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Family Intervention

[Taken from Addiction Intervention by Robert K. White and Deborah George Wright, pp. 10-14 (See References for more info.)]

In a family intervention, the family and friends of the addicted person are gathered together, educated, and trained by a counselor. This takes place in two or three sessions prior to the actual intervention session. The addicted individual may or may not be aware that the family is attending these sessions.

Once the family is prepared and the appropriate treatment plan is determined, the actual intervention is scheduled. Many times the addicted individual is not told the exact nature of the meeting. It is usually necessary to use some deception in order to ensure that the addicted person will attend. However in some cases, the addicted person is made aware that they are attending a counseling session.

The intervention session itself is very structured, and the family knows ahead of time exactly what they will say and when they will say it. The process is designed to convey the love and concern that the family has for the addicted person and to prevent any display of anger or resentment. Each family member takes a turn to briefly state his or her concern, several incidents that have caused that concern and his or her desire for the individual to seek treatment immediately. Typically, the treatment center has already been advised of the intervention and the initial admission information has been provided. In most cases the initial treatment setting is a residential program, which may be followed by outpatient group therapy. The hope is that the person will be admitted to treatment that day.

Consequences

The impact of an intervention is its ability to create and present the "crisis" in the addicted person's life to a point where the person chooses treatment. If the person chooses not to go to treatment, then there are usually some significant consequences that go into effect. The spouse may be ready to file for divorce. The adult children may refuse to invite the person to family functions. The job may be terminated. In general, the family and friends withdraw their support (financial, emotional, and otherwise) until the person seeks help. It is important to note that these consequences are not done to punish the individual. They are usually designed to help the family member take some action that will protect themselves from the person's abusive behavior.

Part of the process of intervention is helping the family to determine what is within their power to do and not do. The family cannot control the addict's drinking or drug use. However, they can control their own response to that use. The spouse need not remain in an abusive relationship. The boss need not employ a person who fails to show up for work. The adult children need not protect and rescue an alcoholic parent who refuses to accept help when it is offered.

These kinds of "tough love" consequences are not always a part of intervention; however, they are typically recommended. Many interventions have been done without consequences for the person not going to treatment. It is generally recognized that the chances for success (i.e., the person goes to treatment) are better if there are some consequences included.

Goals

The primary goal of any intervention is to motivate the person to seek treatment immediately. There may even be a sense of urgency involved because of serious medical complications. Many times the family has initiated the intervention because of a current crisis that could be life threatening. Motivating the person to seek appropriate treatment therefore becomes the highest priority for any intervention.

There are, however, numerous reasons to do an intervention, even if there is little hope that the person will go into treatment immediately. Listed below are some of the secondary goals that can be accomplished, even if the person does not seek treatment immediately.

  1. The enabling system is destroyed. This will make it more likely that the person will seek treatment at some time in the future. It becomes difficult for many addicts to continue their addiction without the support of their chief enablers.
  2. Family and friends receive basic alcohol and drug education. When the people that are closest to the addicted person understand the disease, they are better able to deal with it.
  3. Participants are exposed to the local treatment resources. The family becomes aware of and may even visit the local treatment centers. When the addicted person reaches out for help in the future, he or she will be able to act quickly.
  4. The conspiracy of silence is broken. Just the fact that the family is able to sit together and speak openly about the problems that have occurred over the years is very important. Often there have been incidents that were kept secret.
  5. The family is exposed to Alcoholics Anonymous and Al Anon meetings. (Narcotics Anonymous and Nar Anon for drug addiction). These are the twelve-step groups that are free and widely available that act as support for the recovering person and his or her family.
  6. A contingency plan may be used. If the intervention takes place and the addicted person refuses to go to treatment immediately, the family may suggest a contingency plan. This plan allows the person to "try it their way first." They may be refusing to go into inpatient treatment, but are willing to go into outpatient treatment. The family agrees to hold off consequences as long as the person follows through and does not relapse. If the person does relapse, he or she agrees to go into inpatient treatment immediately.

Limitations

The process of intervention designed by Dr. Vernon Johnson is a very effective means to motivate the addicted person to seek treatment; however, there are significant limitations that need to be understood in order to intervene successfully. Family intervention is not possible in all or even most cases. In order to conduct a family intervention, there are several essential ingredients needed. A group of concerned and caring people must agree that the addicted person has a serious problem with alcohol or other drugs, and that the person needs intensive treatment immediately. The caring individuals must be able to convey their message in a non-judgmental, non-punitive manner. This turns out to be a rather tall order for most families with a chemically dependent member. Since chemical dependency is a family disease that usually takes years to progress, the family may be angry, apathetic, or in denial. The following list includes many of the problems encountered.

  1. The family no longer cares what happens to the person.
  2. They are too angry and punitive.
  3. They fear the anger of the addict.
  4. They are in denial that a problem exists.
  5. Some of the other family members are also chemically dependent.
  6. The family is geographically dispersed.
  7. The family is too fearful of the risk in changing the family system.
Some of these problems can be dealt with in the preparation sessions or in specific counseling sessions, but often they cannot. It is a mistake to think that family intervention can be used in every case. There are clear indications for its use and clear requirements that must be met.

Fortunately, there are many applications of the intervention process that are possible. The model of intervention developed by Johnson contains fundamental principles that can be applied to many settings.

Intervention Principles

  1. The person has a disease that is causing significant damage in his or her life.
  2. Denial is part of the disease process that prevents the person from fully appreciating the damage.
  3. The person is unlikely to seek help on his or her own.
  4. The people that surround the person can change the environment by destroying the enabling system and making it more likely that the person will seek help.
  5. One of the most important factors in influencing the person to seek help is the sense of love and genuine concern conveyed by the interventionists.
  6. Anger and punitive measures have no place in an intervention, and will only serve to increase the person's defenses and make it less likely that he or she will seek help.
  7. Consequences for not going to treatment should not be designed to punish the addict. They should be designed to protect the health and well-being of the addict.
  8. Individuals that require an intervention are in a great deal of denial and will need an initial period of intensive treatment such as a twenty-eight day residential program or an intensive outpatient program.
  9. It is useful to intervene even if the person is not likely to go to treatment. There are many secondary goals that can be accomplished (see above).
  10. Intervention is not "confrontation." It is a well-organized expression of genuine concern for a person that is sick with a chronic illness.

The Changing Face of Intervention by James Fearing, Ph.D.

How many times have you heard it said, "You can't help alcoholics or addicts until they hit rock bottom on their own." They must ask for help themselves. Unfortunately, there are many addicts and alcoholics dying around us unnecessarily every day due to this old idea.

Growing knowledge and solid clinical experience in the chemical dependency field contradicts this previously accepted, outdated information. A professionally facilitated intervention can be done long before the alcoholic or addict hits bottom. In assessing success rates of such interventions, an informal poll taken at the National Association of Independent Interventionists Conference (AIS) in 1995 revealed that 90% of professionally facilitated interventions resulted in the identified patient entering treatment as a direct result of the intervention. Another research study published in 1996 (Treatment Today Magazine, 6-96, J. Fearing), which compared the inpatient treatment experience between self-referred patients and the intervened patients provided additional insight into the validity of intervention. This study compared both groups of patients (self-referred and intervened) as well as polling the attending treatment staff. The results of this research demonstrated that the intervened patient has as great a chance of positively experiencing inpatient treatment as the self-referred patient. This information supports the prospect of raising the bottom for alcoholics and addicts and breaking through their denial system via professionally facilitated crisis intervention.

During the early years of the practice of intervention, it was common to hear stories of interventions in which the facilitator or interventionist created a negative, shaming environment. This approach was often used in the name of "tricking" or coercing the identified patient into treatment. Unfortunately, this negative approach placed alcoholism into the good-guy bad-guy category versus supporting the medical model or the disease concept. This harshness gave the intervention process a negative image, an image sometimes exaggerated by cavalier interventionists calling themselves bounty hunters or headhunters. One interventionist using the old model intervention printed "Have Net Will Travel" on his business card. This barbaric approach both sabotaged and minimized the legitimate therapeutic component found in the intervention process. It could, and often did, leave both the patient and intervention team participants with deep emotional scars.

Carefrontation versus Confrontation
Throughout the past decade, professionals in the field of chemical dependency have developed the clinical framework for successful interventions, which are presented in the spirit of love, care and concern. This model of intervention is many times referred to as carefrontation versus confrontation. This strategy calls for everyone on the intervention team to speak from the I perspective and not the you perspective. It assigns any negative behaviors discussed throughout the intervention process to the disease and not the person. In many instances, upon meeting the identified patient at the crucial start of the intervention, the term intervention is not even used to describe the process. This is due to the aforementioned negative stereotypes of the word intervention may have associated with it. Many times it is described as a family meeting or family consultation. Another key byproduct in using this caring approach is that it assists the patient in positively preparing them psychologically for the treatment process ahead. It also creates a safe and supportive environment for the start of the healing process for all intervention team members. This process gives family members a head start towards participation in the family program component of the treatment program. This is achieved through opening up healthy communications for the entire family system and establishing a solid foundation through educating everyone involved. In some instances, using this new model intervention, the interventionist will stay involved well after the point of admission into the treatment program. This process is called co-case management and positions the interventionist as a liaison between the treatment center, the family and the patient.

Crisis interventions are now being used successfully for addressing many other destructive behaviors including gambling addiction, computer addiction, sexual compulsivity, eating disorders and more. Another change seen in the area of crisis intervention has been the dramatic increase in number of corporate interventions being performed nationally. In the past few years, Corporate America has become more proactive in its handling of valuable employees who are addicted. It is not at all uncommon to see an executive intervention done successfully in the board room using the same framework as the family intervention, which is done in the family room.

Qualifications of the Interventionist
Throughout the past decade, the percentage of difficult and complex clinical cases admitted into hospitals and treatment centers in the Unites States has increased dramatically. Many treatment providers state that the patients of today are "sicker" than the patients of the past. Informal estimates suggest that 50% to 75 % of people in substance abuse treatment carry dual diagnoses. Many come to treatment with multiple addiction plus mental health problems such as depression, physical and sexual abuse trauma, personality disorders, mood disorders and anxiety disorders. As a result, many treatment programs have found it necessary to strengthen their clinical staff with professionals who have the training and experience to treat people with dual disorders.

Likewise, clinicians who facilitate interventions must have an adequate level of training, experience, and professionalism. There are many unexpected clinical challenges and surprises encountered during the pre-intervention training for an intervention. Examples could include unresolved grief, sexual compulsivity, incest, physical and sexual abuse, illegal activity, sexual identity issues, and more. If the person who is facilitating the intervention is working without the appropriate clinical foundation and training to handle the unexpected, there is a chance the intervention can end up in a disaster.

The importance of making good decisions in planning your intervention is extremely significant. One of the biggest decisions will be deciding which professional interventionist is most appropriate to facilitate your intervention. The following set of questions will help qualify the person (people) being considered.

  1. What is their educational background? What level of education have they completed and what is their training? Do they possess actual supervised clinical counseling experience in their training, or did they just take a one-week course in intervention?
  2. Are they certified in chemical dependency counseling? What organization is their certification from? (i.e., ICDP, State of Minnesota, etc.) What other professional organizations are they active members? (i.e. EAPA, MARRCH, NAADAC, etc.)
  3. What is their experience in providing intervention services? How many interventions have they facilitated? How long have they been providing intervention services?
  4. What are their fees? When are they paid?
  5. What model intervention do they use? What does the intervention process itself consist of? What are their success rates? What population of clients are they most comfortable working with? How long after the intervention does the interventionist stay involved with the case, if at all?
  6. Check with reputable treatment centers and ask for a referral for professional interventionists they are familiar with. They will have a short list of interventionists they are most comfortable in referring.
In critiquing the range of intervention specialist's qualifications working in the addictions field today, there can be a great deal of difference from one interventionist to another. There has been a national association started within the past few years called the Association of Intervention Specialists (AIS) whose goals include bringing better organization and accountability to this segment of the chemical dependency field. Up to this point, there has not been a standardized competency test or an agreed upon certification process for interventionists. The responsibility of making sure the interventionist you choose is appropriately trained and competent falls on the shoulders of the participating family or organization scheduling the intervention.

In conclusion, I want to restate that the process of crisis intervention has changed dramatically throughout the past few years. It has matured and grown from its infancy. It is helping thousands of suffering addicts and alcoholics, as well as their families find help and begin the healing process. Our research shows us that not only can we successfully "help people get help" through crisis intervention, but that the intervened patient has as good a chance of a successful treatment experience as the self-referred patient. The top clinics and hospitals around the country endorse intervention and are daily making referrals to trained interventionists. The days are over when friends, employers, or health professionals need to sit back and wait for someone to hit rock bottom and ask for help on their own. Most importantly, we now have a clinical process, which is respectful, sensitive, and caring for the entire intervention team as well as the identified patient.