Inpatient Treatment Programs

The Minnesota Model

Inpatient treatment was, for a brief period, the major modality for treating substance abuse in the United States. An inpatient treatment program model that emerged and diffused in the 1940s and 1950s set a standard for the treatment of alcoholism and eventually, substance use disorders for nearly 40 years. Commonly called the Minnesota Model (MM), it integrated Alcoholics Anonymous (AA) philosophy into a formal treatment protocol. It thus attracted proponents from the AA community who would prove to be key in its diffusion and legitimization.

Passage of the Hughes Act in 1970 (named for the first openly recovering alcoholic to serve in the U.S. Senate) established the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It was shortly followed by the Drug Abuse Treatment Act of 1972, which established the National Institute on Drug Abuse (NIDA). These new federal organizations provided the foundation for the rapid growth of treatment for substance use disorders (SUDs). Authors of both acts might have intended to create a national system of SUD treatment, but what has evolved over 40 years is not a system, but at best an aggregation of networks of treatment.

Growth of this new industry, as evidenced by the quadrupling of alcoholism treatment programs in the 1970s, was made possible by the prior existence of the MM. An established treatment model was available and it made sense, both intuitively and in terms of a track record, albeit based largely on anecdote rather than careful evaluation. Private insurance payments were forthcoming in some instances due to state mandates and in others due to actions by insurance industry leaders who were recovered alcoholics. The potential for reimbursement opened the floodgates for private treatment providers. In response the need for standards and accreditation to inform third-party payers became evident.

The emergence of the MM can partly be attributed to the spread of the AA philosophy across the state of Minnesota as well as its application at three renowned Minnesota-based treatment sites: Pioneer House, Willmar State Hospital, and the Hazelden Foundation. What made the MM particularly noteworthy in its earliest years was that it represented a well-defined system that could be replicated.

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