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Alltyr’s 'practical' approach to addiction treatment looks beyond the 12 steps

It usually takes more than one attempt for a person fighting alcohol or drug addiction to get sober. For some people, it’s a lifelong battle, with multiple stays in treatment facilities, followed by years of sobriety, then a shocking relapse and an arduous climb back out.

Others are successful at beating their addiction and stay sober for a lifetime, often thanks to Alcoholics Anonymous and community and family support. But those who aren’t able to beat addiction often wish that there were another way to get their impulses under control.

Mark Willenbring, M.D., founder of Alltyr Clinic, a St. Paul-based alcohol-and-drug-dependence treatment program, believes that he has found an option for people who cannot stay sober on traditional 12-step-based treatment programs. At Willenbring’s clinic, in operation for just three years, patients are treated for addiction with what he calls a “scientific approach,” employing a range of pharmacological remedies to help keep their addictive impulses under control, including — but not limited to — antidepressants, ADHD medications, opioid antagonists and sleep aids.

Willenbring, who worked at the University of Minnesota and the Minneapolis VA before moving to the National Institutes of Health to lead a program responsible for funding research grants on alcohol addiction treatment, says that his approach works for patients who have “failed” traditional treatment programs because he looks at the deeper causes of their addiction and treats them with a scientific approach. The most widely used addiction-treatment approaches, based on the Minnesota Model of 12-step recovery, rely on hope, rather than on science, Willenbring said. That is why they so often fail.

“The problem is that the people who work in these programs don’t believe in science,” Willenbring said. “Their treatments are not scientifically based. They treat the Big Book like the Bible. It hasn’t changed since the beginning. In contrast to that ideological approach, our approach is a practical one. People pick and choose how they are going to fight their addiction. We change the treatment when it isn’t working. There’s no set program.”

Willenbring, a Minnesota native, has chosen to take on some pretty big rivals. Alltyr has seen its fair share of national publicity of late, with lengthy articles in the Atlantic Monthly and the New York Times, but it has treated, by Willenbring’s own estimation, “between 300 and 400 patients so far.” By contrast, countless numbers of addicts and alcoholics have sought treatment through AA since it was founded in 1935.

Willenbring is evangelistic about his program, and he may well have good reason. Patients who’ve been interviewed about their experiences seeking treatment have been overwhelmingly positive about their experiences treating their addiction using his program’s pragmatic approach. And Alltyr’s practical approach also extends to its cost — usually between $3,000-$2,500 for a year of treatment — just a fraction of the cost of a month of residential treatment at a facility like Hazelden, which can run up to $26,000 without insurance coverage.

Dr. Mark Willenbring
Alltyr Clinic
Dr. Mark Willenbring

Earlier this year, I visited Alltyr Clinic, a busy, modest, medium-sized office space in downtown St. Paul. Willenbring, an enthusiastic, knowledgeable man, spent time explaining his unique approach to addiction treatment and therapy. 

“When I decided to leave NIH and came back to Minnesota, I don’t know where I should go,” Willenbring told me. “I wondered if I should get a job or do research or try to change the system so that it’s one that’s based on science, one that’s modern and professional rather than antiquated.” After spending some time debating his options, Willenbring opted to set out to change the system. That’s where Alltyr was born.

“For the most part, people are very excited to have an alternative to treatment,” Willenbring said. “Rehab programs have coerced the public to believe that the 12-step system is 100 percent effective if you do what you’re told. They have been unbelievably effective at blaming their customers when the product fails. We see a better way to help our patients.”

To give me a better sense of how his program works, Willenbring offered to introduce me to a patient who could tell me more about personal experiences with Alltyr.

Last month, on a chilly spring day, I met with Teresa Conlan, a forthcoming, bright-eyed 54-year-old who has spent her entire adult life struggling with alcohol addiction and mental health concerns. Conlan, a graduate of several traditional residential rehab programs, was one of Alltyr’s earlier clients. She told me that she’s been sober since she began seeing Willenbring more than two years ago.

MinnPost: What brought you to Alltyr Clinic?

Teresa Conlan: I have been through treatment several times. This last time that I was hospitalized because things had got very bad. I have depression. I’d started drinking again. It wasn’t intentional but I got drunk and I ended up taking pills. I was not thinking straight. I ended up in the hospital and in intensive care for many, many days. I was in a bad place. So I felt like I’d run out of options.

MP: You’d tried several different addiction-treatment programs. What made you think things would be different with this approach?

TC: I didn’t know if it would be different, but I didn’t know what else to do. My stepdaughter told me about Dr. Willenbring and I just thought, “Oh, another psychiatrist. Seen ‘em all.” Then I went through a very, very bad bout of depression. It was horrible. Terrible. I was never so depressed in my life.

I’m usually very supportive of AA, but at that time I thought, “If I have go into another AA meeting, I just won’t handle it.” I know it’s good for a lot of people, but I was burnt out. I went to meetings for many, many, many years. I knew a meeting wouldn’t work for me this time. And this felt like the opposite of AA. 

MP: It sounds like this felt like a last-ditch effort.

TC: I just didn’t care. I thought, “I’ll just do what I need to get out of there.”

MP: When Dr. Willenbring explained the Alltyr approach to addiction treatment, what did you think?

TC: It sounded bizarre. But I thought, “Go ahead. Put me on whatever you want.” I was in that frame of mind. I didn’t believe any of what he was telling me. I just went thorough the motions.

But somehow Dr. Willenbring got me on the right mix of antidepressants. It took a while, but I finally ended up on Eflexor. He also put me on Naltrexone. It worked. That was two years ago, and still, to this day I have no desire for alcohol. It’s like when I started taking Naltrexone, a little switch went off in my brain. There have been times — I still get a little up and down — and I’ll think, “I should just have a drink,” but the thought doesn’t actually trigger a craving. I know it sounds crazy to tell people that, but it just works for me.

MP: It sounds like you almost can’t believe that this therapy is actually working for you.

TC: I’m such a different person. It’s almost like I can’t believe it. It actually feels funny to tell somebody about what’s going on right now, because it sounds like, after all these years of fighting my addiction, I’m saying,  “Just take these pills and everything will be fine.” And that sounds unbelievable — at least to me. Before, if somebody would’ve told me that this was an effective way to fight addiction, I would’ve been like, “Oh, yeah: Right. That is just crazy.” The whole thing sounded bizarre to me, but I was in such a bad place I was willing to try anything.

MP: Can you explain what it feels like to lose your desire for alcohol? 

TC: I started drinking when I was 15. So that desire has just been part of me for so long. When I started out with Dr. Willenbring, I thought, “I’m going to go see him for now, but I’ll start drinking again soon enough. I just have to shake the cobwebs out of my head first.” But once I started on these medications it was almost maddening. Drinking just doesn’t appeal to me anymore.

Teresa Conlan
Courtesy of Teresa Conlan
Teresa Conlan

I don’t know what it is. I just don’t have the craving for alcohol that I used to have. There are times when I say to myself, “I just really would like to have a drink.” But actually drinking just doesn’t sound good to me. I don’t get that euphoric high I used to get when I think about drinking or getting drunk.

When Dr. Willenbring put me on the Naltrexone, I asked, “What’s that for?” and he just said, “This is for cravings.”  I was like, “Yeah. Right. Like that’s gonna work.” I don’t know exactly when it took effect, but it did. I would think of drinking and then I’d just think of something else. My craving for alcohol never kicks in. When I watch my boyfriend have a glass of wine, before I would think, “You know what? That really looks good to me. I really could use some of that.”  But it just doesn’t sound good to me anymore.

MP: You’ve been going to Alltyr for over two years now and you’ve been sober for most of that time. You’ve had other long periods of sobriety followed by relapse. Do you worry that you won’t be able to maintain your sobriety with this method of treatment?

TC: I’m waiting for the other shoe to drop. I wonder if the drugs will wear off some day, but so far I feel really good. The last few times I saw Dr., Willenbring, I said. “I’m waiting to see what’s going to happen here.” He said, “Well, it’s working.”

Right now I feel good. I ask myself, “What am I going to do if I get depressed again? Will that trigger my drinking?” But I don’t know about that. I’ve been out of the depression state for some time now. The only thing I can say is that right now I just don’t have the craving to drink. I also don’t have the need to get out of my head as much as I used to, to just veg out, to get numb. Before, if I was faced with something exhausting, I’d just want to numb out or zone out. Drinking would help me do that. Now, when I want to get away, I eat a lot of chocolate and watch TV.

MP: Do you have a plan of action if you start to crave alcohol again? Or feel depressed?

TC: I’ve thought about that. I’d call Dr. Willenbring immediately. These days, I see him every five months. When I was first seeing him, we met every week. If the cravings came back, I would call him and I would say, “I need to see you.” I would hope that he would adjust my medication. This is the first time that I feel real hope for myself and for my future.

MP: During your long periods of sobriety in the past, did you feel cravings for alcohol all the time? What did you do then?

TC: I was in AA then, so I went to meetings every day. I respect AA, but it is a different world. It worked for me for a while. It did. It really did. I hate to say, “Just take a pill and everything will be better.” I don’t know if it will work for everybody. All I can say is this works for me right now. And I wish that more people knew about this kind of treatment. I know people who, like me, have been in treatment so many times. Maybe this could work for them.

MP: You spent a lot of time in AA. Do you still have a connection there?

TC: Every month I see my old sponsor. I have lunch with her and we talk. That’s about the only communication I have with AA right now.

MP: What does your sponsor think about this approach?

TC: She thinks it’s very controversial. She said, “Well, if you feel the urge to drink, you have to call me. If you want to go to meeting, I’m there.” She’s been sober for 30 years. She still goes to meetings twice a week. I don’t know why it’s just not for me right now.

MP: Do you have a family history of addiction and mental illness?

TC: My mother was an alcoholic. She died of suicide when I was around 30 years old. She and my father were Holocaust survivors. She had a really, really hard life. 

MP: Do you think kind of this treatment could’ve helped your mother?

TC: I really wonder about that.  Back then, they didn’t know how to deal with women alcoholics. My mother was at Hastings Mental Hospital. She had shock treatment. She was one of the first women at Hazelden. They just didn’t have addiction treatment programs for women like her. So she was out of luck.

MP: Would you recommend this approach to addiction treatment to others?

TC: Yes. Especially if they keep relapsing. All the talking in the world is not going to make some people not have cravings and go back out there. I just wish more people would try this. I explain it to myself like this: I have a chemical imbalance in my brain. In order to get in synch I need to take medication that balances me out. It makes sense to me. And for the past two years it’s working. Keep your fingers crossed: Maybe we can follow up in a few years and can see if it is still working. 

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Comments (4)

About time!

I am happy to see that someone is using science. We've come a long ways from the days when AA was developed in the '30s. The religiosity of AA and the blaming the addict when they relapse (didn't work the program hard enough) have always bothered me. This is a brain chemistry disease. Treat it like one. That being said, there are wonderful benefits to the supportive aspects of AA and some of the lofty goals in their life philosophy. No reason not to "take what you like and leave the rest' in addition to other treatment strategies.

Outcomes data

There are a couple ways to evaluate different approaches. One is the goal of total sobriety - the cure. That is the best outcome, but not the only desirable one. The other is risk reduction - how much time over a time period (a month, a year or longer) the person isn't using. A combination of these two measures is the best way to evaluate the program, with one proviso. Patient acuity is also a factor. If a person has other medical or psychiatric issues, treatment is more difficult and tends to have lower success rates.

Fact is that a very high percentage of those with addictions are highly resistant to seeking treatment of any kind, and they are able to come up many reasons for not to do so. That confronts a problem with the industry. Programs tend to focus on how other programs don't work very well, but their program is the best solution. This in fact provides an additional excuse for not seeking treatment. Everyone can trot out their success stories, if the person who has gone through treatment is comfortable with sharing their success, but mostly what we see are people who are struggling with relapse. And this story had no outcomes data.

A person with a broken leg tends to get prompt treatment. Our society doesn't have the same attitude toward addiction, with delayed treatment sometimes having terrible consequences (I'm sure you can come up with an example of this). Getting treatment should become more like calling 9-11 for a medical emergency and debating which program is best when no program is certain to work is just one factors that magnifies our national addiction problems.

A New Way!

I'm so glad that there is a non-AA protocol for sobriety. I went to AA for years but finally could not take the almost cult-like attitude that was dictated if one wanted to stay sober. While it may work for some who can turn their lives, their wills, and their spiritual character over to a group philosophy, it totally lacks any physical aids other than the philosophy of "don't take a drink". I'm grateful that Dr. Willenbring is bringing a scientific bent to recovery. Many lives can be saved if addiction can be fully accepted and ensconced in the scientific and medical fields. Good going, Mark!

Great success story!

Thoughts:

There are a zillion different ways to deal with dependence and none are perfect.

Makes me wonder why the author decided to turn a great story of recovery into an anti-AA story. I hope the owner of the clinic presents his business to the public in a more favorable light, for addicts need a positive picture rather than a negative one.

Teresa has put in a lot of work on her recovery and should be congratulated on her successes.