Part 11 My day at Myllyhoito

The war injury hospital in Kauniainen has new users. It now houses Kalliola Clinic, where I got to familiarize myself with substance abuse rehabilitation for one day. First, I had coffee with the staff, and received a hand-written programme. To start with, I was directed to a lecture on grieving, by family therapist Aino Koskiluoma, and into two group sessions. I also had a discussion with the social worker in charge, Outi Raidén. I felt that the encounter had been very positive, and that they had thoroughly prepared for my visit.

The principles of Myllyhoito

Kalliola Clinic has provided ‘Myllyhoito’ treatment since 1982. Outi Raidén explained that the clinic offers a treatment regime following the Minnesota model. The model originated at the Hazelden Foundation (now Hazelden Betty Ford Foundation) clinic in the United States.

The foundation of the Minnesota model is the Alcoholics Anonymous (AA) 12-step recovery programme. The AA movement is based on peer support and mutual sharing among alcoholics. The AA movement was initiated by Bill Wilson and Robert Smith (”Dr Bob”) in the 1930’s.  They got to know each other and noticed that being peers was helpful for them.  They considered it important that people can be themselves, without masks, and equal to others. For them, being free of substance abuse was based on renewed life values and new content in life. The 12-step programme and later the Minnesota model were both built on consideration for human spirituality. Spirituality means finding a connection with another human being and with oneself.

 Later on, professionals started to utilize peer support based on experiential expertise in psychiatric and substance abuse treatment. In the 1950’, the Hazelden Foundation clinic started applying this model systematically in treating alcoholics.

In Finland, this model is called Myllyhoito, as it was named by Social Counsellor Toivo Pöysä, who was the first to bring the model to Finland. Myllyhoito is professional treatment based on the 12-step programme. In the AA movement, there are no professionals, and the groups are based solely on peer support. In Myllyhoito, the clients process the same 12-step programme with the help of a professional. The intention is to make the person aware of their substance addiction, of how they can recover, and of how to access other necessary help, for example through health care, social work, or working with people close to them.

In Myllyhoito, substance addiction is seen as a disorder, with the possibility of recovery. The treatment is referred to as rehabilitation, and the clients as rehabilitation clients or patients. The purpose of the treatment is to offer a caring human presence and a sense of each person being important. During the treatment, the client starts processing questions regarding why they drink or why they act the way they do.

The 12-step programme

Myllyhoito is closely connected to the peer groups of AA (Alcoholics Anonymous), NA (Narcotics Anonymous), Al-Anon or ACA (Adult Children of Alcoholics), as well as the 12-step programme. According to Raidén, the purpose of the 12-step programme is to bring hope among those who are still suffering from substance abuse. The first step in the programme is handing over one’s own control to a higher power, which each person can construe as they wish. The uniting factor is that the person regrets the things they have done and wants to leave self-centred life behind them. Faith in God is not a prerequisite for recovery. There is, for example, a ‘Twelve steps for atheists’ group.

Each rehabilitation client processes the 12-step programme, which includes in condensed form the principles that lead to a life of sobriety. The steps describe a process where the alcoholic or drug addict finds sobriety, maintains it, and recovers. Part of recovery is that the person honestly admits that they are powerless with regard to alcohol, and that they cannot recover without help from others. The person seeks a new kind of spiritual connection with some power greater than themselves. They make up for the wrongs they have done to others, and tell others about their new way of life.

On evenings and weekends, the aforementioned groups run independently at the Kalliola clinic premises, so the rehabilitation clients can easily get to know them. The rehabilitation clients can also go to groups outside the clinic.

Cross-disciplinary professionalism combined with expertise by experience

A specific strength of Myllyhoito has been multidisciplinary professionalism of the care staff, combined with expertise by experience.

The professionals are trained in the fields of social and health care or pedagogy. Among them are substance abuse therapists, substance abuse counsellors, nurses, an assistant nurse, a family therapist, a social worker and a doctor.

The workers’ task is to act according to social and health care legislation and to monitor the carrying out of practices according to ethical guidelines, as well as to ensure that the client’s legal rights are protected.

Understanding substance addiction

In Myllyhoito, people refer to treating an illness, but Raidén himself prefers to talk about a ”state resembling an illness”.  Sooner or later, substance addiction leads to the development of physical ailments.

Raidén emphasized that different countries have different drinking habits, and that drunkenness is tolerated in various ways. In any case, alcoholic-type drinking causes problems to the individual and their close environment.

In Myllyhoito, substance addiction is also seen as a community problem which concerns the people closest to the rehabilitation client.

Because of this, it is considered important that the rehabilitation client’s network becomes involved as part of the rehabilitation process. The client’s most essential service network, and possibly their employer, in cases where the person has been directed to treatment, are invited to network meetings where the participants discuss the progress of the rehabilitation and agree on future treatment.

The people closest to the rehabilitation client are asked to send a letter to the clinic. It is read out loud to the client, which evokes emotions. In addition, meetings can be arranged with a family therapist and the people close to the client. Family members can also be directed to Al-Anon groups to find treatment for themselves. Lectures for people with an alcoholic in their lives can also be arranged.

After the rehabilitation period, some of the clients continue in open care, for example at the A-clinic. A network meeting is arranged with the provider of further care. The recommendation is that all should continue their treatment in AA / NA groups.

The rehabilitation period

 The treatment is based on a rehabilitation plans made by a referring party or by a multidisciplinary team in cooperation with the client. The plan includes, as required, individual, pair or family meetings during the rehabilitation period or after it. The basic period of rehabilitation lasts 28 days, which can be extended, if necessary. For the duration of this period, the clients reside at the clinic.

After the basic period, short periods at the clinic are recommended, for example at 3, 6 or 12 -month intervals. After a possible relapse, the rehabilitation client can come back for an intervention period or for a short, one-week crisis treatment.

The treatment model is not suitable for people who are, for example, in maintenance treatment. On the other hand, clients directed to treatment from their workplace or through child welfare are always welcomed. The clients who have been directed are not all immediately motivated to engage in rehabilitation, but during the period their thinking may change.

Day groups

For rehabilitation clients, two group meetings with their peers in the clinic are included in their individualised day programme. One of the groups is run by a substance abuse therapist, and the other is a peer group. The guided group proceeds according to a pre-set plan, and each rehabilitation client e.g. introduces their history of substance abuse to the others, as well as recounting their progress in recovery. The peer group is run by the person who has stayed longest in the group. The rehabilitation clients can also meet the workers individually.

As I participated in the day’s groups, I noticed how the clients are encouraged to ask each other for help. This supports the idea that no one needs to manage on their own. Every person in the group can mirror their own experiences and feelings to those of their peers. The people share their experiences with great courage, and they appear to develop a good connection with each other.

A touching part was the serenity prayer, which the group wanted to pray for me, because I was with them only for the one day. I was moved by the attention shown to me, and by their well-wishings.

Literature sources:

Fourth Step Inventory. Introduction to the 4^th Step Inventory Workshop (2007) In Big Book Alcoholics Anonymous, Dallas B. (479), 522–4391.

12 – Tervetuloa! Opas AA:han (2014) AA:ssa ohjelman avulla raittiina. [12 – Welcome! A guide to AA (2014) Sober in the AA with the help of the programme ]Vaasa: Suomen AA-Kustannus ry.

Kaksitoista askelta ateisteille (Moniste, 1 sivu). [Twelve steps for atheists. Print-out, 1 page.]

Kalliolan klinikka. Moniammatillista Minnesota-mallista hoitoa päihderiippuvuuteen. Helsinki: Kalliolan setlementti (ei painovuotta). [The Kalliola clinic. Multi-disciplinary treatment for substance addiction. (Not dated).]

Kuvaus Myllyhoito-mallista. Kalliolan setlementti. (Moniste, luonnos, 12 sivua) [A descrpition of the Myllyhoito model. Kalliola Settlement. (Print-out, draft, 12 pages)]

White, William L. & Miller, William R. (2007) The Use of Confrontation in Addiction Treatment – History, Science, and Time for Change. Counselor, 8(4), 12–30.