What Family Members Need to Know Alcoholism and drug addiction affect the entire family system and similarly, recovery can positively impact the family system. Family members quite often play a critical role in supporting their loved ones to seek help and enter treatment. In fact, it is often the family member or friend who makes the initial call to gather information and explore treatment options.
For this reason, we see the role as helping family members to navigate and understand the treatment and recovery process. The commitment is to help individuals and families find the appropriate level of care to address their addiction issues.
Is it true that I need to let my loved one hit “rock bottom” before he/she will consider treatment? Absolutely not! Perhaps one of the biggest myths that family members have heard and come to believe is that there is nothing that can be done when someone is in active addiction except wait around for him/her to “hit bottom” and suddenly decide to enter treatment.
Family members, friends, employers and other significant others can often have great influence on when a person seeks treatment. Alcoholics and addicts do not have to lose everything in order to get the help they need. It is possible to arrest addiction at any stage, and intervention is most successful when early interventions take place.
The decision to enter treatment is usually made a result of significant consequences that result from the drinking or using. As family members you can start the process by identifying your own enabling behaviors that might be preventing your loved one from feeling the consequences of his/her addiction.
There are also professionals, called Interventionists, who are trained to work with families to help support their loved ones to choose treatment and recovery.
What should the family expect after treatment? The program emphasizes that recovery from alcoholism and drug addiction is a process and not a destination, so it ensures that every client, regardless of where they are coming from, has a complete continuing care plan at discharge.
This plan is formulated through recommendations from the multidisciplinary team of doctors, nurses, clinicians, nutritionist, wellness staff, and spiritual counselor. The team provides each client with ongoing professional referrals depending on their individual needs.
This may include recommendations for: individual therapy, Intensive Outpatient Programs, Group Therapy, Extended Care placement, Recovery Residence placement, medical and psychiatric referrals, and Addiction Coaches.
What is an Intervention? An intervention is a deliberate process by which change is introduced into peoples' thoughts, feelings and behaviors.
A formal intervention, like we are discussing here, usually involves several people preparing themselves, approaching a person involved in some self-destructive behavior, and talking to the person in a clear and respectful way about the behavior in question with the immediate objectives being for the person to listen and to accept help.
Although the intervention process has been formalized, the idea is not new. Thinking back, most of us can remember a time when someone or something - a teacher, friend, or set of circumstances impressed us in a seminal way which altered how we understood ourselves and changed our perspective.
Moments like these constitute turning points where new vistas open allowing us to see things differently and to recognize opportunities we did not know existed before. The overall objective of an intervention is to begin to relieve the suffering caused by a self-destructive behavior - the suffering of the person engaged in it and the suffering of family and friends.
What self-destructive behaviors are appropriate for intervention? Any self-destructive behavior can be addressed in an intervention: alcoholism, alcohol abuse, alcohol addiction, drug abuse, drug addiction, gambling, sex addiction, eating disorders, computer addiction, internet addiction and any other self-destructive behavior.
Generally people think of substance abuse as being most applicable to intervention. In fact, that will be the example used throughout this discussion.
However, any addiction or compulsive behavior is appropriate. Even an elderly person, no longer able to live alone safely yet resisting assisted-living arrangements can be helped through the intervention process.
Why is it necessary or desirable 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.
What can my family expect to happen during an intervention? In order to prepare for an intervention, family members and friends gather to discuss the details with the interventionist. They jointly decide what form the intervention will take, identify who should be included in the intervention, develop education and treatment plans, develop an intervention plan and schedule, and then execute the plans.
Family and friends often enter this process with apprehension and frequently with a high level of frustration and anger. They often feel betrayed, confused, guilty, and defensive. They sometimes blame each other as well as themselves and the addicted person for their difficulties.
All can expect these feelings tempered or resolved during an intervention. Sharing and expressing feelings gives purpose to the rehashing of old pains, and allows the family and friends to receive comfort and to begin to resolve the built up rage and hurt that has influenced many of their relationships and interactions.
These intervention meetings transform the family in ways necessary for lasting change to occur.
And this cohesive group approaching the addict offers something much better than a confrontation. The group creates a different world for everybody to live in.
How did the idea of intervention develop? Family intervention, where family and friends band together and encourage a drinker to accept help for his drinking, has been used successfully for over thirty years, ever since Vernon Johnson first began experimenting with the technique in the early 1960's.
This intervention technique was and continues to be the standard against which all further developments are compared and measured. And rightfully so. Johnson's classic volume I'll Quit Tomorrow, published in 1973, includes the basic rationale and approach to interventions still used today.
This approach was published later as a separate book, Intervention, in 1986. Both books remain excellent primers on the subject for the professional and layperson alike.
However, there have been many developments over the last few decades. And even though these developments are but variations on Johnson's basic themes, some of them are significant. First of all, people recognized that the intervention technique was applicable to a broader range of environments and issues than just alcoholism in the family as most people originally thought.
For example, intervention is now used not only in domestic situations with family and friends, but also in many other environments, among them businesses and corporate boardrooms (often called "Executive" interventions), the military, professional sports, and various professional associations including impaired professional groups in the mental health field.
And in addition to addressing alcohol abuse and addiction, interventions are also done for people with other compulsive behaviors such as drug abuse, drug addiction, gambling, sex addiction, eating disorders, computer addiction, internet addiction and other self-destructive behaviors. Recently they are even being performed for violent rages.
Thus intervention activity has increased both by serving a wider and more varied population and by addressing a broader range of issues. And concomitant with this increase has been an increase in several other areas including the numbers of people conducting interventions and in refinements and variations on the intervention technique itself.
As the applications of interventions has grown, and as more people with a broader range of backgrounds have become involved in conducting interventions, many refinements on Johnson's original techniques emerged.
Some of these refinements are due to the population served. For example, the approach to interventions can vary considerably from one conducted in a safe corporate board room to one conducted in a potentially violent poor inner city apartment.
Also the mechanics of the intervention often vary depending on the style, training and history of the interventionist: some interventionists are assertive, some relaxed and laid back; some interventions are done by one practitioner, others have more than one: some interventions are done in the drinker's home, others in the interventionist's office; some interventions focus on getting help for the drinker, others on promoting recovery for the whole family.
In short, the acceptance by the general public, the refinements in intervention approaches and techniques, and the range of self-destructive behaviors for which interventions are now appropriate, have all increased substantially since Vernon Johnson first expressed his ideas on the subject over twenty years ago.
Why haven't I heard about interventions before? Because people don't do them very much. "Intervention" is not a common household word.
Interventions are not being used nearly as much as they could be for two major reasons. First of all, people cannot do what they don't know about, and even after the remarkable advances of the last decades, the public still remains generally unaware that the intervention process exists.
Of equal concern, the little that is "known" about interventions is too often simplistic, distorted, incorrect, overstated, understated, or misconceived. For example, the public generally believes an intervention to be an aggressive, intrusive, attack of some kind, rather than being, as it truly should be, the kindest and most loving thing family and friends can do. Unfortunately some are intrusive attacks. Increasingly, however, interventions emphasize love and concern rather than blaming or name calling.
What are the forms or variations an intervention can take? There is no absolute right way to intervene in someone else's life. In fact, there is a school of thought that argues that any form of intervention is abhorrent, a violation of free speech and of an individual's right to choose.
Nevertheless, as individuals and as a society we are always influencing others whether or not we want to, and sometimes we decide to intervene purposefully.
In addition to family interventions there are workplace interventions involving Employee Assistance Programs, executive interventions for senior personnel in professions or corporations, court involved interventions and diversion programs, interventions by Impaired Professional Programs conducted by professional membership organizations, and many others.
When thinking about family interventions, however, there are generally four basic orientations: Simple, Crisis, Classical, and Systems.
1) Simple Intervention Sometimes just a simple request from someone who matters can turn the tide. Simply ask the person to not drink. Believe it or not, this sometimes works. It is extraordinary how many times this has not been done because of a belief that nothing was ever going to change. And if this has not been done, it should always be the first step before any more complicated or involved form of intervention is embarked upon. (Occam's razor)
2) Crisis Intervention This is the polar opposite of the Simple Intervention. Crisis Interventions occur in dangerous situations involving reckless driving, weapons, hospital emergency rooms, or violence or threats of violence.
It is obvious in these situations that a person is in immediate danger to himself or others.
The immediate objective in these cases is to calm the crisis and to create safety for all.
Remember, a crisis often creates golden opportunities for family members to help someone accept help.
3) Classical Intervention The most common form of family intervention remains the Johnson's approach or some variation thereof. It has been used for over thirty years for thousands of interventions with great success.
The focus is on the drinker. The immediate goal is for the drinker to enter treatment, hopefully soon.
Family involvement varies, but at the very least there is enough involvement to plan the intervention prior to the intervention day. Family involvement is often extensive after intervention day to address problems that arise either for themselves or for the drinker.
Family education is primarily aimed at preparing for the intervention day. There is frequently some additional education after intervention day to help the family adjust to the changing circumstances.
Many treatment programs have fine family programs designed to educate the family in addictions and how to take care of themselves when living with a recovering person.
4) Family System Intervention A family systems intervention focuses on the family. The goal is for everyone in the family to change their ways, at least in regards to the self-destructive behavior, knowing that this changed behavior will have a tremendous influence on the drinker.
In this view the whole process is considered to be the intervention. Intervention day itself is not nearly as significant as in a more classical approach since the whole family, including the drinker, is considered the subject of the intervention. The drinker is sometimes invited to participate in the process from the start.
Family involvement begins very high and continues to be high whether or not the drinker goes to treatment. The educational process is viewed as integral and emphasizes the basics of addiction, the roles of guilt and shame in the family system, and the recovery plan for each family member.
The goal is for each family member to change behavior and consequently change the situation or system in which the drinker has thrived.
Note that although these forms of intervention were discussed separately, they are rarely so distinct in practice. Many of the characteristics of one can be found in the others depending on the situation.
For example, system considerations are always a factor even in the more classical approaches, but are usually not so openly addressed. Because of the many differences among families and situations, an actual intervention often becomes a blend of several of these forms.
How do you determine which intervention approach to use? Of the several things that need to be considered, the first is always the issue of urgency and safety. If you are responding to a crisis, the intervention approach you choose will reflect that urgency. Immediately address the crisis and ensure everyone safety. Family education and future plans can come later.
However, if you are dealing with a chronic problem the classic, the family systems, or a blend of these approaches are available to you.
Your decision on how to proceed will depend on several factors including what your family members are prepared to do, on their geographic dispersion and to a great extent on the orientation of the interventionist you find to help you.
Discuss with the interventionist the most realistic and practical approach to take given the thoughts, feelings and location of the family members.
Remember, an intervention is often a highly charged emotional experience and the family needs to be working with someone they trust. In theory all of the intervention orientations work.
However, most interventionists have developed a personalized approach that leans to one form or the other. Look for someone whose approach makes sense to you. Choose someone you can trust and then let them help you.
What can my family expect in the long run from doing an intervention? A new dance.
Think of a family's interactions as a choreographed dance. Everything they do and say to each other has been perfected by hours of rehearsal. Each member recognizes their cues and executes their steps without thinking - day after day after day.
Imagine the dancers circling around one member's drinking problem. Everyone knows the moves by heart, even the drinker. And although everyone hates the dance, no one can imagine how to stop doing what they are doing. In fact wanting to stop has become a part of the dance. Guilt and suffering are also written in. The family could go on like this forever.
An intervention is a controlled or choreographed crisis. The dance, business-as-usual behavior of the drinker and family, is stopped for a long enough time to get everyone's attention.
One day a group of the dancers stand still when they would normally being turning somersaults. At that moment everything changes in the family.
Although the transition is not always smooth and some dancers may bump into each other at first, the important thing is that the dance is brought to a stop; the drinker has no one left to do the old steps with. And at long last the family has the drinker's complete attention.
It now becomes possible for a different dance to begin.
An intervention changes the dance.
PRACTICAL MATTERS: What should my family think about when considering an intervention? Major considerations in all interventions include the following: Can my family do an intervention without professional guidance?
How can I know if the interventionist is any good? How urgent is my situation? What should be the objective of my intervention? Who should participate in the intervention? How should I handle angry, hopeless or reluctant family members? How can we intervene when my family lives all around the country? How much time will be required of the participants? How much elapsed time does an intervention take? Where will the planning meetings and the intervention take place?
What kind of treatment works best? To Remember The first item is truly the place to start.
Can my family do an intervention without professional guidance? Of course, but be very careful.
Interventions are difficult and delicate matters and it is important that they be done properly. Nearly all interventions can benefit from the advice and counsel of a professional experienced in the intervention process.
Many families waste a great deal of time and effort trying to organize an intervention by themselves and often it is so difficult that the intervention never takes place at all. Sometimes, unfortunately, it does take place and at best nothing happens at all and at worst a great deal of harm is done.
The first thing to do is to seek out the advice and council of an interventionist. At least make the call and talk a little. You don't have to commit to anything until you are ready.
How can I know if the interventionist is any good? By the interventionist's experience and your sense of comfort and trust.
Specialized training is required to guide a family and work colleagues through the intervention process successfully. Most people, including many in the addiction field, have a simplistic view of interventions, greatly underestimating the knowledge, skill, flexibility, and courage necessary on the part of an interventionist.
Although a background in addictions and human behavior is essential, the normal aims and methods of individual, group and family therapies are insufficient.
The amount of training, experience, skill and supervision among people doing interventions varies considerably, and it is difficult to evaluate an interventionist's qualifications or performance.
So when meeting an interventionist for the first time, inquire about how long he or she has been doing interventions, about how he or she conducts interventions.
Develop a sense of whether or not the interventionist knows what he or she is doing. Follow your instincts; you will know.
How urgent is my situation? The driving force in many interventions is urgency and safety. Do you need to act immediately to save the person's life, or is this an ongoing problem that does not pose an immediate threat? The answer often determines what actions can be taken.
For example, an elderly couple slowly drinking themselves into the grave is not in as urgent need as a man on a binge with the car keys in his hand.
A family dinner where adult children gather to speak reasonably to their parents about going into treatment could get the attention of the elderly couple, whereas nothing short of an arrest for drunk driving may stop the man on a binge.
Thinking about the level of urgency prior to the initial meeting with the interventionist will make the meeting more productive.
What should be the objective of the intervention? The relief of suffering is the underlying agenda of any intervention. Changing the self-destructive behavior at the root of suffering is always the focus regardless of the form an intervention may take.
Nearly all families begin the intervention process in the same basic stance: "A person in my family is drinking too much. I worry he will have an accident and die. I want him to stop drinking so he will be happy and the rest of us can stop worrying. Nothing we have done so far has done any good. An intervention is our last hope. Will it work?"
An immediate objective of most interventions is to have the drinker accept help of some sort - detox, residential treatment, outpatient treatment, AA, therapy or some combination of these. The classical model often defines treatment for the drinker as its primary objective.
Sometimes a family can readily understand how changes in their own attitudes and behaviors can be a powerful influence on the drinker and are willing and able to invest time in their own education and treatment.
When this happens the objective of the intervention is broadened into having everyone in the family (including the drinker) accept help of some sort -- education, self-help groups, therapy and other forms of appropriate treatment.
Who should participate in the intervention? In the classical intervention, everyone who is meaningful to the drinker is a candidate for inclusion in the intervention. For a family systems intervention, anyone who is affected by the drinker's behavior is a candidate for inclusion.
Elderly family members are sometimes not included because of their health or from a desire to minimize stress for them. This is often a mistake and serious consideration should be made to include them whenever possible.
Children are also powerful members of the family, and although they should be protected at all costs, they often can be participants in an intervention to everyone's benefit including theirs.
Furthermore, the process is not dependent upon the number of people. Successful interventions can occur between a husband and wife or parent and child with little or no involvement from anyone else.
How many people actually participate depends upon many factors; geography and other practical concerns must be considered. If the family is dispersed around the country and some members cannot afford to attend, the intervention can still be conducted.
How should I handle angry, hopeless or reluctant family members? Always discuss with the interventionist the most realistic and practical approach to use. Do not make decisions about these matters prior to this discussion; the interventionist may have some helpful ideas.
Sometimes people are too angry, too hopeless or too frightened to participate in an intervention. Other family members may want to be there to show support but are truly not interested in learning very much about the situation or in discussing how it has affected them.
Still others may be willing to do whatever it takes, within reason, of course. And still others are very aware that the problem is much larger than just one person and that everyone needs long-term sustained help. It is not uncommon to have all these positions present at the same time in the same family.
How can we intervene when my family lives all around the country? During the initial stages family members often use the mail, phone and email to communicate with each other and with the interventionist. Sometimes they can only come together for a day at most and preparation work by phone or fax is the only option.
Other times they can come together for a long weekend (3-4 days) and can take advantage of all the benefits of face to face communication.
Sometimes a family member cannot participate fully due to schedule commitments, cost of travel or for other reasons. These situations can be accommodated also. People who cannot be present sometimes write letters that can be used quite effectively.
How much time will be required of the participants? The minimum time investment usually involves two or three sessions with the interventionist, the time spent on intervention day, and a follow up session. Sometimes this can be reduced even further.
As a practical matter, however, interventions should be viewed as a long term process requiring a rather large time commitment. Discuss this with your interventionist.
Families often use the intervention process as an opportunity to educate themselves about the illness, to develop an understanding of their role in the drinker's problems, and to formulate and execute treatment plans for themselves.
Occasionally a family will decide that they want the support of extensive family therapy for the educational and emotional support they need to make the changes in all their lives.
How much elapsed time does an intervention take? A normal time period is in the range of two to three days to several weeks preparation time prior to intervention day, and as much time as necessary after that. This can vary considerably.
Where will the planning meetings and the intervention take place? Meetings among the family members, with or without the drinker, can take place anywhere that makes sense including the drinker's home, the interventionist's office, a friend’s home, a friend's office, a church, a hotel room, anywhere at all.
What kind of treatment works best? There is debate about what kind of treatment works the best. There are choices between inpatient treatment, outpatient treatment, AA, and of course the "nothing but the person's change of heart" approach. An argument can be made for almost any of these treatment approaches.
Sometimes it will be obvious which approach is more suitable. For example, if the person is in an acute crisis, inpatient care is more than likely advisable. Cost considerations also drive treatment decisions. The interventionist could favor one approach over another.
Again, your interventionist has a broad range of knowledge of the treatment resources available. Be open and discuss all these considerations.
TO REMEMBER Hope, ambivalence and fear are common for many people embarking on an intervention. An intervention can sometimes be quite stressful. Remember the fundamentals.
First of all, no one can predict with certainty how someone will react. Acceptance, anger, relief, hope, confusion are all usually present to some degree, and sooner or later each will emerge. How each will manifest prior, during and following intervention day varies considerably.
Second, reduce your investment in the outcome of what occurs on "intervention day." Remember that intervention day is only one part of the process. Intervention truly starts with the first inquiry for help and lasts well beyond intervention day.
Family and friends continue to learn and change for months and years. It is this knowledge and change that, in the long run, not only help family and friends maintain perspective and resolve, but may also help the person to take the matter seriously and to focus on accepting help.
Finally, the intervention is always done with love and respect. And no matter what happens on intervention day, it will most certainly get the person's attention. If the person refuses to do what is requested, he/she nearly always changes for the better in some way, usually by accepting some form of help later: either later that same day, the next day, the next week, or the next month or two.
In short, it will never be business as usual again for anyone.
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