Feature Issue on Addiction and IDD

Vinland Center employees.

Vinland National Center is a non-profit, substance use disorder (SUD) program focused on treating individuals with mental health issues, intellectual and other disabilities, and traumatic brain injuries. Our approach has proven beneficial for a wide variety of individuals who can benefit from slower-paced treatment plans that use more repetition than traditional treatments. If clients have struggled to keep up with group material or assignments at other treatment programs, this could prove to be a positive change for them.

We offer inpatient services in Loretto, Minnesota, and outpatient services in Minneapolis for SUD and problem gambling, as the latter is a significant issue for some of our clients. We offer the problem gambling service free of charge to Minnesota residents through a grant.

When I started working at Vinland in 2017, clients weren’t getting to us until they had, on average, tried six other treatment episodes. This was mostly due to our population trying to succeed at a conventional SUD program, which didn’t adapt to their individualized learning needs. Many of them have disabilities that aren’t immediately apparent, so if they don’t self-identify, clinicians aren’t aware they are working with someone who might benefit from less of a homework/paperwork driven teaching style, or a more experiential style, until it’s too late.

Therefore, this population tends to invest in ‘passing,’ instead of self-advocating for their needs to be met. Often this results in them being labeled as ‘non-compliant’ for not getting to groups on time or finishing assignments, or simply taking up too much time in groups asking for clarification or repetition. This potentially sets them up to feel like a failure or that the treatment doesn’t work for them. We’ve put a great deal of effort into helping other providers know that we are here, and teaching them how to potentially identify when a client might be struggling with a traumatic brain injury or a cognitive or other disability. The end result is we are now seeing many clients come to Vinland for their first or second treatment episode, instead of their seventh. Of course, this makes it much easier on everyone to be able to establish trust, connection and most importantly, hope.

A Vinland Center clinician leads educational training for outside providers.

Crucially, people with traumatic brain injuries may not realize that many of their newer behaviors, such as dysregulated emotions, dramatically increased impulsivity, and/or short-term memory issues are often related to their injury. If they left an emergency room with no discussion of the brain injury, for example, we can often be met with denial because doctors had not discussed it with them. This once happened with a client of ours, who lay unconscious for eight hours in a ditch after being thrown head-first through a car windshield. He later assumed everything was fine because the surgeon who treated his injuries didn’t inform him of the brain injury or potential after-effects.

A great example of our more experiential/non-traditional approach is that we offer grace for being a few minutes late to group therapy sessions, which is often not the norm in many SUD treatment programs. Our groups might start at 8:00 a.m., but in fact, due to many clients suffering with short-term memory issues, we’ll often page missing folks, and the session actually starts as late as 8:15. At Vinland, that’s no big deal! At many programs, if you’re late to group, that is a mark against you. In addition, the optimum timeframe to successfully focus and concentrate has about a 20-minute limit, particularly with those contending with a cognitive disability or brain injury. We utilize this knowledge by taking a group break for 10 minutes so they can go to the bathroom or maybe grab a smoke. (I was in treatment myself in 1981, and often said, ‘One addiction at a time!’). Then clinicians page everyone to come back for the rest of the hour. It’s amazing the results clients get from this less structured and rigid approach, and how much they appreciate the flexibility. This approach is also more successful with people who have used methamphetamines to self-medicate for attention deficit disorder or attention deficit hyperactivity disorder because of many similar side effects. We also have the freedom here to stop group therapy sessions and use our 179 acres of land to switch into a meditative session. A walk to the lake or fishing off a dock are quite commonly used as part of the recovery process.

Vinland is a fully-accredited substance abuse treatment center licensed by the state of Minnesota, using evidenced-based approaches to addiction treatment. Our staff are highly-trained and licensed professionals, and work in our residential facility in Loretto, Minnesota or our outpatient programs in Minneapolis.

So, what else makes us different?

We are Minnesota’s only treatment center that is designated as disability responsive and one of the only treatment centers in the country that is accredited by the American Society for Addiction Medicine at the 3.3 level. In fact, so few providers met this level of care that ASAM eliminated it in its latest edition of The ASAM Criteria. In fact, in the latest edition, just one chapter is dedicated to working with people with cognitive disabilities, so it is critical for providers to develop these skills.

Traditional treatment programs are often not able to dedicate the time and staff needed to help someone with a brain injury or other disability succeed in an often fast-paced, homework assignment-driven program. We often tell other programs that a client doesn’t necessarily need to attend Vinland just because they have a disability, as any substance use disorder treatment program can do what we do. It’s just a matter of time, willingness and of course, staffing.

Because we are designed to work with those with cognitive disabilities, we know that this skill-set requires a much smaller client-to-staff ratio; approximately eight clients to one clinician. Most residential treatment programs have a ratio of 15 to 30 clients per clinician caseload. Obviously, this doesn’t leave time for much one-on-one interaction, which we have learned is a requirement when working with our population. More time is needed for processing and comprehension, while repetition and reminders are essential. Just the need to slow down communication and be willing to repeat one’s self is where we often lose clinicians in other programs, as they simply do not have the time and/or infrastructure to do so.

Still, Vinland is known for its willingness to give free trainings and presentations to other treatment programs to help educate them on what we do. This has recently become a greater need with the ASAM criteria changes, which assume every residential or inpatient SUD program should be able to successfully provide treatment for those with TBIs and other disabilities. So, we need to get busy training the others!

Tom Beckers, Vinland’s director of residential services, and I are now scheduling several trainings and conference speaking engagements on this topic. Also, Tom recently attended a “train the trainer” program through the Minnesota Association of Resources for Recovery and Chemical Health’s (MARRCH) conference. We hope to impress upon other providers the need for adaptation in programming to adjust to this exceptional need from the community.

I also serve on the Treatment and Veteran Court circuit, providing this training to professional staff within the court and justice-involved arena, and have recently presented our work to groups of substance use disorder and mental health providers in our state. In these trainings we focus on bringing awareness to the prevalence of cognitive disabilities within the SUD and criminal justice populations, then teach signs and symptoms. We cover basic questions they could ask to help determine if someone has a TBI, taken from the Center for Disease Control’s Acute Concussive Evaluation . We then share what we have learned in our years of providing this care, including simple and free approaches they might try to assist the client and help set them up for success. These include reminder calls and sticky notes the day before their court or other appointments. In the future we will also be speaking with police, jail staff and sheriff’s offices in the state, as many justice-involved individuals have cognitive disabilities.

Our goal in this work, and our mission, is to enable individuals with disabilities to live productive and fulfilling lives through a whole-person approach that addresses the mind, body and spirit. As we spread the word about our treatment strategies, we will strive to ensure this mission is not lost.