An intervention provides family, friends, and sometimes even colleagues and employers an opportunity to tell someone in their own words how the person’s use of drugs or alcohol has been a problem in their lives. “It is a planned event, not spontaneous, and addresses the substance abuse problem an individual has by focusing on the negative effects and destructive behaviors exhibited,” explains Beau Nelson, DBH, LCSW, chief clinical officer at FHE Health. “It will include the next steps that are being recommended, such as treatment, and the consequences (boundaries) if the plan presented is not followed.” The term “intervention” can be confusing because it can be used to refer to the various therapeutic approaches used to treat addiction, many of which are evidence-based and effective. These include motivational interviewing, cognitive behavioral therapy, and couples therapy. These evidence-based treatments and several others, typically take time and commitment on the part of the person with the addiction but are generally helpful. What we are discussing in this article is not a treatment per se, but rather a planned attempt by a group of people to persuade someone they have a relationship with to either quit alcohol or drugs on their own or go into a treatment program. It’s important to remember that this approach may not lead to immediate results. “The person with an addiction to alcohol is often impaired by a brain that is atrophied because of heavy drinking and poor nutrition,” explains John C. Umhau, MD, MPH, CPE, addiction medicine specialist and director of AlcoholRecoveryMedicine.com. “On a superficial level, they may seem rational, but in reality, they are unable to make choices that are obviously in their best interest,”
How Interventions Work
Most alcohol and drug treatment centers have counselors who are trained to help families prepare for a confrontation, which always takes place in a “controlled” environment, specifically selected to put the person in a position in which they are most likely to listen. Many times, these interventions take place in the workplace, with the full cooperation of the employer. Sometimes the intervention comes as a total surprise. But newer techniques recommend that the members of the intervention team tell the person with the addiction that they will be talking with a counselor about their drinking or drug use several days prior to the actual intervention. This process may be led and guided by an interventionist who is hired by the family or group. An interventionist should be a qualified mental health professional with training and experience in addiction treatment.
Do Interventions Work?
From a professional standpoint, interventions are generally not recommended simply because there is not enough research available to support their effectiveness. That doesn’t mean they can’t be effective; it just means that the studies required to demonstrate their effectiveness have not yet been carried out.
Alcohol usePrescription drug misuseIllicit drug useCompulsive eatingCompulsive gambling
Dr. Nelson notes that there is not much research regarding the efficacy of these types of interventions. However, they may be helpful in getting family members and friends to come together with regard to setting boundaries. “It may be successful at limit-setting in a situation where there are destructive behaviors affecting the family and friends of the substance-using person. It may also be a step that may contribute, in the end, to a positive outcome, and that in itself can be helpful,” he explains. A few studies on the effectiveness of interventions in getting people into treatment were conducted during the 1980s and 1990s. They typically showed that family members chose not to follow through on confronting their loved one. One study showed that when people did follow through on an intervention, they were able to get their loved one into treatment. But in the end, this was a very small number of people, and the outcome of therapy was not reported. Bear in mind that all therapies—no matter how effective—were at one time unproven. These therapies went through experimental stages, refinements, and research until finally, enough studies were conducted showing their effectiveness that they became accepted practice. But just because they are accepted practice doesn’t mean they are guaranteed to work for everyone. Some clinicians have had the experience of working with people whose families have conducted interventions. In some cases, they report that interventions have been helpful in persuading their loved ones to get help. Others have had much more negative reviews, in which the intervention was poorly conducted or the person with the addiction was not in a place to hear the feedback. In these situations, interventions caused an even greater problem for the person with the addiction and an even greater rift in their family. “Making a break from an individual if the intervention does not receive the intervention well can often cause people to need support long after the intervention,” Dr. Nelson notes. “Self-care, emotional support, and dealing with implications means following up together as a group and using professional resources and groups like Al-Anon for continuing care.” People who use substances report mixed reactions to being confronted by family, friends, and professionals. In one study, a confrontation was perceived as more helpful when a trusted individual focused on offering hope and practical support. Confrontations that seemed hostile or hypocritical were viewed as unhelpful.
Types
There are several types of drug and alcohol interventions. The type of intervention that your medical professional recommends will depend on your goals, unique experience with addiction, and family dynamics.
Johnson Model: Created by Vernon Johnson (“the father of intervention”), this is perhaps the most recognizable form of intervention. The Johnson model involves the family and a guided interventionist who confronts the loved one with a substance use disorder without their prior knowledge of the meeting. Invitation Model: Also known as systemic family intervention, this method was developed by Ed Speare and Wayne Raiter. It focuses on a family-oriented approach to addiction. As the name implies, the entire family or support network (including the person with the addiction) is invited to a workshop led by an interventionist so they can discuss how the disease has affected the family unit. Field Model: Similar to the Johnson Model, the Field Model involves a confrontational approach, where the person with the addiction has no prior knowledge. In this model, however, the interventionist is trained in handling crises during the intervention process and after. It’s often recommended if a family believes their loved one is a danger to themselves or if they have uncontrolled co-morbid conditions like depression or bipolar disorder.
Alternatives to Intervention
Community Reinforcement and Family Training (CRAFT) is an evidence-based method for helping families get help for their loved ones. CRAFT has replaced interventions as the preferred method of getting help for people struggling with addiction. Rather than targeting the person with the substance use disorder, this evidence-based method aims to work with the concerned significant others (CSOs) so that they can assist the identified patients (IPs). “The CRAFT program offers a gentle alternative to a heavy-handed confrontation, and the research suggests it may be a more effective way to help unmotivated loved ones get help for their substance-abuse problem,” Dr. Umhau notes. He also suggests that as a research-based program, CRAFT teaches practical steps that support recovery, with less of a risk of alienating people from the support systems that are vital for long-term success. CRAFT helps CSOs to:
Break patterns that enable or increase a loved one’s drinking or usingDevelop and improve communication skills with the IPsIdentify their loved one’s substance use triggersIdentify triggers for violence and develop a plan to keep themselves (and their children) safeLearn or re-learn to practice self-care and reconnect with their values
“Research exploring the effectiveness of interventions suggests that the type of engagement promoted by CRAFT training is more effective than detaching with ’tough’ love in bringing a reluctant family member into treatment,” says Dr. Umhau.
Steps to Consider
If you decide to have an intervention for your loved one, you’ll need to take a few steps to help you prepare logistically and mentally.
Research Treatment Options
You’ll want to present your loved one with some detailed suggestions for treatment, so you’ll need to do your research ahead of time. If the person agrees to get help, it’s best to already have a treatment center, counselor, or meeting in mind so you can take action immediately. Make sure to find out in advance whether your loved one’s insurance plan will cover treatment as well as what steps are required for admission, such as a referral from a primary care provider. The best approach to treating an addiction depends on many factors, including the substance being used, how severe the addiction is, the addicted person’s attitude towards treatment and quitting or cutting down, and whether they have concurrent mental and/or physical health problems. Treatment options may include:
Behavioral therapy Detox Medication Motivational interviewing Residential treatment Support and self-help groups, such as Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery
Choose an Interventionist
“Interventions should be coordinated and carefully planned with a licensed healthcare professional, along with family and friends of the person dealing with addiction,” explains Antonello Bonci, MD, the executive chairman of VITA Recovery. “Professionals are necessary to help the individuals conducting the intervention organize their thoughts and feelings, strategize responses to each person’s reactions, focus on making loved ones feel special and cared for rather than attacked, and to help create treatment and long-term care plans.” Unfortunately, there is no current system for evaluating the credentials of interventionists and very little information on which to base your decision. If you feel an intervention might be right for your loved one, consider the following common-sense considerations. These are not based on medical fact or research, but they may help you think about whether to employ an interventionist:
Inquire about certification. The Association of Intervention Specialists (AIS), Family First Interventions, and the Network of Independent Interventionists are three organizations that offer certification. Get a personal recommendation. Do you know anyone who was helped by the interventionist? If so, were their problems similar to those of the person you care about? Were their characteristics (such as age, culture, and how long they have had the addiction) similar? A personal recommendation from someone dealing with similar issues can be helpful. Talk to the interventionist. Did you develop a good rapport? Do they seem to understand the problems you are describing? Do you get a good “gut feeling” from this person? Consider the costs. How much do you stand to lose if it doesn’t work out? Could these funds be used on a different program that offers more credibility?
Gather an Intervention Team
Depending on the situation, an intervention can involve the following people:
The person with the addictionFriends and familyA therapistA professional interventionist
“Intervention events should also be thoughtfully timed so as not to occur during a high-stress time, like during work or relationship transitions,” recommends Dr. Bonci. It’s also important to consider who should not be on the intervention team. Someone your loved one dislikes or a person with an unmanaged mental health condition or substance use disorder is usually not a good fit.
Give Consequences
Members of the intervention team should be prepared for the individual to respond with anger or another strong emotional reaction. Regardless of the reaction, following through is essential. “They need to be prepared to enforce the consequences they set,” Dr. Nelson emphasizes. While you’re not trying to punish your loved one, you do want them to understand that there are consequences if they refuse to seek help. Such consequences may include:
Asking them to move out until they’re ready to begin the recovery processLosing visitation rights with childrenTaking away their car
“During the intervention, loved ones should be careful to avoid blame, shame, and yelling, and be as specific as possible with relaying facts about how the person’s substance use has affected their lives,” Dr. Bonci recommends.
Know the Risks
Professional intervention is not an option for every family and every situation. The decision to choose the intervention path is one that should be made carefully and with the advice of an experienced counselor. Confronting someone with an addiction is a very risky approach. It can easily backfire, making the person experiencing addiction feel attacked, alienated, and misunderstood instead of supported. You may not be able to persuade your loved one into treatment. In fact, trying to do so may actually make both their addiction and your relationship with them worse. In these cases, an intervention can worsen an addiction. They may cause the person to seek comfort in alcohol and drugs, and to seek out the company of those who “understand,” such as drinking buddies and drug dealers.
Seek Support
Whether or not your loved one decides to seek help, you can likely benefit from the encouragement and support of others in your situation. Many support groups, including Al-Anon, help family members understand that they are not responsible for their loved one’s addiction and that they need to take steps to care for themselves regardless of whether or not the person they care for seeks treatment. Dr. Nelson notes that family and friends need support even if they are able to convince their loved one to enter treatment. “The people in their life still need to take care of each other, create a strong support system, and utilize professional resources for education and guidance as the family and friends navigate the recovery process with their loved one,” he says.
Potential Pitfalls
Many people working in the field of addiction know what they are doing and genuinely want to help their clients. But there are others who just want your money, and will prey on the desperation of loved ones who are looking for a miracle cure. There are no miracle cures, and overcoming addiction is hard work, especially for the person with a substance use disorder. Interventions for addiction are big business, especially in the United States, where they are often portrayed on TV and in movies. Families of people with addictions pour their life savings into interventions, hoping to save a loved one who seems to no longer see reason. We know from decades of research that people do not become addicted purely by nature or nurture, but a complex interplay between the two. It’s common that someone with an addiction is also struggling with underlying issues that they themselves may not even be aware of. That means an interventionist or well-meaning family member is even less likely to be aware of them. Although some people are able to overcome severe addictions on their own, it takes great determination and access to alternative ways of coping to do this. For many others, overcoming addiction requires treatment, and it often takes many attempts to completely quit alcohol and drugs. This does not mean that people are never helped by an intervention. The process of becoming aware that their behavior is harming them and the people around them is an important step toward recovery, and the first step through the stages of change from pre-contemplation to contemplation. Ultimately, it is important to remember that an intervention is no quick fix, even if it leads to the individual entering treatment. Long-term support, care, and effective treatments are needed for success. “Because alcoholism is typically a relapsing disorder, any immediate benefit of an intervention will be tempered by the availability of long-term social connection and engagement in therapy,” Dr. Umhau explains. For more mental health resources, see our National Helpline Database.
