New Book Questions Value of Established Treatment Methods in Age of Fentanyl

With drug overdose deaths soaring past 100,000 American lives lost in 2020, and with opioid-use disorder patients often experiencing rounds of inpatient treatment followed by relapse, overdose and sometimes death, has the so-called "Minnesota Model" of addiction care fallen short of its celebrated potential to transform lives?

Put more directly, in an age of opioids, is the method embodied within the time-tested traditions of Twelve Steps and Alcoholics Anonymous — an approach pioneered by the state's treatment mecca, the Hazelden Betty Ford Foundation — no longer up to the task?

That's the thorny question raised in "Opioid Reckoning," a new book published last month by University of Minnesota Press by independent scholar and Macalester College historian Amy C. Sullivan.

A provocative look at the limitations of conventional addiction treatment in the face of the modern opioid epidemic, the "reckoning" in Sullivan's title stands for the collision between the polite traditions of getting sober in the Twelve Steps, and the need for ideology-free addiction medicine in the face of a deadly scourge.

"The key takeaway from the Minnesota model is the need for abstinence and following the program once you leave treatment," Sullivan said in a recent phone interview. "You go to AA meetings and get a sponsor and keep going to AA meetings.

"It was revolutionary in the time that it was created in the 1940s," she says. "It took inebriates out of the asylum and allowed people to have a space to heal with the care of nurses, peer support and a priest or a pastor. That's what Hazelden created for working professional men."

What "Opioid Reckoning" explores is whether a more successful approach can be found in the trading of AA's self-examination and chemical prohibitions for the more pragmatic approach known as harm reduction.