Is the revered Minnesota model of talk therapy for alcoholics outdated? Joan Mathews Larson, Ph.D. of Health Recovery Center thinks so. Her holistic way of treatment through biochemical restoration sets out to prove it.
TAKING THE CURE
Reprinted with permission by MPLS. ST PAUL Magazine,
©April 1995
By all accounts, Rob Mathews had been a well-adjusted Richfield teen who earned good grades, acted in school plays, played halfback on a neighborhood football team, and volunteered as a reading tutor. But after his father died of a heart attack at age 42, Rob's experimentation with booze and pot became addiction over the next 41/2 years. Eventually he entered St. Mary's Hospital, where counselors in the chemical-dependency unit for adolescents theorized that Rob's habit was rooted in his grief and guilt about his relationship with his dad. He completed his inpatient treatment, and after a half-way house stay, Rob began his senior year of high school.
But he still experienced huge emotional peaks and valleys. Because she thought his highs and lows might be triggered by his heavy consumption of junk foods and cola, Joan Mathews Larson asked a physician to test her son for hypoglycemia. The results confirmed her hunch: Rob's blood sugar was severely imbalanced.
"Rob's mood swings were just incredible," Larson recalls. "The day he died he had seen his counselor and found out he had enough credits to graduate. He was ecstatic when he came home from school. But by the middle of the night he had swung the other way. Rob had came into my room and talked about how bad he felt that his dad was dead and how sorry he was that his drinking had caused so much trouble. He wanted me to know he wasn't going to be a problem anymore.
A few hours later, at 6:45 a.m. on Sept. 23, 1975, Rob's older brother heard the car running in the garage and found him lying under the exhaust pipe. Rob Larson was pronounced dead at Fairview Southdale Hospital. He was 17 years old.
Believing her son's depression may have been linked to his low blood sugar- a physical condition the chemical dependency unit at St. Mary's was not designed to address- a grieving Larson began searching for answers. "I had to know what could have been done for this child who was so suicidally depressed," she says.
At the time of Rob's death, Larson, a former fashion and advertising illustrator, was in the midst of earning her certification as a substance-abuse counselor at Metropolitan State University. After years of research, she not only confirmed the alcoholism-hypoglycemia link, she designed a treatment program that replaces the natural chemicals alcohol destroys in the brain, thus more quickly stabilizing the recovering person. In 1981, Joan Mathews Larson launched Heath Recovery Center, one of the first such holistic treatment programs in the United States. In the process, she pitted herself and her tiny Minneapolis outpatient program against the renowned and perhaps the most revered chemical-dependency treatment method in the world.
Minnesota is internationally recognized as the birthplace of the most widely accepted method of chemical-dependency treatment, the so-called Minnesota model. The core idea of the method- created in the 1950s and practiced by the celebrated Hazelden Foundation and other local inpatient chem-dep programs- proposes that addiction to alcohol and other drugs is a multidimensional disease, with physical, spiritual and social effects. Yet most Minnesota-model based programs treat the disease primarily as a psychological disorder, addressing the underlying problems- from festering emotions to low self-esteem- that have caused the patient to abuse chemicals.
There's no disputing that the treatment has saved thousands of lives. But as the Star Tribune reported in 1993, traditional talk-therapy programs actually fail far more often than they succeed. Based on more than 600 U.S. studies, recovery statistics show that only 25 percent of those who undergo traditional treatment remain sober after one year. The Star Tribune also reported data from the Minnesota Department of Human Services indicating that almost two-thirds of those admitted to chem-dep programs in the state had been in treatment before: more than half of those repeat patients were in for their third, fourth or fifth attempt at treatment.
For 30 years, the American Medical Association and the World Health Organization have recognized alcoholism as primarily a physical disease, and researchers have documented its organic effects on the brain and body. Why, then, considering their low success rates, do the vast majority of treatment programs- a $4.9 billion-dollar industry- continue to treat alcoholism primarily as a psychological disorder?
Joan Mathews Larson began asking that question in earnest in 1978, when she and two other counselors used a grant from the National Institute on Alcohol Abuse and Alcoholism to establish a chem-dep program for women at Chrysalis, a Twin Cities treatment center for women.
Alcohol is a concentrated form of sugar that affects the brain within seconds. Consuming large amounts of sugar causes the brain to secrete excess insulin and adrenaline, producing a sharp drop in glucose, or blood sugar- and likewise producing mood swings and depression. When the Chrysalis team gave glucose-tolerance tests to more than 150 alcoholic clients, and more than 80 percent proved to be hypoglycemic, Larson knew she was on the right track toward a treatment revolution.
"The studies that show how the brain falters behind alcohol are endless" says Larson, who learned that certain amino acids are essential ingredients in the brain's neurotransmitters that regulate mood and emotions. "The main neurotransmitters that keep us sane are all blocked by heavy amounts of alcohol over time. [When that happens], you have a complete change in how people behave and feel."
Some of the most telling research she uncovered was conducted by Harvard psychiatrist George Vaillant, who for 40 years studied 600 academically successful and seemingly well-adjusted college students, hoping to identify preexisting markers that would indicate which ones would become alcoholics. In the process, Larson says, "the researchers reported such negative changes in the alcoholics' behavior that 20 or 30 years into the study they were calling them sociopathic.... The researchers' only explanation was that the alcoholics' brains were no longer working in the normal way. Their brains had been altered and were missing key chemicals. "It's even more shocking to see what happens to these depressed people when you reload those chemicals," Larson says, "After three weeks, their depression has lifted."
Building a treatment program based on reloading those essential chemicals became Larson's mission. Using the findings of researchers who understood the connection between hypoglycemia and alcoholism, Larson constructed a nutritional formula that, over time, ended the depression and alcohol cravings experienced by many recovering alcoholics. According to Larson and other researchers, the metabolic swings experienced by many recovering alcoholics make them crave sugar and - if they smoke or consume caffeine- cigarettes, cola and coffee.
In January 1981, Larson opened Health Recovery Center at 33rd Street and Hennepin Avenue. There, working without salary at first, Larson saw her first outpatients with the help of three counselors. She also spoke to groups of treatment professionals about her "biochemical repair" theories.
"In my excitement over the fact I was seeing people whose depression was lifting and whose cravings were diminishing, I wanted to teach everybody what we were doing," recalls Larson, who earned her doctorate in nutrition in 1985 from California's Donsbach University, now the International University for Nutritional Education. She instead met with skepticism and occasionally, outright defensiveness. One remark by a former counselor and state Department of Health and Human Services staff member summed up the mindset then shared by many treatment professionals, Larson says: "At the end of one talk he said to me, 'You're telling me I've been doing it wrong for 17 years?' I understood then that people were comfortable with what they had been doing and didn't want anything else new."
Larson also recalls a conversation at that time with former medical director of St. Mary's chem-dep program, who appeared with her on a WCCO-TV forum: "During a commercial break he leaned over and said to me, 'Young lady, I have never seen a case of hypoglycemia among alcoholics,' I asked him how many he had tested. He said 'None', You'd think the medical profession would want to claim this. After all, they named alcoholism a physical disease in 1957,"
Larson does acknowledge the need to address psychological, social and spiritual aspects of the disease; counseling and aftercare are part of her program at Health Recovery Center, which also encourages participation in Alcoholics Anonymous. But she laments the confrontive approach used by many traditional programs.
"The whole system is antiquated because it isn't based on science," Larson says. "It's based on someone's notion that there is some psychological flaw in alcoholics and that if we talk to them long enough, we'll straighten them out."
Neuro-research has greatly advanced science's understanding of brain chemistry and the role natural chemicals play in maintaining normal thought patterns and feelings. It's also been proven that alcohol diminishes or destroys many of the substances the brain uses to create and regulate emotions.
"Alcohol causes people to become malnourished, "says Joseph Beasley, an internist and former medical professor at Harvard and Tulane Universities who developed a similar treatment program at Comprehensive Medical Care Clinic in Amityville, N.Y. "One, because alcoholics don't eat as much when they are drinking heavily: two, they don't absorb what they eat because alcohol affects the metabolism control center in the midbrain and causes the stomach, intestines, pancreas and liver to malfunction. And alcohol is a diuretic, so they urinate more. So alcoholics wind up with tremendous deficits in total body nutrients, especially potassium, zinc and calcium. It's a huge, unrecognized problem.
"Unless they get nutritional help, these patients continue to crave alcohol and may experience fatigue, depression and anxiety and go back to drinking in a very high percentage of cases."
Larson agrees, citing a 10 year Johns Hopkins University study of Alcoholics Anonymous participants, reported in 1985. "During the first five years there was hardly any change in the high levels of anxiety and depression they were experiencing," Larson says. "This began to improve after five years, but it's no wonder so many people drop out of AA in the beginning. These people may be sober, but a lot of them aren't very well."
Health Recovery Center claims a success rate of 74 percent, based on Larson's 31/2 year followup study of 100 patients, published in 1987 in the International Journal of Biosocial and Medical Research. (Subsequent short-term studies show a success rate of more than 80 percent, she adds.) Not only were three-quarters of the study group still sober one year after treatment, but most of the patients also reported significant reduction or elimination of such common symptoms as alcohol cravings, anxiety and depression within six weeks of beginning treatment. Beasley also documented recovery rates similar to those of Health Recovery Center in a 1991 study, published in the Journal of Substance Abuse.
Another eye-opener was a 1984 National Institute of Mental Health finding: That 25 percent of deaths among treated alcoholics were suicides, most occurring in the first year after treatment.
After 15 years of drinking a quart of vodka a day and two failed attempts at conventional treatment, Alan Dalum of Crystal feared alcohol would cost him his job as a telecommunications customer-service representative, his marriage and, eventually, his life. And he felt powerless to do anything about it.
But eight years ago, Dalum, now 44, discovered The Amino Revolution, written by psychologist and nutrition counselor Robert Erdmann, about the use of nutrients and herbs to biochemically "repair" alcoholics. Dalum also learned about Health Recovery Center and decided it might be his last hope for controlling his recovery. In 1987, Dalum began the six-week treatment regimen. First, he was given an intravenous formula, administered under medical supervision, to remove the toxic effects of alcohol and other drugs. Several times a day, he took an oral formula of natural chemicals (amino acids, essential fatty acids, vitamins and minerals) to reduce withdrawal symptoms and to restore a sense of well-being. Health Recovery Center also tested Dalum for chemical imbalances that may have been causing unstable moods or emotions. (Commonly used tests analyze blood sugar: brain allergies: prostaglandin E1, the loss of which can result in depression: and histamine, which in high levels can cause obsessive/compulsive behavior.)
Next, Dalum was given key natural chemicals to replace those destroyed by heavy drinking, including phosphatidyl choline (which improves memory) and tyrosine (which combats depression). Finally, Dalum abstained from caffeine and nicotine, both of which precipitate a drop in glucose. Studies show that alcoholics who are most prone to relapse are those who smoke. Larson says.
Dalum says he started to feel better physically and mentally about a week into the program. "It was a rapid turnaround," he remembers. "I had no alcohol cravings ....things started to make sense." Today, he is sober, successful, happy and a wonder to friends, colleagues and former counselors who marvel at his transformation.
Dalum, whose uncles were alcoholics, says he feels that traditional programs don't do enough to treat the physical causes and effects of alcoholism. "From a biochemical standpoint, they don't have the necessary tools to repair the damage done by alcohol." he says. "I didn't get much out of treatment the first two times. I was very weak and shaky; I couldn't really comprehend what was going on. In a situation like that, you go through the motions to get through the program, but it doesn't really stick with you."
Rita S., a Minneapolis waitress and recovering alcoholic, also failed in conventional treatment and says Health Recovery Center's program saved her life. Rita, 33, says she was fighting a nightly drinking habit that had cost her a job and caused her family to become estranged after repeated attempts to help. A fellow member of Rational Recovery, a nonspiritual support group and alternative to AA, told her about Health Recovery Center's program in July 1993. Rita says she immediately knew it was right for her. "I was ready to kill myself." she says. "The first time I met with Joan, she told me, 'Rita, you can't talk this problem away,' and it was as if a light bulb went on."
Rita says that as long as she follows the nutritional regimen she began at HRC including abstinence from sugar and caffeine and continuing to take recommended nutrients- she no longer craves alcohol or suffers extreme mood swings. "For the first time," she says, "I'm doing Ok."
In the past 14 years, Health Recovery Center has treated more than 2,500 patients- about 200 a year- many with similar stories, Larson says. Like Alan Dalum and Rita S., most HRC patients are self-referrals, many of whom hear about the program from friends or relatives or through local television ads. Seven chemical-dependency counselors, a nurse and a physician, a lab technician and administrative staff- 15 in all- run the center
Each patient is assigned two chem-dep counselors: One to help manage the nutritional aspects of the program and one to address psychosocial needs- and meets weekly with each. Patients also spend two to four hours a day in group therapy and are encouraged to participate in a weekly aftercare program for six months following treatment. Aftercare, which is free at HRC, consists of the same mix of psychosocial and nutritional counseling. The cost of the six-week program is $4,800, which, on a cost-per-day basis, is within the range charged by other area outpatient programs. (The four-week outpatient program at Fairview Behavioral Services, for instance, costs $3,675; HealthEast charges $155 per day for outpatient treatment.)
Larson describes HRC's treatment program in Alcoholism, the Biochemical Connection published in 1992 by Random House's Villard Books subsidiary. Three paperback printings have been published under the new title Seven Weeks to Sobriety. (The outpatient program takes six weeks to complete; the book adds a seventh week for reading and gathering supplements for self-treatment.) The book, which has sold 50,000 copies, has attracted patients to HRC from across the United States, Europe, Scandinavia, Japan and South America. Larson has been a guest on more than 150 radio and TV talk shows, including fitness guru Susan Powter's talk show and NBC's "Life Choices" health program. With more alcoholics seeking help, Health Recovery Center has expanded its Uptown space.
Only three other holistic programs for alcohol treatment exist in the United States, according to Natural Health magazine: Northern California Recovery Systems, in Mill Valley, CA.; Lakeside -Milam Recovery Centers, in Seattle; and Comprehensive Medical Care, in Amityville, N.Y. An undetermined number of traditional treatment programs are beginning to adopt similar methods. Larson says. She is not aware of any other holistic programs in Minnesota, although other conventional treatment programs now purchase and use HRC's detox formula.
Ironically, Larson's biochemical approach has been better received nationally and overseas than in her home state. "The state which has led the nation with the Minnesota model will probably be the last state to come into the 21st century- probably because the treatment people here are still clinging to the glory of those first innovative steps," Larson says. "But the world is moving on."
Spokespersons for several area treatment centers say they haven't learned enough about HRC's methods to comment on their validity. "If it works , fine," says Gregory American medical director of adult chemical dependency at Fairview Riverside Medical Center in Minneapolis.
Hazelden does recognize the importance of nutrition in recovery, says Jean Strobel, a clinical-care manager at the treatment center. "We teach people the importance of eating a balanced diet every day, "Strobel says. "But the idea of putting a lot of different pills in your mouth isn't a good thing to teach a chemically dependent person."
Hazelden vice-president Michael Schiks says his organization is open to new approaches, if they prove effective. "We're always looking for new ideas," Schiks says, "and we've been instrumental in working with alcohol problems in holistic fashion." For instance, Hazelden has integrated chaplains and psychologists as well as chem-dep counselors into one, multi disciplinary treatment team.
Margie Ryan, director of St. Paul based HealthEast's Adult Chemical Dependency Program, says that HRC's schedule of weekly psychological counseling sessions aren't sufficient for most alcoholics in treatment. "It depends on the level of care a person needs," Ryan says. "For patients in the early stages of the disease, weekly counseling sessions might be enough. But alcoholics often need more intensive treatment to achieve noticeable recovery. If you have a sprained ankle, it's enough to wrap it in an Ace bandage. But if you have a broken leg, you need to put it in a cast."
Ryan also reasons that a program such as HRC's would tend to attract patients from a relatively high level of cognitive functioning- people who read and have the ability to understand such concepts as the use of amino acids to "repair" the brain. "You have many more treatment options with that type of person," Ryan says. "Mention amino acids to someone whose thinking is impaired by alcohol or drug use and they wouldn't understand." But she does feel many traditional treatment providers could learn from Larson's work. "On the whole continuum of treatment there is a place for a program like that," Ryan says, "but not for most of the patients we see."
Larson says HRC does attract a "high percentage" of patients in the latter stages of alcoholism who have failed in traditional treatment programs. St. Louis Park family physician Keith Sehnert, who served as HRC's medical director from 1985 to 1991, recalls examining such patients and discovering they had untreated metabolic imbalances .
"I've never met an alcoholic who didn't have hypoglycemia and almost every alcoholic I've met has had food allergies," says Sehnert, who also is a member of the American Society of Addiction Medicine.
"But you go to the higher-ups and it's like talking to the pope about having priests marry," he adds. "It's absolutely against the rules and they don't want to even consider it."
"What Joan Larson is doing is very valid," says Comprehensive Medical Care's Beasley, whose seventh book on alcoholism, Food for Recovery, was published a year ago by Random House/Crown Books. "The medical profession has been asleep at the switch on this. Patients are being damaged by the isolated psychological model of treatment. We need to take a body-mind-spirit approach to this disease. It's the wave of the future."
There are those in traditional talk therapy programs who also endorse HRC's program. Genny Carlin, former director of chemical-dependency services at St. Croix Valley Memorial Hospital in St. Croix Falls, WI., referred to HRC those patients whose histories of relapse may have been triggered by physical problems. "When people have been in treatment three or four times and are struggling, there are missing pieces that need to be addressed." says Carlin, who tried to convey Larson's ideas to physicians at the hospital, with mixed results.
Sehnert says Larson's methods eventually will have great impact on the treatment profession. "Just as Rachel Carson's book Silent Spring changed the way we looked at pesticides 30 years ago, Joan's work will change the way we look at alcoholism," he says. "But it will take 10 years."
Bob Olander, director of Hennepin County's chemical-dependency programs, says change is already happening. The biochemical approach used by HRC has become "much more mainstream," says Olander, who has referred patients to Larson's program. "For years, the field was unwilling to look at physiological issues. But applications of vitamin and acupuncture therapy, and dietary shifts in residential programs, have increased tenfold in the last five years. Joan needs to be given a lot of credit for putting some of these ideas out there years ago."
After decades of research by some of the best minds in medicine and psychology, no one has been able to find a "cure" for alcoholism. And Joan Mathews Larson acknowledges that her program doesn't work for everyone. More research is needed to improve HRC's reported 74-percent recovery rate. But, she says, Health Recovery Center's methods represent the early stages of a remarkable approach to the treatment of this complex disease that further research will refine.
The road has been and continues to be a rocky one for Larson, beginning with the death of her son, but ending, she hopes, with a path toward full recovery for alcoholics for whom the Minnesota model hasn't worked.
"I didn't do this so I could get rich." Larson says. "I found an answer that satisfied me. I knew if we tried this approach it would probably work for many people, and it has. And it belongs to those who need it."
CLEAN AND SOBER: A WRITER'S STORY
by Dan Emerson, associate editor of Minnesota Physician
Bookstore shelves are filled with self-help guides that promise quick fixes for psychological and social maladies- promises that often are nothing more than dust-cover hype. So I was skeptical when I walked into B. Dalton three weeks before Christmas 1992 and spotted Joan Mathews Larson's then-new book, Alcoholism, the Biochemical Connection. But I was also in the throes of the disease, drinking several beers and a bottle of wine each weeknight, more on weekends. Weary of frequent hangovers and constant depression, I wanted more than anything to stop drinking.
I read about Health Recovery Center's seven-week regimen of vitamins, minerals and amino acids. The next weekend I went to a health-food store and bought the necessary dietary supplements. I also bought some beer and wine just in case I needed it to get through the weekend- which I didn't. After more than 12 years of drinking daily, I was able to stop, without physical cravings or discomfort. I began to feel better physically and to feel much better about the future. Since alcoholism is also a psychological addiction, I joined Alcoholics Anonymous and a weekly "growth group" for recovering alcoholics at a Minneapolis hospital.
Alcoholism runs in my family. My parents struggled for years with the disease before achieving sobriety. After two years of my own sobriety, I'm more convinced than ever that treatment can and should address the biochemical aspects of the disease- and that many treatment professionals have much to learn from Larson and her holistic colleagues. -D.E.
Seven Weeks to Sobriety: Testimonials | Joan's story | The Best-Kept Secret | Its Not All In Your Mind | The Difference in Drinkers | Alcoholism's Genetic Link
Replacement Formulas: Aggression, Anger, and Irritability | Anxiety | Fatigue | Insomnia | Memory loss | Pain Control | Stress | Tremors/ Shakiness | Short Attention Span / Poor Concentration | Wernicke-Korsakoff Syndrome
Biochemical Traps That Block Recovery: Test Yourself for Chemical Sensitivities | How to Turn Off Chemical Reactions | Food Allergies | Compulsive Eating Disorders | The Elimination Diet | Breaking Food Allergy /Addiction | Total Load Concept of Stress | Building-Block Theory of Immune System Breakdown from Stress Overload | Candida Albicans | The Nature of the Yeast | Alcoholics and Candida | Treating Candida
Liver Repair, Histamine & Thyroid: | Liver Repair | Thyroid Function | Serum Zinc | Serum Histamine | Paranoia/Low Histamine | High Histamine | Compulsive/Obsessiveness
Biochemical
Depression: |
How
Can You Tell If You Are Depressed | The 7 Kinds of
Alcoholic Depression |
Neurotransmitter
Depletion and Depression | A Word of Caution
About 5-HTP Tryptophan |
St.-John's-Wort
(Hypericum) | Unavailability
of Prostaglandin E, and Depression | Vitamin and Mineral Deficiency and Depression
| Hypothyroidism and Depression | Hypoglycemia and Depression | Food and Chemical Allergies and Depression | Candida-Related Complex and Depression
| Suicide and Depression
Correcting Chemistry: Hypoglycemia and Alcoholism: Glucose Patterns in Health Recovery Center Clients | Hypoglycemic Symptoms | The Hypoglycemic Cycle | The Role of the Adrenals | The Dry-Drunk Syndrome = Masked Hypoglycemia | Controlling Hypoglycemia | The Diet | Key Nutrients That Block Sugar Cravings | Caffeine and Nicotine Have to Go | The HRC Hypoglycemic (Anti-allergy) Diet for Alcoholics | Shopping Tips | Meal Preparation Tips
Planning The Future: Physical Strategies That Heal | Kicking the Cigarette Habit | Your Diet During Recovery | The Rewards of Exercise | Your Maintenance Nutrient Program | Psychological Strategies That Work | Build Yourself a Support System