People wonder what happens in chemical dependency treatment. What is it about treatment that can transform the life of an addicted person?

John P. entered residential primary treatment at Hazelden more than two years ago. Like most first-time patients, he didn't know what to expect.

"I had a vague idea that treatment might include group sessions and counseling," he said. "But otherwise, I had no clue. A lot of people entering treatment have been in denial and they have never thought about what treatment might be. If they had an idea, they might have gone sooner. But you don't want to know and you really have no experience to base it on."

Once a person gets to treatment, whether it's inpatient or outpatient care, the staff and setting there must instill a sense of hope. "If you demonstrate care--if you show that you know they're hurting--then that helps patients believe there is hope and they have the ability to change," said Bruce Larson, supervisor of Counselor Training at Hazelden.

Incoming patients need to be stabilized medically and emotionally. "They need to be distanced from their drug of choice," said Phil Kavanaugh, supervisor of a men's inpatient unit at Hazelden. "Some will need to go through physical withdrawal. A mental withdrawal also needs to take place. Some people can't stop using as long as their drug is accessible."

Once patients reach a calm state--in which they can think clearly, without feelings of anger and fear--they are given the space and time to look at their lives realistically. They are given a respectful, supportive environment in which they can make some life changes.

Under the widely used Minnesota Model of treatment, each patient receives a thorough assessment in the first few days of treatment. A holistic, team approach is taken and every aspect of a patient's life is evaluated: physical, emotional, spiritual, social and intellectual. The information, including chemical-use history, is pooled to form a patient profile; an individualized recovery plan is developed. Key issues such as low self-esteem, anxiety and grief will be addressed. Some patients may have coexisting problems, such as clinical depression or sexual abuse, that need to be addressed as well.

Treatment varies. At Hazelden, for instance, the new patient joins a unit of about 20 patients. It is usually a diverse group in terms of age, race and economic status. The mix includes patients who are well along in their recovery, those just starting to make progress, and new--often skeptical--patients. In this setting the peer group becomes a critical therapeutic element.

"One human being sharing and becoming vulnerable with others and then sharing that back--that's a big reason treatment works," said Larson. "In that process people find hope that they're not alone, they're not unique and terrible, but that they're experiencing the consequences of an illness. They find they can talk about their hopes and dreams and share their pain and struggles in a safe, supportive setting."

Education about the disease of chemical dependency, through lectures and reading, is another key part of treatment. As with any chronic illness, it's critical that patients understand the implications of their disease and how to manage it. They need to be educated about what has happened and what can happen if they continue to drink. They learn that when they drink they can't build trusting relationships. They realize they have to become honest and move from the self-centered life of an alcoholic to one that cares for others.

In the Minnesota Model approach, the Twelve Steps of Alcoholics Anonymous form the spiritual core for a recovery program. The Twelve Steps provide principles for living, and in an inpatient setting patients get AA education every day for the duration of treatment.

Patients concentrate on "doing" the first five steps in treatment. Admission, understanding and acceptance of Step One--"We admitted we were powerless over alcohol--that our lives had become unmanageable."--is crucial. Step Two is recognizing the need for help from "a Power greater than ourselves," and Step Three is the changing of behavior and attitudes based on acceptance of that help. Steps Four and Five lead to improved self-esteem as a result of attitude and behavior change.

In essence, treatment represents "a time for healing that sets the stage for recovery and self-help groups such as AA," said Larson. "It offers an opportunity for patients to connect with self, others and a higher power."

John P. found that bonding with peers was invaluable to his treatment experience. "What surprised me is that so much of your recovery is based on your own initiative and the contacts and bonds you form with peers," he said. "You can't sit back and let it happen; you can't rely on a counselor to provide a magic solution. You often hear that recovery takes place around a coffee table after the counselors have gone home; there's a lot of truth to that.

"Successful treatment requires rigorous self-examination and a lot of work digging up all the old stuff and sharing it with peers. The key is interaction, and that's really no more than learning how to ask for help, which for me and a lot of others is the cornerstone of recovery."

The Hazelden Report is a chemical health column that addresses the prevention and treatment of chemical dependency and other related addictive behaviors. This Report was originally published Sept. 14, 1993 in the Star Tribune newspaper.