Sober N Clean

Ten years ago, a small group of people frustrated by the rising cost of treating addiction decided to try to turn back the clock.

Managed care was eroding the Minnesota Model, the residential treatment programs that made the state the place to go to get sober. Hundreds of treatment centers around the country were closing as insurers tried to cut costs. The survivors, such as the famed Hazelden Foundation, were under pressure to show clinical results. They added medical staff, pushing prices beyond the reach of many.

The little group tried a different path.

They eschewed the clinical psychiatry and pharmaceuticals embraced by the rest of the industry, going back to the roots of the treatment movement: a full month's residence, surrender to a higher power and support from a community of former addicts.

"We went in a direction nobody was going -- simpler, more affordable," said John Curtiss, a longtime Hazelden executive who left to start the new venture.

They called it "The Retreat."

Now housed in a former nuns' retreat in Wayzata's Big Woods, it offers a one-month residential program for about $4,000, about one-seventh of what Hazelden charges. Its outcomes are comparable to that of other major centers, with 50 percent of those who come through abstaining from alcohol and drugs for 12 months afterward, Curtiss said.

Ten years after its inception, The Retreat hasn't exactly reversed the course of American addiction treatment, which continues to get more expensive. But it has thrived and spawned similar centers in Sioux Falls, S.D.; Auckland, New Zealand; and Hong Kong.

"The Retreat is a model for the nation of affordable treatment that works," said U.S. Rep. Jim Ramstad, a recovering alcoholic and longtime national advocate for better access to treatment. He is a regular volunteer at the Retreat.

Making access affordable

On a recent morning, two dozen women gather in a sun-filled room to study the "Big Book," the bible of Alcoholics Anonymous. Young and old, they bend over the volumes, pages heavily underlined.

Ralph C., a bearded, bow-tied volunteer, is talking about spiritual surrender.

"Is it possible that there is a power that has more horsepower out there?" asks Ralph C., who uses just his first name in line with AA's philosophy. "Am I beginning to suspect it's not another man who's going to fix this? Or a counselor or a drink?"

Quit trying to play God, he tells them.

They are among the few who have managed to get affordable help on the road to recovery. Many others never do. In 2006, 23.6 million people age 12 or older needed treatment for addiction, but only 2.5 million, or 10 percent, got it, according to the U.S. Department of Health and Human Services.

Cost is often a barrier -- with most programs charging $30,000 or more for a month-long stay. Not all insurance covers treatment, and not all centers accept insurance.

The Retreat draws half of its patients from Minnesota, the rest from as far away as India and Australia. The average age is 38 and most have college educations.

The program isn't for everyone. With no clinical staff, the typical client is medically stable and highly motivated. Eighty percent have been through previous treatments.

"We wanted to create a dignified, safe place to go, away from the burning house of addiction," Curtiss said.

If they're suicidal or otherwise need medical help, the Retreat refers them to Hazelden. Other centers in turn refer patients here.

"They have a niche," said Ron Hunsicker, president of the National Association of Addiction Treatment Providers. But the fact that the program hasn't been copied by many suggests its clientele may be limited, Hunsicker said. More addicts are showing up for treatment these days needing medical care.

But William Moyers, executive director of Hazelden's Center for Public Advocacy, differs. "I believe the Retreat is the future of recovery," he said. "It's crucial to replicate it." There is a need for cheaper alternatives for those who relapse, he said.

It was the Retreat, Moyers said, that inspired Hazelden to start its Lodge program in 2002, a nonclinical retreat on its Center City campus.

Letting go of insurance

Curtiss was a patient at Hazelden in the 1970s and returned as a counselor. He worked his way up to vice president of Hazelden's national operations, overseeing multibillion-dollar expansions into New York and Chicago.

In the early 1990s, health insurers, anxious to cut costs, were scrutinizing chemical dependency programs. As insurers insisted on medical diagnoses, addiction centers duly produced them.

"You want to see pathology? We'll show you lots of pathology," said Curtiss, describing the mood of the day. As centers hired more medical staff, costs went up further.

Others were uneasy.

"We were going down the wrong path, trying very hard to make alcoholism into a mental illness," said Dr. George Mann, former director of treatment at St. Mary's Hospital in Minneapolis, now part of Fairview Health Services.

Mann, Curtiss and others began meeting to discuss solutions. In 1998, with a grant from the Johnson Institute, they opened a facility with 20 beds in the old Pillsbury mansion in Minnetrista. Curtiss staffed and furnished it for the grand sum of $177,000.

The Retreat didn't register as a treatment center. Instead, it is regulated by the state Department of Health as "board and lodging." It has grown into an 80-bed campus in Wayzata and runs 54 sober living beds in St. Paul for program graduates.

Over the decade, about 3,500 clients have come through the monthlong program, a third of those with financial help provided by donations. The center doesn't have contracts with insurers.

Stoked by volunteers

In any month, 250 volunteers lead chapel services at The Retreat, drive patients or teach the "Big Book." They not only help keep costs down, they form a vital safety net of recovering addicts.

Alcoholism is "not a disease where people bake casseroles and come over," said Dee L., a volunteer wearing a business suit and pearls. A client three years ago, Dee now returns often to tell her story. She does it as much for herself as for them: "This is how I stay sober."

Even board members continue to work for free. The top executive, Curtiss, is paid $140,000 a year.

An early volunteer at The Retreat was Andrew Zimmern, host of the Travel Channel's "Bizarre Foods."

Zimmern left New York City and checked into Hazelden in 1992, in his words: "a homeless, alcohol- and drug-addled wreck." He credits Hazelden for saving his life. Luckily for Zimmern, his former business partner had continued to pay his health premiums, so insurance covered his treatment.

After he left, Zimmern became concerned that too many people couldn't afford the same. So he volunteers at the Retreat.

"We all know recovery works at its simplest," he said, "when one alcoholic talks to another."
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source: Minneapolis Star Tribune, http://www.startribune.com