How Alcohol Treatment Became Divorced from Alcohol Science: The Rise of the Minnesota Model

By Kenneth Anderson, MA

Alcohol treatment wasn’t always divorced from alcohol science; the divorce between the two can be largely laid at the feet of Hazelden CEO Daniel John “Dan” Anderson, PhD (Mar 30, 1921 – Feb 19, 2003). Anderson’s attitude towards science was one of hubris and arrogance.

The History of Alcohol Treatment in the United States

Treatment for alcohol problems in the United States occurred in two major waves: The first was prior to Prohibition (January 17, 1920), and the second followed Repeal (December 5, 1933). Demand for alcohol treatment dried up almost completely during the period from 1915 to 1920 due to state and local prohibition laws, the so-called Wartime Prohibition Act, and other factors, and all but a handful of alcohol treatment facilities had shut down prior to the time that Prohibition went into effect. Alcohol consumption in the US hit an all-time low in 1920 but began to increase as federal Prohibition began to fail.

Although a handful of treatment facilities, such as the Keeley Institutes in Dwight, Illinois and Greensboro, North Carolina, the Murray Cure Institute in Minneapolis, the Washingtonian Home in Boston, and Bellevue Hospital in New York City, etc., continued to offer alcohol treatment throughout Prohibition and thereafter, the post-Repeal era was dominated by new, young entrepreneurs. The HALCO Laboratories chain and the Samaritan Institution chain both appeared in 1934; these were both secret cures like the Keeley and Neal Institutes which had preceded them. Alcoholics Anonymous (AA) was established on June 10, 1935, and Hazelden admitted its first patient on March 21, 1949. Numerous private sanitariums for alcohol treatment also opened in the post-Repeal era.

The post-Repeal era also saw the birth of the scientific study of alcohol in the US. On December 2, 1937, the Research Council on Problems of Alcohol (RCPA) was formed. The RCPA was affiliated with American Association for the Advancement of Science (AAAS). The RCPA published the first issue of the Quarterly Journal of Studies on Alcohol in June of 1940. The Quarterly Journal of Studies on Alcohol moved its editorial offices to Yale in 1942, and in 1943, the Yale Section of Alcohol Studies (later renamed Yale Center of Alcohol Studies) was established. The Quarterly Journal of Studies on Alcohol was the first genuinely scientific journal of alcohol studies to be published in the US. Although the Quarterly Journal of Inebriety had been published from December of 1876 to April of 1914, this was a low-quality journal which had been primarily devoted to the largely failed obsession of its editor, Thomas Davison Crothers, MD (Sep 22, 1842 – Jan 12, 1918), with establishing state-run inebriate asylums.

Shadel Sanitarium in Seattle, Washington was established in 1935 by chiropractor Charles Albert Shadel (Nov 21, 1896 – May 13, 1982) as a branch of the HALCO Laboratories chain. However, Shadel had the good fortune of hiring meticulous scientific investigator Walter Lyle Voegtlin, MD (Mar 12, 1904 – Apr 16, 1975) as his medical director. Starting in 1940 and continuing into the 1950s, Voegtlin and colleagues published the Shadel treatment formula and protocol together with detailed follow-ups of all patients in the medical journals. The Shadel treatment was a form of aversion therapy known as conditioned-reflex treatment which involved pairing alcohol with the emetic emetine to create an aversion to alcohol.

The Winter VA Hospital, which operated in conjunction with the Menninger Clinic in Topeka, Kansas, began offering alcohol treatment when it first opened in 1946. Early alcohol treatment at the Winter VA Hospital was not very successful, so, in 1950, the hospital conducted a four-armed clinical trial to compare Antabuse, conditioned-reflex treatment, group hypnotherapy, and treatment as usual. The Winter VA Hospital published all its results in meticulous detail in scientific journals and found that with its treatment population, Antabuse was the most successful modality. The Winter VA Hospital continued to conduct experimental trials of alcohol treatment throughout its history and publish the results in scientific journals, including trials of LSD therapy conducted in the 1960s. These are just two of a multitude of examples of treatment facilities working hand-in-hand with the scientific community to devise the best possible treatments for alcohol problems.

The Rise of the Minnesota Model

The Minnesota Model multimodality treatment was born in Willmar State Mental Hospital in 1950. The three people primarily responsible for creating the Minnesota Model were psychiatrist Nelson John Bradley, MD (Nov 11, 1917 – Jun 28, 1983), Dan Anderson (see above), and Jean Joseph Rossi, Jr., PhD (Mar 30, 1926 – Dec 10, 2019). In terms of character, Bradley was the administrator, Anderson was the mystic, and Rossi was the scientist. Bradley had been the superintendent at Hastings State Hospital before being transferred to take charge of Willmar in 1950. At the time, Willmar was the only state hospital in Minnesota which admitted inebriates; it had been founded as the Willmar State Hospital Farm for Inebriates in 1912. Bradley brought Anderson with him from Hastings where Anderson had been an attendant. Rossi came to work at Willmar in 1951.

Bradley and Anderson put together a multimodality program at Willmar which combined AA, medicine, religion, social work, and psychology. During the Willmar days, the nascent Minnesota Model still remained a part of the scientific community. The Alcohol Addiction Project was created to study the outcomes of the alcoholism treatment program at Willmar; this was partially funded by the Hill Family Foundation in St. Paul, Minnesota. Rossi was in charge of tracking the outcomes and publishing them in scientific journals.

The results of Alcohol Addiction Project were published in two papers in the Quarterly Journal of Studies on Alcohol: “Dynamic Hospital Treatment of Alcoholism” (1960) and “Effects of Treatment of Male Alcoholics in a Mental Hospital. A Follow-Up Study” (1963). The former was authored by Rossi and Bradley, with Rossi as the lead author. The latter was authored by Rossi, George Alexander “Alex” Stach (Aug 2, 1918 – May 16, 2009), and Bradley, with Rossi as the lead author. Notably, Anderson had nothing to do with this research. Outcomes were as follows:

Table 1) Willmar Outcomes Published in 1960
Year	1955	1956	1957
Subjects	N=1,724a	N=1,894b	N=302c
Improved	30%	27%	34%
Motivated	21%	17%	8%
Unimproved	21%	26%	32%
Dead	3%	8%	6%
Unknown	25%	22%	20%
Totals	100%	100%	100%
a All admissions from 77 rural counties during the period from March 1, 1950 to March 31, 1955. b All admissions from 77 rural counties during the period from June 1, 1950 to December 31, 1955. c This sample included every fifth male admission during the period from June 1, 1950 to December 31, 1956 from 47 rural counties.

 

Table 2) Willmar Outcomes Published in 1963
Institutionalized	11	5%
Dead	13	6%
Lost to follow-up	35	17%
Continuous abstinence	14	7%
Mild drinking	45	22%
Serious drinking	90	43%
Total	208	100%

 

The outcomes were not terrible, nor were they terribly impressive.

Bradley left Willmar in 1960 over a dispute over his salary; he moved to Park Ridge, Illinois, where he headed up the psychiatric department at Lutheran General Hospital. Anderson left in 1961 to serve as vice president and CEO of Hazelden. Rossi also left Willmar around this same time; he went on to produce a sizable body of scientific research papers on alcoholism and treatment during his lifetime.

Patrick Butler (Oct 18, 1900 – Jul 28, 1990), the president of Hazelden, hired Dan Anderson because he wanted to switch Hazelden from a single-modality program which offered only AA to the multimodality program used at Willmar. And now, a word about Dan Anderson’s background is in order.

Dan Anderson and the Building Blocks of the Minnesota Model

Anderson was born in Minneapolis, Minnesota and was raised as a devout Catholic; Anderson attended mass every Sunday throughout his entire life. Anderson’s mother died when he was 13, and his father died when he was 14, so Anderson was sent off to be raised by relatives in rural Williams, Minnesota.

Anderson disliked school and had a bet with a friend as to who would come in lowest in their class; Anderson came in second lowest. At age 16, Anderson was tending bar at the Idle Hours Cafe. However, Anderson never became much of a drinker; he was a moderate social drinker throughout his life.

After graduating high school in 1939, Anderson went on the bum for a while, riding freight trains around the country. Anderson served in the army from June 15, 1942 to December 8, 1945 as a radarman in the Pacific. After the war ended, Anderson decided that he wanted to go to college on the GI Bill.

Despite his low high school grades and some missing courses, Anderson managed to get admitted to the College of St. Thomas in St. Paul in 1946. Anderson started working as an attendant at Hastings State Hospital in 1947; this is what made him decide to major in psychology. Anderson worked nights as an attendant at Hastings earning $120 per month with free room and board and went to classes in the daytime. This was when Anderson met Nelson Bradley, who was superintendent of Hastings from 1948 to mid-1950. Anderson graduated summa cum laude with a BA in psychology from St. Thomas College in 1950. When Bradley became superintendent at Willmar in 1950, Anderson went with him.

Anderson opted to do his master’s degree in clinical psychology at Loyola University in Chicago because he eschewed psychology with a secular, Freudian basis, and wanted to study it at a Catholic University instead. Anderson completed his coursework for the MA in psychology in the early 1950s, but did not complete his master’s thesis, An Exploratory Investigation of Anxiety in Alcoholics, until 1957. Based on the recommendation of Rossi, Anderson opted to do his doctoral work at the University of Ottawa, because they based their psychology program on the teachings of St. Thomas Aquinas instead of the teachings of Sigmund Freud. Anderson did his doctoral course work in Ottawa in 1956 and 1957, even though he had not yet completed his master’s thesis. Anderson did not complete his doctoral dissertation, Personality Correlates of Complex Instrumental Avoidance Learning, until 1966.

Problems with the “Science”

The Hill Family Foundation sponsored an applied research program at Hazelden in 1969, with a grant totaling $182,000. Interestingly, Hazelden chose to publish only minor research from the Applied Research Program in peer-reviewed journals, using its own press to publish major works about its program and outcomes, skipping out on the peer-review process and distancing itself from the scientific community. Sister Mary Leo Kammeier, PhD, CSJ (Oct 24, 1923 – Sep 14, 1978) was in charge of the applied research program and authored most of the Hazelden research which was published in peer-reviewed journals; after her death in 1978, Hazelden simply ignored science and published everything through its own press.

Anderson preferred publishing through Hazelden’s own press because this allowed him to throw out any data that he didn’t like and to vastly inflate Hazelden’ success rates. The first widely distributed published account of Hazelden’s outcomes was Easy Does It: Alcoholism Treatment Outcomes, Hazelden and the Minnesota Model (1982) by Hazelden booster and consultant Jay Clark Laundergan (Oct 29, 1938 – Feb 11, 2022). Laundergan claimed that Hazelden’s outcomes were 54.6% abstinent, 18.0% improved, and 27.4% not improved. However, when Christopher C. H. Cook (living) reanalyzed the Hazelden outcome data in 1988, he found that Laundergan had thrown out the data for 2,392 patients who had been readmitted to Hazelden or entered the extended care program, etc., and only analyzed the data for the 1,246 patients who had completed the program as intended. When the data for all 3,638 patients was included, the outcomes were 37.8% abstinent, 9.2% improved, and 53.1% not improved.

Given Hazelden’s rejection of alcohol science, it’s no wonder that Hazelden was completely blindsided by the publication of the Rand Report on June 9, 1976, which found that:

nearly 70 percent of the NIAAA clients are in remission after treatment; and at the 18-month followup, roughly equal numbers fall into the categories of 6-month abstention, periodic drinking (abstained last month only), and normal drinking.

Hazelden immediately went to the press to claim that the science was wrong and Hazelden’s dogmas were right.

The anti-science of the Minnesota Model was spread throughout the United States in the 1970s, primarily through the Johnson Institute, but also directly and indirectly by Hazelden itself. The Johnson Institute was established on December 8, 1966 in Minneapolis by a Hazelden graduate, Episcopal priest Vernon Edwin Johnson (Aug 23, 1920 – Apr 30, 1999). Although the Johnson Institute was a separate entity and not a part of Hazelden, the purposes of the Johnson Institute were to help people conduct interventions to force people into treatment, to train alcohol counselors, and to establish treatment programs based on the Hazelden Model in hospitals.

The Link Between US Hospitals and Alcohol Treatment

US hospitals had been severely overbuilt in the 1960s and were undergoing an empty bed crisis in the 1970s. Meanwhile, more and more insurance companies were offering insurance coverage for hospital treatment of alcoholism during this same period. There was a sudden great demand to establish alcohol treatment programs in hospitals, and the Johnson Institute took advantage of this. The Johnson Institute established its first alcoholism treatment program in St. Mary’s Hospital in Minneapolis in 1969. By 1980, the Johnson Institute had established treatment programs in over three dozen hospitals from coast to coast. Johnson Institute programs were notorious for their harsh confrontation, ultimately derived from Synanon. Johnson also gained great fame from the publication of his 1973 book I’ll Quit Tomorrow, which sold over 350,000 copies. Although Johnson claimed that he was dispelling myths and exposing truths about alcoholism, in reality, Johnson was promoting the Minnesota mythology and denying the science of alcohol. Johnson helped arrange Betty Ford’s intervention in 1978, cementing his relationships with the rich and powerful.

The Johnson Institute’s greatest competitor in “putting heads on beds” in alcoholism treatment programs was the for-profit CompCare Corporation, which, by 1980, operated CareUnits in 53 hospitals, operated three psychiatric hospitals specializing in the treatment of alcohol and drug addiction, and one alcoholism hospital. The CompCare program was also focused on the 12 steps and used the same types of videotapes and lectures as the Minnesota Model programs but lacked the confrontational component. Another major competitor was Raleigh Hills, which offered aversion therapy instead of 12-step treatment. By 1980, Raleigh Hills was operating 17 aversion therapy hospitals.

Training the Next Generation

Alcoholism counselor training programs were another way in which the Minnesota mythology was spread throughout the country. Hazelden’s alcoholism counselor training program was developed between 1966 and 1968. Willmar’s alcoholism counselor training program had been formally established in 1962, and the Johnson Institute had established its alcoholism counselor training program around 1967. Between them, Hazelden, Willmar, and the Johnson Institute had a near monopoly on alcoholism counselor training, and all three taught Minnesota Model dogma based on AA’s Big Book rather than science and critical thinking. This was a major factor in the divorce of alcoholism treatment from the scientific community. There was little competition in alcoholism counselor training at this time, although an alcoholism counselor training program was established by the Baltimore City Health Department in September of 1967, and several VA hospitals had established alcoholism counselor training programs by 1969, as had the University of Iowa. Hurley Hospital in Flint, Michigan began offering an alcoholism therapist training program in 1965. In the fall of 1970, training programs were established at Atlanta University in Georgia, Galen State Hospital in Montana, and the University of Utah, all funded by Office of Economic Opportunity (OEO) grants.

Spin-Offs and the Perpetuation of the Minnesota Model

A number of alcohol treatment programs spun off directly from Hazelden, and served to perpetuate the Minnesota Model of addiction treatment. Spin-offs from Hazelden’s early single-modality program include Chit-Chat Farms (Caron), established in 1959 in Wernersville, Pennsylvania, Cumberland Heights, established in Nashville, Tennessee in 1969, Lynnville Treatment Center, established in Jordan, Minnesota in 1969, and Carrollton Treatment Center, established in Cedar Rapids, Iowa in 1973.

Direct spin-offs from Hazelden’s multimodality program include Northwestern Hospital in Minneapolis (1970), Edgewood Treatment Center in St. Louis, Missouri (1971), St. John’s Hospital in St. Paul, Minnesota (1971), Nebraska Methodist Hospital in Omaha (1971), St. Joseph Community Hospital in Vancouver, Washington (1973), St. Vincent Hospital in Sioux City, Iowa (1974), Clifton Springs Hospital and Clinic in Clifton Springs, New York (1976), Mississippi Baptist Hospital in Jackson, Mississippi (1976), and Mercy Hospital at Council Bluffs, Iowa (1977). All of these were established by former Hazelden staff.

Finally, there was the Parkside chain of alcoholism treatment hospitals spawned by Nelson Bradley’s program at Lutheran General Hospital in Park Ridge, Illinois. By 1989, Parkside delivered addiction treatment at nearly 100 sites. The Parkside chain collapsed in the mid-1990s.

Hazelden also became the country’s biggest publisher of addiction treatment materials in the 1970s, publishing countless video and audio tapes of their lectures. Of course, none of Hazelden’s treatment materials are tested in randomized controlled trials, because Hazelden prefers the divine revelations of Bill Wilson to the scientific method.

And this is how capitalism and religiosity led to the divorce of alcohol treatment from alcohol science in the United States. Unfortunately, even today, alcohol counselors are trained in alcohol mythology instead of alcohol science, and the overwhelming majority of treatment facilities continue to base their programs on mythology instead of science. Addiction treatment is a $42 billion industry, and $42 billion has a lot of inertia and resistance to change.

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