Besides its beauty, what made Hazelden stand out was a highly developed program that met the needs of alcoholics with a wide range of problems. In the mid-1950s, Hazelden began treating alcoholic women and the members of families affected by alcoholism. It developed a program to help the large number of alcoholics who relapsed after treatment, founded a halfway house in St. Paul, and provided extended rehabilitation for those who needed more time than the standard twenty-eight-day treatment. It created programs to train recovering alcoholics and clergy as alcoholism counselors. Its leaders lectured widely on rehabilitation and were key members of the faculty of the Yale Summer School of Alcohol Studies. Visitors came from around the United States and around the world to see it.
The core of Hazelden’s program was AA’s twelve steps. This is not surprising since most of the founders were alcoholics who had gotten sober in AA. Minnesota was fertile soil for such experiments. The first man to get sober there was a dynamo named Pat Cronin, who had written to AA in 1940, after reading a review of the Big Book, to see if there was a group in Minneapolis. There wasn’t, but two AA members from Chicago showed up on his doorstep just as a historic snowstorm was hitting the city. The three men were snowed in for four days, and when they finally emerged, Cronin was ready to join. He founded the first Minneapolis group, which served as a hub for 450 groups in the upper Midwest. One of the most active members of the group was a fifty-year-old lawyer named Lynn Carroll, who led the effort to create a refuge where alcoholic men could stay for a few weeks after they quit drinking.
A few months after Hazelden opened in 1949, Carroll, who had just been hired as director, explained its purpose to a newspaper reporter:
This is not a hospital but a home. . . . We have no medical staff. . . . We have no attendants keeping tabs on the men here, because we feel that they are entitled to personal privacy. . . . In the life at Hazelden, there is only one restriction—no alcohol—and it is heartening to see the way in which the men live up to it.
As Hazelden developed, a few more rules were added: practice responsible behavior, attend lectures, talk to other patients, and make your bed. AA groups from Minneapolis and St. Paul sent speakers to lead discussions. The residents spent most of the day in informal conversations with each other and in group discussions that sometimes extended deep into the night. For men who might go into convulsions as they withdrew from alcohol, there was a supply of tongue depressors to keep them from choking. Carroll was always available to talk to patients privately, but he eschewed the trappings of a therapist. When a new man arrived and was well enough to talk, Carroll interviewed him, writing a few facts on a note card.8
Carroll had some doubts about his ability to lead a treatment program. He had taught some classes at the AA headquarters in Minneapolis, but he was a lawyer, not a doctor. “There were a lot of problems I hadn’t learned to work out quite right,” he said. But “I got to thinking—what the dickens! I had had psychiatrists and psychologists and they didn’t do me any good and I didn’t know any other alcoholic that they ever did anything for.” The one thing he was sure of was that AA had worked for him, so he began to lecture on the twelve steps. For the first three years of Hazelden’s existence, Carroll was the only counselor and lectured almost every day. He took three weeks to complete a lecture cycle, which became a standard for measuring the treatment period. It wasn’t enough for the newly sober alcoholic to listen. Carroll emphasized the importance of completing the fourth and fifth steps, which would require the alcoholic to write an inventory of his character defects and the people he had hurt and then read it to another person. Since people were free to leave Hazelden at any time, not everyone achieved this, but many did.9
The early results were highly encouraging. Although at the beginning, there were only four or five men in residence at any one time, Hazelden was home to 156 men during its first eighteen months. At the end of that period, 78 percent were still sober or had stopped drinking again after a relapse. Carroll felt confidence in this number because he had followed their progress through contacts with the AA groups that almost all the men had joined after leaving Hazelden. Hazelden still faced many challenges. One of the biggest was persuading residents to stay long enough to absorb the AA program. Most left after three weeks, partly because of the cost. Residents paid a hundred dollars for the first week and eighty-five dollars for subsequent weeks. The board recognized the problem by establishing a scholarship program that paid the expenses for twelve men. They were able to stay for a month, and the extra time made a difference. Carroll reported that only one was still drinking after eighteen months.
As Hazelden was getting started under private auspices, there were exciting developments at a publicly funded institution located 140 miles west of Center City. In 1950, Dr. Nelson Bradley, a young Canadian doctor, was appointed the new superintendent of the state mental hospital in Willmar. It was a daunting assignment. “It’s a 1,600 bed hospital, still a snake pit,” he wrote to Daniel J. Anderson, a psychologist he had worked with at another mental hospital. Bradley was trying to recruit Anderson. “I think we can fix it up,” he said. One of the first items on his agenda was to do something for the hospital’s thirty to forty “inebs”—inebriates. The alcoholic patients were miserable. They were locked in wards with the other mental patients, and they responded by escaping whenever they could. Bradley’s first step was to move the drunks to unlocked wards. Longtime members of the hospital staff predicted disaster, but the number of escapes plunged.10
When Bradley approached Anderson about working at Willmar, he asked him if he knew anything about alcoholics. Anderson admitted that he didn’t, but he promised to investigate. It didn’t take them long to discover the very active AA group in Minneapolis, and the two men began attending meetings. Anderson was skeptical at first. AA members appeared highly motivated about staying sober, but many of his patients didn’t want to quit. He also thought AA might be too religious for some and too rigid for others. But there was no denying that the AA program was working for some people.
When Bradley issued a Handbook on the Treatment of Alcoholism, it cited two principles—“provision of as much psychiatric training as possible” and “presentation of the A.A. program.” Bradley and Anderson were particularly impressed by the importance of using sober drunks to counsel alcoholics. There was no civil service classification for such a job, so Bradley hired his first alcoholic counselor surreptitiously. Later, he succeeded in persuading the state civil service commission to create the position of counselor on alcoholism and quickly hired two more.
Adding sober alcoholics to the staff was the beginning of a revolution in clinical practice. The hierarchy at Willmar was dominated by doctors who had undergone years of training in their fields of specialization. They were used to running the show. But Bradley and Anderson embraced AA’s characterization of alcoholism as a complex disease that affected sufferers on several levels—physical, mental, and spiritual. To address all of these problems, they believed it was necessary to create a multidisciplinary team consisting of doctors, psychologists, psychiatrists, sober alcoholics, and ministers.
At first, the doctors resented working with nonprofessionals. Even Anderson was reluctant to believe that the counselors might know more than he did. He described how he used to argue about patients with one of them, Fred Eiden. Anderson would say, “Fred, this one’s a sick one.”
Eiden would say something stupid like: “I don’t know, Dan, he seems to be getting the program.” That initially did not mean a thing to me because when one is that crazy—what did it mean “to get the program”? . . . And then on another occasion I would see a guy who was well. I tested him and said to Fred: “Fred, he’s in good shape—not crazy.” . . . And Fred would say: “He doesn’t have the program, though, Dan.”
Anderson slowly developed confidence in Eiden’s judgment. He learned that it wasn’t enough to address psychological problems. “After shrinking their heads, I watched them get well right in fr
ont of me. They would thank me. Shake my hand, and say that they were going home—only to wind up back at Willmar,” he said. He also listened to the lesson drawn by many of the relapsed men. “This time I think I’d better see what is going on in the A.A. program,” they said.11
Once the professionals recognized the important role played by the counselors, the staff began to work together to help their patients. The Reverend John Keller, a Lutheran minister who had been sent to Willmar for training, witnessed the change. “I’d sit in a staff meeting at Willmar and see a recovering alcoholic disagree with a physician, but then they’d walk out and still be friends,” he said. “People were here to be together and bring their individual and collective knowledge and experience to provide the care the patients needed.”12
The patients were also impressed. The counselors were living proof that recovery was possible. They dressed and acted like professionals, and they did not hide the fact that at times they disagreed with the physicians. “The frankness of staff promoted a high degree of trust,” a former patient said. Disagreements were inevitable in a program that was pioneering an approach to alcoholism treatment. What Bradley recalled was not the arguments, but the excitement of starting something new. “The enthusiasm we had at Willmar was really something—besides the energy—everyone was caught up in this—we ate and slept it. We talked about it in the coffee shop—we never let go of it,” he said.13
The program that they created by trial and error would combine the best tools of medical science with the insights derived from the experience of AA members. New patients took a standardized test to identify their psychological problems, which became the basis for an individual treatment plan. The plan involved both individual and group counseling, as well as daily lectures on the nature of alcoholism. A patient’s progress was closely charted and discussed during staff meetings to determine if any changes were needed.
Yet Bradley and Anderson never lost sight of the important role that the alcoholic plays in his own recovery. AA meetings were held frequently to give patients the opportunity to hear and speak to sober alcoholics. They were also encouraged to hold group meetings of their own, where they talked without a staff member present. Anderson later described the spirit of camaraderie that filled the alcoholic ward:
Everybody called everybody else, patients and staff alike, by their first names; drinking experiences and alcoholic histories were dramatically revealed at the slightest provocation; advice was freely given based on one’s own experiential background of alcoholism and recovery; hope and enthusiasm were openly expressed about the good prospects for recovery; and coffee was consumed extensively throughout the day and night.
Willmar was not the first institution to treat alcoholics humanely. Unlike the Washingtonian Homes and Massachusetts Hospital for Dipsomaniacs and Inebriates, however, its program would be widely imitated.14
One of those watching Willmar closely was Patrick Butler, whose family had purchased Hazelden in 1951. The Butlers were Irish Americans who made their fortune in construction and mining. They were also a family with a drinking problem: the patriarch, Emmett, had quit drinking in 1945; his son, Lawrence, had been Hazelden’s first patient; Patrick, his brother, followed in 1949 and finally got sober in 1950. Patrick took charge of Hazelden following the sale and was soon traveling from Minneapolis to Willmar to study the progress of its alcoholism program.
Butler was deeply impressed by the success of the multidisciplinary approach and by Dan Anderson, who began lecturing at Hazelden in 1957. He would have gone further in implementing the Willmar program at Hazelden, but he knew that Lynn Carroll, the director, was fiercely opposed to any changes that might dilute its emphasis on the twelve steps. Carroll also didn’t believe that psychologists and other experts had anything useful to offer. He refused to let his assistant attend the Yale Summer School of Alcohol Studies. “What the hell do you want to go there for? You know more than all those Easterners,” he said. He reacted coolly to Butler’s decision to hire Anderson as Hazelden’s chief executive officer in 1961. Anderson was given an office in Minneapolis, allowing Carroll to continue to run his program in Center City.15
But change was coming. In 1956, Hazelden had purchased a three-hundred-acre estate in a Minneapolis suburb for alcoholic women. (Carroll thought housing men and women at Hazelden would be disruptive. “They did not make bear traps big enough to keep them apart,” he reportedly said.) Called Dia Linn, at first the facility followed the same program as Hazelden. Soon after Anderson was hired, he began to implement the Willmar program there. Several years later, following an expansion of Hazelden to accommodate a steadily growing patient population, Anderson finally moved his office to Center City and Carroll left.
Although Anderson proceeded to institute the multidisciplinary model at the main campus, he made a significant change from the staffing at Dia Linn by appointing a sober alcoholic as the head counselor. In doing so, he underlined Hazelden’s commitment to the principles that Carroll had pioneered. As Hazelden grew into the largest private rehabilitation center in the country, it inspired the rapid proliferation of new facilities in Minnesota. By 1977, there were more treatment centers there than in any other state. The “Minnesota model” was dominant just as the growth of alcoholism treatment was increasing around the nation.16
Once the importance of alcoholism treatment was generally accepted, there remained the problem of getting the drunk to recognize that he needed to stop drinking. In the early years of AA, it was believed that only a man who had lost everything and hit bottom could begin rebuilding his life. Things had changed by 1953. In Twelve Steps and Twelve Traditions, Bill Wilson wrote:
Alcoholics who still had their health, their families, their jobs, and even two cars in the garage, began to recognize their alcoholism. As this trend grew, they were joined by young people who were scarcely more than potential alcoholics. They were spared that last 10 or 15 years of literal hell the rest of us had gone through.
It was still necessary for alcoholics to confront the painful truth that they were powerless over alcohol, but AA had discovered that it was possible to “raise the bottom.”
By going back in our own drinking histories, we could show that years before we realized it we were out of control, that our drinking even then was no mere habit, that it was indeed the beginning of a fatal progression.
When the newcomer recognized himself in the story, it became easier to accept his problem. It didn’t work for everyone. Some continued to drink, but the next time they got in trouble, many remembered what they had heard. “It was then discovered that when one alcoholic had planted in the mind of another the true nature of his malady, that person could never be the same again,” Wilson said.17
The staff at Willmar also faced the problem of convincing patients that they were alcoholics. Although many had been committed by the courts, they continued to insist that drinking wasn’t the problem. Their success in getting sober was not high—27 to 34 percent. What was a surprise was that patients who had entered the hospital voluntarily were not any more successful. “The conclusion we had to draw was simply that almost all alcoholics are probably locked in resistance and that few initially are able to admit and accept their alcoholism,” Anderson said. This resistance manifested itself in many types of conscious and unconscious behavior that alcoholics use to preserve their self-esteem. Unable to face the fact that their drinking is causing behavior that violates their deepest moral values, drunks blind themselves to the brutal truth. As alcoholism worsens, their denial of the facts grows, becoming “massive and extremely difficult to penetrate,” Anderson said. “The terminal stage alcoholic, for example, may be dying from cirrhosis of the liver yet denying any history of uncontrolled or excessive drinking.”18
There was good news in the fact that voluntary and involuntary patients at Willmar had the same rate of recovery. If fewer voluntary patients got sober than expected, many of those who initially resisted treatment had changed their minds
. Anderson attributed this to Willmar’s success in breaching their defense mechanisms and getting them to recognize their problem with alcohol. The first priority was to convince patients that concern for their welfare was the sole motivation. Their greatest fear was being condemned, so it was essential to convince them that they were in a place where their problem was understood and help was available.
Once this was achieved, it was possible to begin educating them about alcoholism. This was addressed on multiple levels. Anderson had a PhD in psychology, and in his lectures to patients, he explained what science had revealed about alcoholism. In a photo that shows him speaking to patients, he is standing beside a blackboard on which he has written “ambivalence,” “ambiguity (conceptual, normative),” “wet vs. dry conflict,” “utilitarian stress-relief,” and “high risk culture.”19
It wasn’t enough to talk in generalities. It was also necessary to gather the facts of the patient’s life history in order to show him that alcoholism was at the root of his self-defeating behavior and then to persuade him to do something about the problem. Staff members could play a key role in this process, but others might contribute. “Even other alcoholic patients who have only partially shed their own denial systems are in a good position to help with this, due to the seeming fact of human nature that we can always see another’s problems more clearly than our own,” Anderson said.20
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