It can be emotionally draining and painful to observe the actions of a relative, friend, or other loved one who is suffering from a substance use disorder to alcohol or drugs. Sometimes the urge to step in and “force” the person to stop using drugs is overwhelming, and loved ones may actually wind up creating more tension than good when they try and confront a person with a substance use disorder. One option is to schedule an intervention with other concerned loved ones in an attempt to use group support to help the individual see the issue.
What Is an Intervention?
An intervention refers to a situation where concerned individuals confront a person who has a self-destructive behavioral problem and attempt to convince that person that they need to seek treatment for the problem. In the current context, an intervention refers to an organized attempt by concerned others to get a person with a suspected substance use disorder to become involved in formal treatment. Interventions for substance use disorders and other forms of addiction are gaining so much popularity that entire television programs and series have been created that somewhat glamorize and often mistakenly present how this process is supposed to work.
What types of issues might warrant an intervention for an individual who has a suspected problem with addiction? Some examples include:
- Suspected alcoholism
- Suspected street drug abuse
- Suspected compulsive gambling
- Suspected prescription drug abuse
- Suspected polydrug abuse
Why an Intervention?
Individuals who struggle with addictive behaviors are often so focused on their needs and what they view as the positive aspects of their behavior that they do not see the overall picture. In order to rationalize their behavior, they either distort the truth or are actually unable to objectively view the big picture. The common term for the situation is that the individual is in denial; however, refusing to actually objectively look at a situation is common in individuals who are involved in a number of potentially anxiety-provoking situations, such as individuals who have been diagnosed with a terminal disease, individuals who are enmeshed in dysfunctional relationships, individuals presented with logical information that threatens one of their core beliefs, etc. In fact, telling someone that they are “in denial” about their substance use or other behavior simply complicates the issue and most often elicits resistance.
Instead, it is much better to objectively present the truth to the individual, roll with the resistance, and let them make an informed decision once they are presented with all the evidence and with different points of view regarding their behavior. This is what a well-planned and staged intervention attempts to accomplish.
An Intervention Is Not…
A concerned and well-planned intervention should attempt to confront the individual in question in a non-threatening manner and to objectively explain to that person the ramifications of their behavior. Individuals planning an intervention should not approach the situation as:
- A trap or ambush, even though interventions are often planned and performed without the awareness of the target person
- An opportunity for those in the intervention to vent and release their anger or frustration on the subject
- A method to force the person into treatment against their will (Even though some models of interventions will present the subject with contingencies or even sanctions for not going into treatment, the intervention should not be viewed as a means to force a person into treatment.)
- The last resort to get the person help for their addiction (An intervention may or may not be successful in getting the person into treatment; however, it is never the last resort. Instead, it might be the first step in helping a person realize that they have a problem with an addiction.)
A General Approach
There are several different models of interventions for individuals with addictive behaviors. In general, the intervention is performed by family and friends of the person and in conjunction with a physician, licensed mental health worker, or interventionist. An interventionist is trained in a specific type of intervention model and organizes the process. In all cases, the members of the intervention team should include at least one professional such as an addiction treatment specialist or professional interventionist, family members of the subject, close friends and coworkers of the subject, and sometimes clergy who are also very familiar with the person.
The goal is to confront the person and explain the ramifications of their addiction. Typically, each member of the intervention team provides very specific examples of the person’s destructive behavior and how it impacts them. Once each person has explained how the individual’s behavior affects them, a number of treatment options are offered, and the consequences for not getting involved in treatment are explained.
A general plan to organize a successful intervention includes the following components:
- An initial planning session: A family member or friend of the target person forms a planning group to organize an intervention. At this stage, it is best to include a qualified professional, such as an addiction medicine physician, addiction therapist or counselor, or a professional interventionist to help organize the intervention and oversee the planning sessions. This will ensure that the intervention is run properly.
- Research: The initial group forms a team that will actually perform the intervention. The group members will need to research appropriate treatment programs and can even make initial arrangements to get the person enrolled. It is a good idea to have at least three different treatment programs as options for the person.
- Deciding what to say: Team members should decide exactly what they will say to the person, and the group should approve each person’s speech. It is a good idea for each member to actually write a short letter to the subject. Only facts about the person’s behavior and how it affects each individual should be presented. Specific incidents should be described, and there should be no blame placed or accusations made. The subject of the intervention cannot argue with facts or with how each team member feels about the person’s behavior. This reduces resistance.
- Identifying consequences: It is useful to identify specific consequences that will take place if the person does not get treatment. For example, asking the person to move out of the home, withdrawing from contact with the person, taking away contact with children, taking away financial incentives, etc., are common consequences.
- Setting the intervention: Set the date, time, and place of the intervention. Make sure everyone can be there. It should not be at the subject’s home, but instead should be at a neutral place, such as the home of one of the team members. Typically, public places are not preferable because individuals cannot comfortably express their feelings in these places. Obviously, performing the intervention in a bar or restaurant where alcohol is served is out of the question. Of course, make sure the target person can attend the meeting but do not tell them what is about to happen In some models, the subject of the intervention actually attends all the planning sessions and the actual intervention.
- The intervention itself: Hold the intervention as planned. In one of the most popular models of intervention, the Johnson Model, research has indicated that many of these interventions do not go past the planning stages. It is important to actually hold the intervention if the group expects any type of results.
- Follow-up session: Team members should follow up with the individual as they enter treatment. Support is critical in recovery. A successful intervention does not end with dropping someone off at a treatment center. Even if the target person refuses treatment during the initial intervention, group members can follow up with the individual and still attempt to convince that person to get treatment. Oftentimes, subsequent interventions may be held.
There are several different recognized approaches used by interventionists for addictive behaviors. The most common ones are outlined below.
- The confrontational approach: In the confrontational intervention approach, the idea is to actually force demands on the subject that will motivate that person to go into treatment. This is probably the approach that most people think of when they think of an intervention for drug abuse or addictive behaviors. However, this approach has the least probability of being effective.
- Love First: The Love First or Tough Love approach is a confrontational approach where each person first expresses their care for the person and then makes demands or consequences if the person does not comply and get treatment. Again, very confrontational approaches are not generally successful.
- The Johnson Model: The Johnson Model uses a team approach that is broadly described above. The problem with this model and many like it is that these interventions rarely get past the initial planning stages; however, when they are implemented, they can be effective.
- ARISE: A Relational Intervention Sequence for Engagement (ARISE, which was formally the Albany–Rochester Interventional Sequence for Engagement) is a model that utilizes a number of different planning meetings, intervention meetings, and a final meeting that presents consequences to the subject if they do not enter treatment. This model includes the subject of the intervention at all stages of planning and at the actual intervention. It is the model preferred by the Association of Intervention Specialists (AIS), a professional body of interventionists that offers training and licensing for individuals wishing to become professional interventionists. The model has some empirical support for its effectiveness.
An intervention is an organized, group attempt to confront an individual with a substance use disorder or other addiction in a nonthreatening manner and convince that person that they need help in the way of formalized treatment for their behavior. There are a number of different models of interventions for substance use disorders, and there is very little research comparing different models of interventions.
Independent research on the overall effectiveness of interventions is also scant; however, for the most part, when interventions are performed, they appear to have generally positive effects in getting a person into treatment. Research looking at the success rates of individuals exposed to formalized interventions in treatment programs is mixed, and conclusions from this type of research are difficult to make because relapse rates for individuals with substance use disorders generally tend to be relatively high. Relapse may actually be part of the process of recoveryfor individuals with substance use disorders. Thus, it can be difficult to ascertain what criteria should be used to designate successful treatment outcomes in many cases.
It is known that individuals who engage in formalized treatment programs for substance use disorders generally have fewer relapses and better long-term success in recovery than individuals who do not utilize these programs. Thus, if performing intervention can successfully convince an individual to get into a formal substance use disorder treatment program, the chances that that individual will eventually be successful in recovery are enhanced significantly. The effectiveness of a formal intervention will be enhanced if an intervention specialist or professional mental health care worker who specializes in the treatment of substance use disorders is part of the intervention team.