It’s become a staple phrase in addiction medicine, “The addict must ‘hit bottom’ before he or she can be encouraged to change.” As long as the addict has a job, a family, a home and friends, the thinking goes, the addict can be convinced that the problem is manageable and not serious enough to merit a change. When the benefits of a healthy life are stripped away, the addict is forced to face the addiction head on and make the needed adjustments.
There’s one major problem with this theory; for many addicts, the bottom means death. Family members may resist the idea that they must wait for their loved one to be in a fatal accident or die from a drug overdose before they can help. In other words, they’re looking for a way to make the bottom visible, long before the addict’s life is actually hanging in the balance.
A well planned intervention with the right professional can mean the difference between life and death for an addict. Doing nothing and waiting for your loved one to hit bottom is like waiting for cancer to cure itself. Obviously no one can make an addict sober up if they don't want to. You can however help speeed along the recovery process by letting the addict hear the truth about how his or her behavior is affecting friends and family.
Choosing the right person to help with an intervention is not a decision that should be made lightly considering what is at stake. A good interventionist should be able to educate everyone involved about addiction and understand different approaches to the intervention process. Here are some examples:
In the Johnson Model intervention, the family confronts the addict directly, and speaks in clear terms about what the addiction is doing to the family and what the addiction is destined to lead to. The addict may hear, for the first time, that addiction can lead to death or long-term disease, and the addict may hear that the family will no longer look away from addicted behavior. The family, in turn, learns more about addiction and may acquire tools that allow them to help the addict deal with the problem and truly heal.
This traditional style of intervention utilizes surprise in an effort to break down that wall of denial. Here, the family pulls together a team of concerned people who know about the addiction and who want that addiction issue to stop. The team could be made up of almost anyone at all, but typical participants include:
Spouses or significant romantic partners
The family holds a series of meetings in which they plan what they’d like to say, and then they surprise the addicted person with a meeting. Here, they outline all of their comments and they push the person to accept treatment or accept a series of negative consequences.
Confronting someone with an issue that is so personal, and threatening to bring about negative consequences if the person doesn’t change, is never easy. It’s not surprising, then, that studies suggest that 70 percent of people who plan an intervention like this don’t ever hold the formal conversation. It might be too hard for people to think about discussing this topic with the person they love, and it might not seem that holding a confrontation could be effective.
Families might also ameliorate the relapse risk by participating in family therapy. This isn’t a given when families utilize surprise interventions, but family therapy can help the family continue to learn about addiction, and perhaps, they could change their habits and create an environment that is less conducive to substance use and abuse. Families who take this approach may be building upon the success they had in a surprise intervention, and they may see their family heal as a result.
While a surprise intervention can be shocking, providing the person with a wakeup call fueled by confrontation and a bit of embarrassment, an intervention like this may deprive the addicted person in some ways. While the family might have time to learn about an addiction during the planning stages, the addicted person is left out of those talks. The addicted person is also left out of conversations about treatment options, and may not have a feeling of ownership about the treatment plan chosen as a result. An invitational method may help, as the addicted person is allowed to participate in discussions from the very beginning. As soon as the interventionist is hired, the addicted person has the opportunity to learn.
An invitational approach may also have benefits for the family. While a traditional intervention is focused solely on the addicted person’s habits, and the goal of an intervention like this is simply to get the addicted person into treatment, an invitational model focuses on the needs of the family as well. For example, the CRAFT Model (Community Reinforcement and Family Training) is based on the idea that the whole family has a role to play in keeping an addiction alive or making an addiction fail. Families that go through CRAFT are asked to:
Even if the addicted person never chooses to learn about addiction and never attends even one training session, an approach like this can help the family learn to escape from the addicted person’s behavior. Enabling stops and the family might gain emotional health, no matter what the person might do.
Not all intervention models fit neatly into a surprise/invitation box. There are some models, including the ARISE model, that use components of both types of interventions in order to encourage addicted people to change. In these models, addicted people are encouraged to participate in educational sessions, and their family members learn to change their behavior and discuss the need for treatment in an open and honest way. If people don’t change, the conversations become more and more intense, until a formal surprise intervention is held. The person has the opportunity to learn and is invited to participate, but if the person simply will not change, the surprise can come into play.
Interventions like this can also be quite effective. For example, a study of the ARISE method in the American Journal of Drug and Alcohol Abuse found that 83 percent of people who used this model were able to convince the addicted person to enter a treatment program. More than half were able to see success in the early stages of the intervention, before the surprise was needed. It’s likely, however, that these families took comfort in the idea that they could intensify their efforts if the early gentle pushes didn’t bring sweeping changes.
Family members may know, on a gut level, which type of intervention is likely to bring healing and help the situation to change. Families that aren’t sure, however, may benefit from interviewing interventionists and family mediators who use different approaches in their work. Families can ask questions such as:
It is our belief that a professional interventionist should be knowledgeable in all intervention styles but also be flexible in each situation. For more information or to ask questions, please give us a call.
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