Family style invitational interventions

When doing an intervention I find it helpful to work with the addict as well as the family members who have had their lives destabilized and who feel they have lost their sense of control. The central philosophy of family-style intervention revolves around working not only with the addict but with the entire family to restore that feeling of control and healthy boundaries, after which, the theory goes, recovery of the chemically dependent individual can follow.

Sometimes, the intervention comes as a total surprise to the alcoholic, but new techniques have been developed in which the members of the intervention team tell the alcoholic that they are talking with a professional about his drinking/substance abuse problem several days prior to the actual intervention. With the newer invitational model, the addict realizes that the most important people in his life are meeting about his problem, and when he is finally invited to the discussion, he does not feel as "ambushed" as with the earlier intervention techniques.

Why is it necessary to conduct an intervention? Because nothing else has worked. Most people attempt to change a person or situation through reason and discussion, usually one-on-one. When this fails, frustration may lead to anger. This can go on for years. Appeals to reason and one-on-one discussions rarely produce change in someone engaged in self-destructive behaviors. On the other hand, an intervention that includes several people meaningful to the person, that is executed in a controlled and logical way, that focuses on changing everyone's behavior at least for the moment, is highly effective.

Different styles of Intervention

June 15th, 2010

A&E’s “Intervention” is a reality series that follows one individual struggling with addiction per episode. Family and friends gather with an interventionist toward the end of the episode and an intervention is planned. The addict is then given a choice between leaving immediately for rehab or risk losing contact, financial support or some other privileges from their family and friends.

All interventions are not the same

This style of intervention used in A&E’s “Intervention” is known as The Johnson Model (JM), as thought up by Dr. Vernon Johnson in the 1960s. This intervention model has, because of the show, become the most recognizable version of addiction intervention. An interventionist using this style aims to abruptly break the denial that is harbored by the chemically independent individual. By assembling loved ones and presenting an ultimatum, the addict is forced to hit “bottom”, in hopes of pushing them toward recovery and avoiding further destruction.

There are alternative intervention approaches, including Motivational Interviewing (MI), and CRAFT (Community reinforcement and family training). These relatively more recent and less confrontational approaches also employ professional counselors or interventionists who seeks to move the addict into a state in which they themselves are motivated to change their behavior (MI) or who focus on teaching behavior change skills to use at home (CRAFT).

By using common psychological techniques such as mirroring and reflecting, MI practitioners gradually make the client face the consequences of their action, taking the burden of motivation away from loved ones. CRAFT practitioners, on the other hand, use a manual-drive method to improve the addict’s awareness of negative consequences, reinforce non-drinking behavior, and improve communication skills and participation in competing activities. Both methods also prepare family members (or friends) to initiate treatment, if necessary, when the patient was ready. Though far less dramatic and “TV worthy,” MI has been shown in research to be very effective at increasing clients’ motivation to change in many different setting including addiction. It’s also my favorite technique because it allows for amazing, non-confrontational, change.

Some of the reasons to question the confrontational Johnson Model used in A&E’s “Intervention” have to do with the fact that although they’ve been shown to increase treatment entry rates once a successful intervention has been performed, they haven’t been shown to do much for treatment completion rates. Even more important is the fact that multiple studies have found that a small percentage of those who seek consultation in this method actually go through with the family confrontation portion. Instead, the more collaborative and supportive MI and CRAFT methods have greater participation and have been shown to provide even better treatment entry as well as improvement in communication and overall relationship satisfaction between the families and the addicts (which JM interventions provide as well). Additionally, a significant portion of individuals who enter treatment after a JM intervention end up leaving treatment early or relapsing quickly since they themselves have not yet internalized the motivation to quit.

Pressure and shame can backfire

This phenomenon can be seen in Corinne’s episode of A&E’s Intervention. Addicted to heroin and crystal meth, Corinne had lost control of her life and her family was desperate to save her. Corinne is a diabetic and had not been taking her insulin for years, using her needles to shoot-up instead. When Corinne overdosed nine months prior to taping, Corinne’s family knew they needed to intervene. During taping, an interventionist was brought in to meet with the family. She helped them to plan out how they will address Corinne. She started by emphasizing how desperate the situation has become and encouraged them to be forceful with Corinne. She explained that this is a life or death situation and that if Corinne refuses treatment, they might consider turning her in to be arrested. As Corinne arrives, she reacts harshly and explains that she is not “ready” for treatment. She flees the room for a short time only to return and agree to go into rehabilitation as they had requested.

As is too often the case, Corinne struggles at the first treatment center and is quickly transferred. Eventually after getting clean, her family is overjoyed. Unfortunately this is short lived when three weeks after taping, she relapses several times. As usual, I think it’s important to know every tool available when considering how to help an addict – that’s why I believe that knowing about MI and CRAFT (as well as other intervention methods) in case the more popular Johnson Model Intervention doesn’t work is crucial. It’s a matter of life and death.

Citation:

Miller, W.R., Meyers, R.J., and Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: Comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688-697.

Rollnick, S., Allison, J. (2003) Motivational Interviewing, in The Essential Handbook Of Treatment and Prevention of Alcohol Problems (2003)

Children's Mental Health Awareness Day

I regret to have been neglecting my blog, however I am have been busy in the world of neurotransmitters, trauma informed care and the war on drugs. I have been spending a lot of time learning about how one develops a propensity for addiction and how we can better intervene early in those at risk's lives to prevent the heartbreak and devastation of addiction.

Awareness of the brain workings as babies grow up into children and teenagers can help us better understand and work with our children. Not sure if you have heard of the phrase "trauma informed care". It is a fascinating new approach to working with children and adults who grew up with trauma. And it is no secret that a large percentage of addicts and alcoholics suffered harm in their formative years. Research is now supporting that during these years of brain development, trauma affects the brain more than we ever believed before.

I have decided to learn more about this so that I can implement better care to the families dealing with current and past trauma in my practice. So this summer I will start the process of becoming a certified trauma counselor. I am thankful that I have a love of learning. For me the brain is absolutely fascinating.

Have a great one!

One Day at a Time

How powerful these words can be. As I go about launching this business I have to remind myself one day at a time. There are things I need to do every day, but I am no good to anyone if I overwhelm myself and try to do it all today. Furthermore, when it seems like such a daunting task, I need to tell myself one day at a time, and do what I can each day. That may sound like a contradiction but it makes sense to me. How is that for a first blog post.

I intend for this blog to be a place to share information that may be of interest to families in crisis, families in recovery and any one who is effected by a loved one's addiction. I look forward to candid conversation and welcome all comments.

Welcome.