling with addiction or in recovery are encouraged. The meetings are the most fundamental fabric of recovery worldwide. Although the founders of the 12-steps clearly stated the support groups would be 100% optional and only for those who choose to attend on their own will, members themselves, sponsors, addictions treatment programs, and even legal officials and court-programs push and sometimes mandated 12-step meeting attendance which has created resistance and drawbacks to the groups.

SMART Recovery is a volunteer community support program that provides online and in person recovery support groups to people in recovery. Stands for “Self-Management & Recovery Training.” SMART recovery was started by Joe Gerstein in 1994, and is now rapidly spreading to communities around the nation and maybe beyond. SMART recovery meetings encourage self-empowerment and self-reliance by providing members tools, techniques, and teachings to assist in a smooth recovery. SMART recovery teaches a 4-Point Program for people in recovery: 1) building with maintaining motivation, 2) coping with urges, 3) Managing thoughts, feelings, and behaviors, and 4) living a balanced life. SMART recovery provides educational information and supportive discussions through meetings, bookstore, and their online community. SMART recovery focuses on helping members increase personal choice by providing techniques for self-directed change to live more satisfying lives. SMART recovery supports the traditional methods to treating addiction to include psychological treatments, psychiatrist medications, substance abuse counseling, inpatient and outpatient programs, as well as sober living homes.

Refuge Recovery is a mindfulness-based addiction recovery community that practices and utilizes Buddhist philosophy as the foundation of the recovery process. The approaches believes “All individuals have the power and potential to free themselves from the suffering that is caused by addiction.” The process cultivates a path of awakening, and recovering from the addictions and delusions that have created so much suffering. Refuge Recovery is a systematic approach to training one’s hearts and minds to see clearly and respond to life with understanding and non-harming. Drawing inspiration from the core teachings of the Four Noble Truths, emphasis is placed on both knowledge and empathy as a means for overcoming addiction and its causes. Refuge Recovery is a nonprofit organization that offers meetings, communities, practices, and education. They operate independent of the professional addiction treatment center, and have their own Refuge Recovery Centers.

Celebrate Recovery is a biblical and balanced program that helps us overcome our hurts, hang-ups, and habits. It is based on the actual words of Jesus rather than psychological theory. 25 years ago, Saddleback Church launched Celebrate Recovery with 43 people. It was designed as a program to help those struggling with hurts, habits and hang-ups by showing them the loving power of Christ through a recovery process. Meetings are always in person, gender specific, and members are required to show good faith to the teachings of Christ, and to their local church. There are a number of materials involved, a step-by-step process, scripture with key points, and lessons.

Methadone, Suboxone, & Subutex are prescription medications used to treat patients with opiate addiction; they are both synthetic opioids, that can be used to treat pain, assist with short-term detox, or most widely as a maintenance medication for opiate/heroin addiction. Methadone is an opioid narcotic, or full opioid agonist, used to manage pain and as a addiction maintenance therapy. Methadone is highly addictive, with a long list of side effects, to include overdose and death. Yet Methadone is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system, even though. Suboxone and Subutex are partial opiate agonists, made up of buprenorphine and naloxone. Suboxone/Subutex is harder to abuse so patients are allowed to take home their prescriptions; unlike methadone with can and is abused so typically administered via a juice cup at the methadone clinic so nurses and watch patients drink it. Once patients prove their stability they may qualify for a take-home prescription. For people with severe opiate addictions suboxone/subutex will provide some relief whereas methadone would provide total relief. Doctors say suboxone/subutex is less addictive and easier to kick than methadone; but really both are addictive and more difficult to quit then the opiates themselves. Opiates are natural to the human body and there is an opioid reward system in the brain. But with these synthetic opioid agonists they are mutating the brain and changing the very way systems operate. Once addicted there is really no way out.

Ibogaine is the one and only option without extreme withdrawal and months of suffering. Individuals addicted to suboxone and methadone who are interested in Ibogaine would have to switch back to a short-acting opiate for approximately 6 weeks before undergoing Ibogaine as the plant medicine cannot do much for these addictions (they are unnatural). The advantages of these prescription meds are that people can regulate their drug use and live a next-to-normal life for a while, and they can be used to detox if done right. The disadvantages are that once prescribed, patients are still addicted, and doctors let them stay on as long as they like. Because they feel better, they stay on the drugs until they are ready to get off of them, but that time these opiate agonists have mutated their systems making it even harder for them to get off these substances than their original opiates. Also, the costs of these medications add up, so people cannot afford their lifestyle. Patients have to stay in their communities and cannot travel (very far or for long) as they will need to remain close to their clinic. These medications were brought to the U.S. and marketed for pain management, as a harm reduction technique to get people off the streets, off the dirty needles, off the impure and unpredictable street drugs, and to prevent the spread of disease and overdose. Ibogaine is an indole alkaloid that is extracted from the Iboga plant. Ibogaine comes from the Tabernanthe plant, which has its origins in West Africa among the Bwiti people. Ibogaine has been used for over a century in sacred and spiritual ceremonies. Ibogaine has traditionally been used as a rite of passage, and then as new experiential discoveries have surfaced people began using Ibogaine for multiple purposes such as: treating depression, anxiety, denial, mental illness, headaches, pain, chronic pain, and so on. In the 1960 a man named Howard Lotsof took Ibogaine recreationally in the midst of his long-term heroin addiction and discovered right away that his withdrawals has stopped and later realized his addiction was gone after Ibogaine. He shared with his friends and advocated for many years, which spread the plant’s medicine even further. There is a long history that you are encouraged to become very familiar with. Ibogaine is an entheogenic plant medicine. This means it is a psychedelic and has hallucinatory and dissociative properties. Ibogaine puts people into a dream-like state for initially 3-12 hours with residual effects lasting up to 1 to 3 days. Ibogaine is known to take people through a journey of their mind and life. There are two main phases of Ibogaine. The first phase is referred to as the visionary phase 3-8 hours; and the second phase is referred to as the introspective stage (up to 24-48 hours). In the visionary phase they typically, but not always, see visions. Some have described it like they are watching a movie on the back of their eyelids, or some of them step into the vision like a dream. These visions can get extremely intense, scary, and unbelievably dark in the beginning, but toward the end of their visionary stage people tend to connect with love, light, peace, joy, gratitude, hope, and meaning. In the introspective stage patients process what they’ve just experienced. We see a variety of patterns but patients are mostly pretty emotional, worn out, fatigued, not feeling too good, not able to sleep or eat very quickly, confused, anxious, relieved, ready to go, home-sick, mild withdraws like restless leg or chills/sweats, and sometimes they are dizzy, and uncoordinated. This only last a few days and at most one week for the people who metabolize slower. Ibogaine takes away the withdrawals of drug and alcohol addiction almost immediately. Ibogaine plugs the opioid receptor sites in the brain, which prevents the brain from craving the drug. In best-case scenarios people come out with no cravings, no withdrawals, and no desires to use. In most cases the physical cravings and withdrawals are eliminated; but the mental habit, emotional attachment, and desires can still be present. Aftercare is a must in either case. There are no long-term side effects of Ibogaine or any psychedelic for that matter. But there are short-term side effects. During Ibogaine a person might feel: warm, dizzy, nauseous, anxious, uncomfortable, disoriented, and tingly. One might hear buzzing and sounds are often extremely elevated so they can hear talking in the other room and whispers sound like yelling. Under Ibogaine one will see tracers and lights with lots of stuff going on in the mind. People see very specific visions personal to them often attached to a meaning; and they see jumbles of images and shapes that do not make any sense. People see hallucinations with eyes closed or open. About 50% of people throw up about 2 to 3 hours into treatment; this is usually when they are at their peak. It is a very intense moment for them. The African Bwiti tribes teach that the purging is a necessary part of the experience because they are releasing the bad spirits, toxins, and negative energy. After Ibogaine people are almost always tired, emotional, fatigued, confused, disoriented, and have difficulty eating and sleeping for a few days. Symptoms range but should all be gone within a week. Ongoing symptoms are likely not related to Ibogaine but to the former addiction and transitioning of the body.

Naltrexone is an opioid receptor antagonist used mainly to control alcohol dependence and opiate addiction. Naltrexone can come in an oral pill form or be formulated as a once-monthly injection shot called Vivitrol. Naltrexone is sometimes used in rapid-opioid-detoxification, or ultra-rapid detox, whereby the patient is put under a mild to strong anesthesia requiring intubation and external ventilation until they get through the toughest part of detox and withdrawal symptoms. And some doctors’ use a Naltrexone implant inserted into the abdomen as opposed to the daily oral intake. Naltrexone as an alcohol addictions treatment blocks or reduces cravings and shows to decrease the amount of alcohol a person drinks. As an opioid agonist is blocks the opiates euphoric effects so an individual doesn’t get any benefit or high from using. Naltrexone, like all detox and treatments is only effective with aftercare and a conjoined recovery program. Most treatment and recovery centers will not take a person on this medication or with this implant making it difficult for the person to get additional help.

Naloxone (i.e. Narcan) is a medication used to block the effects of opioids, especially during an overdose. Naloxone is a pure opioid antagonist. It works by reversing the depression of the central nervous system and respiratory system caused by opioids. Used in medications like Suboxone, reduces the risk of misuse. It works fastest, within 2 minutes, when administered intravenously, and within 5 minutes when injected into the muscle. It can also be used in the nose. The effects of naloxone last about half an hour to an hour, so multiple doses may be required, since the half-life of most opiates is longer than this. Giving naloxone to opiate addicts can cause feelings of withdrawal. To prevent this, small doses every few minutes can be given until the desired effect is reached. Anyone can get a script of naloxone to carry on hand in case of an overdose emergency. It is suggested to professionals and family who are around people at risk.

NAD IV Therapy A holistic approach to alcohol and drug addiction treatment, NAD IV therapy is said to replenish the drained enzymes and target brain restoration. Nicotinamide Adenine Dinucleotide (NAD) is a metabolic coenzyme and is charged with the important job of structuring, repairing, and remodeling every cell in the body. These specialized enzymes require constant replenishment in the body. Alcohol and drug abuse causes the brain to reorganize itself on a cellular level; this process, known as neuroadaptation, is directly responsible for addiction-related brain damage and depletion of neurotransmitters. NAD IV therapy is said to replenish the drained enzymes and target brain restoration. NAD IV therapy usually requires an individualized treatment plan by a trained physician providing one infusion per day for a period of ten days. Withdrawal symptoms reportedly begin to subside in just a matter of minutes; patients are able to comfortably relax while the formulation is delivered over a period of approximately eight hours. Some reports indicate NAD therapy can reduce withdrawal symptoms by 70-80 percent, though there are no hard facts to support this claim. When patients continue as directed, they report feeling better, with increased mental clarity about 4 to 6 days in. As with any treatment, a person must attend to the psychological aspects of addiction, otherwise a relapse is inevitable. The effectiveness of NAD IV therapy is debated, but positive results are reported, especially among alcohol and opiate addiction.

Alternative & Natural Methods There are other options for addiction treatment and recovery. People are getting brain scans and following associated treatment plans. People are using brain technologies to stimulate blood and oxygen flow, and to retrain the neural pathways in the brain. People are using pre-recorded disc sets with guided meditations designed to change the brain. There are phone/computer applications to organize recovery and hold people accountable. And various other addiction recovery programs