What is an Intervention?
An intervention is a step-by-step process with a specific purpose: to give significant others the opportunity to confront their loved one about their addiction and the need for help and treatment. Above all, it’s a process by which family/friends can learn to talk to each other, to be honest, real and direct, while at the same time expressing their care and concern for the addict. It is usually a last resort when all other efforts to address the problem have proven ineffective and significant others don’t know what else to do.
Intervention (not to be confused with clinical interventions) is an orchestrated or facilitated process that requires an extended session (or sessions) during which the family trains for the ultimate conversation or confrontation.
During the final culminating session, the alcoholic/addict (a/a) is present to hear what his/her significant others have to say. The family describes disheartening, disappointing, embarrassing, sometimes frightening scenes that occurred because of the addiction. They further tell the addict how each person was and still is affected, and present him or her with a proposal or ultimatum to get help – or else.
An intervention can take place anywhere, at any time (at the practitioner’s office, a significant other’s home, the workplace, hospital, a restaurant, etc.), but it must occur face-to-face.
Each intervention comprises five phases, each of which has specific objectives that must be achieved before proceeding to the next phase:
I Initial Contact & Assessment
IV Rehearsal & Action Planning
The basic premise of the intervention – the assumption that reality, caring, and leverage will be enough to convince the loved one to get help.
I. Initial Contact & Assessment
Intervention begins at the point of initial contact from a family member or significant other, which usually takes place on the telephone. The interventionist is in assessment mode the moment s/he answers the call, ready to conduct a screening interview to determine whether an intervention is the way to go.
Before deciding to proceed with the intervention, there are specific criteria to consider.
There must be a sufficient number (ideally more than two) of significant others available who not only possess the necessary leverage, but also are functioning well enough to handle the rigors of an intervention. Leverage is the edge when an edge is needed. We know, going in, that true caring and indisputable evidence are not going to be enough to penetrate the walls of denial. This can only be accomplished through the threat of the imminent loss of something substantial, something the addict is dependent on, that is life-threatening and life-disrupting. This is what forces him/her to face life in a way s/he isn’t accustomed to doing. Usually the addict is dependent on his or her significant others for something (shelter or financial support), but had up to that point taken that support for granted, had been blinded by denial or had continued to be the recipient of the support without having to do anything to deserve it.
The significant others, by virtue of their ability to communicate clear and consistent messages, force the addict to choose: treatment, or else. The family must be ready to be tested by the addict. What happens if the addict chooses not to comply, not to enter treatment? How will the family respond if the addict fails to stay abstinent or adhere to other stipulations after treatment? Will they follow up with a plan, take appropriate actions?
Chances are great that if the intervention will fail if the addict doesn’t take his significant others seriously or doesn’t believe they will follow through on their ultimatums, it will not achieved its desired outcome. If they’re acting co-dependently, he or she will respond accordingly, resume using and continue to use until s/he absolutely has to face the consequences of his/her addiction.
As long as there is a sufficient number of willing and able significant others who possess the requisite leverage, the next step is to proceed in setting up a meeting with all participants – except, of course, the addict.
Expect there to be a great deal of shame, embarrassment, avoidance, denial and lack of understanding about what it means to be an addict and how to respond effectively.
The clinician or interventionist begins by reviewing some of the aforementioned information regarding the chosen strategy and what to expect during the course of the intervention. S/he addresses issues of shame and embarrassment, avoidance and lack of understanding. The goal is to unite the family in a team effort.
Perhaps the most important part of the process is not only to educate, but also to inspire the family to embrace the pursuit of recovery as a family and not allow them to isolate on the addict as the only one who needs help and treatment.
The key areas of psycho-education encompass information on the disease of addiction, on codependency, and on stigma.
The disease of addiction is defined as a “pathological dependence.” What that means is that there is an overpowering attachment, a “pathological” relationship established – an indestructible bond of survival-based proportions – on a source of relief. That source of relief can be either a chemical or an activity.
Why someone becomes an addict is not nearly as important as what happens once one is addicted, and how one can find the necessary course of action.
The disease concept provides a solid foundation on which to build. Addiction needs to be explained in terms of physiological processes and emotional dynamics, i.e., loss of control, powerlessness, becoming obsessed and consumed, being in denial and “universalizing” these behaviors, as well as dealing with the weight of shame associated with the addiction.
In the early 1950s, the medical establishment officially defined alcoholism as a disease, a pathological dependence, implying a physiologically based craving. A pathological dependence is also a pathological relationship.
An addiction is an established relationship, one that has emotional as well as physical implications. The relationship is with a source of relief. In many respects, it’s like carrying on a secret love affair. The addict’s need to relieve pain is the underlying force driving the addiction.
The backlog of emotional pain may be the primary predisposing condition for becoming addicted in the first place. A lack of emotional nourishment in family-of-origin relationships (and, for that matter, all other relationships in the addict’s life) is an ongoing theme. And the addiction is yet another non-emotionally-nourishing relationship in the addict’s life, one that causes additional frustration (even while it temporarily relieves frustration), and providing temporary relief while causing an even greater backlog of pain. Over time, the addict feels increasingly worse overall than he or she did prior to becoming addicted. This is how an addiction takes on a life of its own and feeds on itself. It’s been said that the addict is his/her own “doctor of death.”
To be deemed a disease, the following conditions must apply:
The disease is Primary. The source of the addiction has become the addict’s primary relationship, more powerful than any other, more important than anything else. The dependency becomes an overpowering force in the addict’s life, while the other relationships become less of a priority and more peripheral. The addict must first stabilize (must achieve sustained sobriety) before any other problem, symptom or issue can be effectively treated.
The disease is Progressive. Over time, the addict is becoming more addicted and the relationship more entrenched. Generally, there is a steady course of deterioration, functional impairment and mounting problems in all facets of life (including mental, emotional, physical, spiritual, academic, occupational, and relationships with family and friends).
The disease is Permanent. The saying, “Once an addict, always an addict,” is true. The general consensus is that the addict never was and never will be able to use the substance or engage in the activity in a controlled or recreational manner. There will always be susceptibility and vulnerability to relapse. The chemical effect is irreversible; that is, will forever loom as an extraordinarily powerful need-gratifying agent that provides extraordinary relief. There is no way to undo its potential to hook the addict all over again. This why the addict could be clean and sober for any number of years, then “have a drink” only to discover, after a matter of days, that s/he is as much or more involved with (the substance or activity) and out of control than ever before.
Depending on how much time there is to educate the significant others about the disease, the interventionist may also elaborate in an effort to further their understanding. S/he could shed light on the emotional and psychological components of the disease of addiction, as there are subtleties and nuances that make it different from a purely medically oriented disease. Another consideration is whether it will pay, with this particular group of significant others, to go into greater depth. Sometimes less is more: keeping things simple, rather than complicating them, may be advisable.
Loss of Control
The first two of the Twelve Steps are accurate: by the time the addict needs help, powerlessness and unmanageability have already set in. Recognizing these facts marks the first steps in the recovery process. The addict has become powerless, has lost control despite whatever consequences are entailed in that loss. Addiction is commonly believed to manifest by an obsessive-compulsive behavior pattern. The addict becomes obsessed and consumed by the need for the substance or activity – it’s first and foremost in the addict’s consciousness. “Scoring,” getting high, maintaining access to whatever provides relief: this is what has become the centerpiece of the addict’s motivation. The addict behaves in ways that are uncharacteristic of him or her because of the addiction. There is also a shift in relationships that occurs, as the addict tends to limit relationships to those that accommodate the addiction, and withdraw from those that do not.
The Interplay between Dependency and Denial
Assuming probability, the pathological dependence begins at the point of discovery. Discovery refers to the first or second time a user discovers a source of easy and immediate – extraordinary – relief, becomes “hooked,” and has no awareness of being hooked at this early stage of the process.
The moment the addict becomes dependent on a source of relief (i.e., a substance or activity such as pornography, sex, or gambling), denial kicks in. Denial is a defence system that has at its disposal a wide range of weapons that protect and preserve the dependency by eliminating internal and external threats or conflicts of interest. It obliterates any thought, concern, fear or recognition of resultant problems, (i.e., health-related, family, occupational or legal problems). It blinds the addict to behavior that is out of character, that compromises his or her values or morals.
Denial is always operating in the interest of the dependency. As the dependency progresses, denial progresses, developing more elaborate and sophisticated defences as it is forced to contend with mounting problems (conflicts of interest). The addict has no idea that s/he is hooked – that s/he has become pathologically dependent. He or she is oblivious to the extent of his/her involvement, the loss of control; the addict either doesn’t see problems mounting or doesn’t attribute his/her problems to addiction. Denial renders the effects of the addiction ego-syntonic; that is, there is nothing happening that is out of the ordinary, no cause for alarm.
The illusion of choice as it relates to control is woven into his/her self-talk, the addict’s inner dialogue. The addict believes, “I can control it if I want to.” “I can stop if I have to.” “As long as I maintain control.” “Why not (choose to) feel better about everything, myself, my relationships, my life?”
Dependency and denial occur and begin simultaneously, are equal and synergistic; that is, the dependency is as strong as the denial is effective; the denial is as effective as the dependency is strong. Denial operates to protect and preserve dependency at all times and at all costs.
“Wherever there is an addict, there is a codependent.” There is always someone feeding the addict and someone being fed by the addiction. Wherever there is an alcoholic, there is a codependent inadvertently supporting the addiction in collusion with the addict. In effect, the codependent is going down with the ship. His or her caretaking prevents the addict from bearing the full consequences of his/her addiction and from recognizing that he or she needs to seek help. The codependent may perceive the addict as needing or deserving special accommodations, either because on some level he or she feels responsible for the situation the addict is in, or believes that s/he could somehow change it for the better (i.e., get him/her to stop); or else the codependent thinks the addict needs him or her, couldn’t make it without him or her.
If there is a relationship in which one person is sick or pathologically dependent, then the relationship as a whole is sick, and both people are in denial. These are key distinctions. It will make a huge difference to the addict if the significant others are seeking help for themselves as well as for him/her, as opposed to repeating enabling behavior. This way, the burden of shame is shared by everyone.
Codependent significant others are driven by their own unmet and unconscious emotional needs. Codependents need to be needed, need to control; it is their focus on the addict that helps them escape their own pain. They are more caught up with other people’s needs, wants and feelings than with their own.
Codependency usually makes for a distorted sense of boundaries. Codependents don’t know where they end and the addict begins. The “co-” in codependent implies “together as one,” dependent on each other, merged with each other, symbiotic (as opposed to inter-dependent, which involves two separate individuals coming together). They assume responsibility for others, take other people’s problems on as their own and derive satisfaction from believing that they are appreciated for their efforts.
Codependency is an addiction in itself. Codependent significant others are struggling, in pain, desperate for relief. Their rescuing efforts afford them the feeling, if only momentarily, of being appreciated, needed, or special, which is especially significant when such moments are few and far between. They get to feel powerful, feel they are making a difference – which compensates for their underlying powerlessness, for feeling like they never make a difference. It gives them an illusion of control when they feel like they have no control. They get to be heroes.
Despite the emergence of the disease concept, addiction still carries a huge stigma. A stigma is a visible or known attribute that relegates a person to a substandard or less desirable category of people. In the case of addiction, the stigma is not visible, but still known. The stigma labels the person as “defective,” branded as an outcast, as an example of what not to be. Whether people are aware of it or not, their tendency is to react with avoidance, indifference and disdain to anyone with a stigmatized condition. Internalized shame related to stigma is often the reason for secrecy, for not seeking or getting help, for trying to fix the problem alone. This applies to both addiction and codependency.
Stigma creates shame and the need to relieve or escape that shame, and therefore feeds denial. The tendency is to see things more favourably than they actually are, to lose objectivity and to somehow avoid the issue altogether. “Nothing is wrong.” “We don’t need help.” “It’s not the addiction. It’s the job, the school, the pressure, something happened, his/her childhood.” “S/he can’t be addicted; s/he is not that type of person.”
In our society, there is not only a stigma associated with having an addiction, but also with having any kind of mental/emotional problem and with needing/reaching out for help. This applies to both addicts and codependents. It is also not at all unusual for therapists and treatment practitioners to suffer the loss of objectivity, at which time, their ability to identify and discuss the possibility of an addiction can be hampered.
Recollection is the process by which the counsellor extracts necessary information, specifically irrefutable evidence of the problems related to the addiction. This information will later be used to break down the addict’s denial during implementation.
Every participating significant other recalls events and situations through which they have been profoundly impacted in some way (i.e., have been angry, hurt, disappointed, or shocked). The recollection may refer to an argument during which the addict behaved irrationally, exhibited angry and threatening behaviour, was unable to function, failed to show up, developed health problems (got sick or lost weight), was hung over, or was lying or asked them to lie for him/her. All of these are common examples.
During recollection, the significant others usually see how their (codependent) perceptions and communication further exacerbated the situation. They begin to see a difference when being more objective and detached, and how much more effective they could be by making the addict responsible for him/herself. They will learn to distinguish between codependent and natural responses to seeing a loved one in peril, self-destructing.
IV. Rehearsal & Action Plan
After concrete, irrefutable evidence is presented, the next step is rehearsal and action planning. The participants must be given ample opportunity to practice what they will be saying to their loved one, and how they are going to say it. When they have rehearsed sufficiently, appear clear, confident and ready to proceed, it’s necessary to go over the details regarding implementation.
One of the main challenges during Rehearsal is balancing objective reality with heart. It’s teaching the family to be to the point, clear, concise (non-tangential) and accurate in terms of what took place, how s/he was affected, followed by statements regarding future intent and impact to their relationship.
In order for the confrontation to be effective in influencing the addict’s decision to pursue treatment, they must convey consistent messages (explicitly or implicitly) and present a solid, unified front that serves as a reality check. An intervention is, among other things, an all-out assault on the addict’s denial. These messages may be expressed in words and can come across non-verbally, (i.e., by a show of emotion).
“(We) are here because we love and care about you.”
“You are screwing up your life and ours.”
“(We) are and continue to be affected by your addiction.”
“(We) are not going to continue standing by helplessly while you self-destruct.
“(We) must be honest with you and ourselves (more than we were before). You need help.”
“(We) will be there for you, love and support you and will you the help you need.”
“It’s time you took responsibility for yourself and get the help you need.”
“If you don’t (stop using and go into treatment), I don’t want to be a part of your life or be around you. I will not support your self-destruction.”
After the significant others demonstrate their ability to communicate the facts in a clear, direct, honest and caring way, the counselor can proceed to action planning, which includes logistics, i.e., date, time, place; reviewing the order of events and the content of their communication; what they are going to say to the addict (trick or mislead the addict) in order to get him/her to the intervention; identifying the treatment facility (if possible a “Plan A,” “Plan B” and “Plan C”) that will be awaiting the addict’s arrival; while taking any other final questions in consideration Murphy’s Law – “Whatever can go wrong, will go wrong.”
During action planning, it is not at all unusual to encounter one or more family members having reservations about lying, deceiving or misrepresenting information to their loved one; doing so goes against their principles. As long as they understand why they have to surprise the addict, that they don’t want him/her to have any prior knowledge or ability to mobilized a defense, they’ll more likely proceed with greater peace of mind. The idea is that the ends really do justify the means.
It is usually during the recollection and rehearsal/action planning stages of the intervention that the significant others go up against their codependent tendencies. The concept of, “It’s not your problem. You didn’t cause nor can you control the addiction,” is particularly challenging. Recognizing their limitations bursts the bubble of their sense of inflated importance.
The counselor must also determine whether the significant others are physically and emotionally ready for the rigors of the intervention. It’s better to know sooner than later if there is potential for a member to sabotage the process. It’s not at all unusual to exclude participants deemed unfit from participating. This happens, for example, when encountering a significant other driven by codependent needs, whose communication is laden with pity or guilt and who just doesn’t seem able to adjust his or her tone or content of communication during the rehearsal phase. Rather than being objective and holding the addict accountable for the consequences of his/her addiction, the codependent will feel sorry or make excuses for the addict, and remain in an unalterable rescuing mode – at which time he or she, not the addict, becomes the center of attention.
Another problem is family members’ inability to trust the process or align with the basic premise of the intervention – the assumption that reality, caring, and leverage will be enough to convince the addict to seek treatment. Sometimes there are other issues or stressors that keep the significant other from being able to focus, such as a tendency to go off on tangents. It is possible to have to exclude a significant other due to physical weakness or frailty; others must be excluded because they just doesn’t understand or are too upset themselves (because of having as big or bigger problems than the addict). Needless to say, it is the addiction and need for treatment that must be the focus of the intervention. It’s the job of the interventionist to keep the process moving forward, everyone focused and on track.
At the arranged time and place, with the addict present, the significant others will proceed to address him/her directly. The hope is that s/he is moved by the expression of love, they break through denial, that s/he accepts his/her need for help, and (ideally) go immediately into treatment. This is where treatment begins.
What usually happens is that the interventionist first takes a moment to introduce him/herself and set up what is about to occur, and establish the purpose and some of the rules. For example, “I’m John Doe, counselor. Your family sought my help to address their relationship with you. They just want to talk to you about their concerns. We’d like you to just listen to what they have to say, and, when they’re done, to hear from you. Whatever reactions you have, you’ll need to wait for them to finish.”
Despite having rehearsed the process, once the addict is present, the level of tension in the room is heightened substantially. The counselor knows that the intervention is likely to be successful the first time the significant others communicate clearly and directly and the first time the addict listens and hears what they are saying. While at the start the tension may be extremely high, by the end there is tremendous relief and a sense of accomplishment.
One obvious measure of success is whether the addict ends up in treatment; since that is the stated goal. However, even if Murphy’s Law occurs, and if for some reason the addict doesn’t go immediately into treatment, the intervention is, by no means a failure. The long-term effects of the intervention on the family and everyone who participated, including the addict, may not manifested until long afterward. Anyone at any time thereafter could have a revelation. Delayed effects are not at all uncommon. For example, the fact that they acted, did all they could and did not stand by helplessly in denial is something the addict might appreciate long after the fact.
Case Example/Nick’s Intervention (Implementation)
I. Counsellor's Introduction
“Your family sought my services in an effort to talk about what’s been happening, to come together as a family. Each person here has things they want to say to you. We’d like you to just listen to what each has to say, and when they’re done, you’ll have a chance to respond.”
II. Jennifer (sister)
I feel sad, powerless, shocked and angry when I look back on the relationship we used to have, the kind of person I remember, which is in stark contrast to where you are now, and which leaves me wondering what happened. Now we’re pretty cut off from each other. I miss that person I remember, the person you used to be: sweet, loving, carefree, helpful, and talkative; they way you were when we played and hung out together.
It’s become clear to me that your problems with alcohol and pot contributed to the changes I’ve seen take place over the course of the last ten years. One of the memories that sticks out is when you were living at home with Mom and Dad and you were working for a moving company, when you were not showing up, your boss calling to find out where you were. You were out drinking the night before and you lied about having the day off to Mom and Dad. I thought about covering for you, but I decided not to, that it wouldn’t be in your or anyone else’s best interests to do so. You woke up wasted or hung over. You ended up losing the job for not showing up, on more than one occasion. No doubt, if you weren’t drinking, you would not have gotten fired. It was downhill from there.
Another memory that really bothers me was back in October when I saw you at Aunt Barbara’s house. You were so angry, scaring both Barbara and me, losing your temper like that. You were intimidating, out of control and disrespectful. My recollection is that you had been drinking the night before and was quite hung over that next day, in an extremely foul mood. I never saw that side of you, which I doubt would have come out had you not been drinking at the time.
At this point, I want to rebuild trust, have a better relationship, see you more often like we used to, be moving to greater independence, get a job that you keep, and be a family again. The only way I can see this happening is by you getting some help and by remaining clean and sober.
III. Winn (mother)
I feel I’ve lost you and want you back in my life again. I want to be in your life in a positive way. I realize I’ve made mistakes and I regret them. I wasn’t there for you in a way you needed me to be. I feel I’ve I failed you as a parent. I wish it were different. I wish I was a better parent. I don’t think I knew how to parent. But I did the best I could. Despite my best efforts, I feel I’ve lost you. But I haven’t given up.
I’m disappointed how our relationship turned out. The last time I remember affection between us was when you were five years old, putting your arms around me.
As much as I might want you back in my life, in our lives, it’s become apparent that it’s not going to happen or cannot happen they way things are for you right now. I see you at a standstill and heading in an unproductive direction.
I can go back to as recently as December, when I came to Aunt Barbara’s to give you a job—so much yard work for you to so—so that you cold earn some money, perhaps pay for your own car insurance—and how you blew up at me. It was noon and you were barely out of bed. I was shocked and hurt to hear you swearing like that and how resentful you were about me sending you to treatment at Serenity Lane, when I was only trying to help you. I wanted you to build some self-esteem, not destroy it. You were hung over and in a bad mood. I doubt you would have blown up the way you did had you not been drinking as much as you had, to leave you so hung over the next day – you wouldn’t have blown up like that. You were downright scary and out of control. You never got to do the gutters.
I want to look forward to having an adult relationship with you, do things together, take you for a haircut, go to a movie or to lunch. I want you to feel more comfortable being with me. I want to see you moving forward in your life, become independent and self-supporting, working or learning a trade, which I believe you are capable of doing. But it’s apparent that the only way that could happen is if you are sober, and achieve a sustained period of sobriety. I want to see you get the help and get your life back.
IV. William (father)
I know we have a long history, a lot of “water under the bridge” and probably neither one of us is happy about what happened, I wish I could do some things over again, but obviously I can’t.
As I’ve watched our relationship deteriorate over the years, I’ve gone from frustration to feeling like a failure, hopeless, helpless, guilty and burned-out. So many days I just tried to not think about you, to keep from crying, to get through the day. As I see it, everything we had to deal with, the car wrecks, parties, police stations, embarrassing situations, lost jobs, were related to you using drugs and alcohol.
I remember the coaching job you had that season with the JV Girls team, which I’m sure we both regret. There were issues related to being unkempt, smelling of pot and alcohol, making inappropriate comments, all of which resulted in you getting fired. A couple of years ago when we were on a family trip together in Lake Co, that night when you over-drank, were totally plastered and you started screaming, blew up, became belligerent. It was so embarrassing and painful to me that I decided right then and there that you had to get some kind of treatment. Shortly afterward you went to New Beginnings.
Then that job at the Lake Navel Shipyard with Joe Knight, a great job, a great opportunity—you had transportation provided. But when you repeatedly showed up for work stinking of booze, looking like a homeless guy and obviously in no condition to work, you got fired from that job. He didn’t want to but had no choice but to fire you.
Then most recently when you missed Christmas Eve Mass, something I looked forward together with the family, you went out drinking and never made it there. And the Colts game… having bought tickets for you and me to go together, you missed ‘cause you never got out of bed to make to the house, obviously too hung over. You couldn’t even call me to tell me you weren’t coming.
All in all, I see a pattern of irresponsibility, which is no doubt related to your use of drugs and alcohol. I want to see you doing something better with your life. I want you back more than ever, more than anything to have a better relationship. Do more things together, but I don’t see that possible unless and until you are sober and can sustain sobriety. It’s clear that you have a problem. You need help. I want to support you better. I want to see changes. I had to do something. I couldn’t take standing helplessly watching you continue to self-destruct. I’ve come to terms with the fact that my ability to support you, our ability to get our relationship back on track and you getting on a track in your life, all depends on you getting the help you need.
V. Aunt Barbara
When I first took you in it was to give you a whole new start, get some basic needs met, give you a place to live that would be better for you, less stressful, away from your parents; provide a bicycle, TV, transportation to work using my car so you could move forward in your life. I wanted to get to know you better and I believed that if given a chance you’d turn your life around. When you first moved in, your father had established the stipulation that you remain clean and sober, and you were supposed to get a job. Whenever I discussed substance abuse with you, you seemed to think it wasn’t a problem for you at all.
Within one month, it became apparent that our arrangement had completely fallen apart. We went to a therapist who tried to formulate a new contract for you to continue staying with me, which obviously never worked out. I was often picking up empty bottles of booze, had seen you throw up in the sink on more than one occasion. It appeared to me that you were going out every night drinking, sleeping all day, many days in a row, which made it impossible for you to look for work or work, and for you to contribute as you had agreed.
After lots of battling, you finally agreed to get a job. I was doing a lot of the work you were supposed to be doing. I was thrilled when you finally got that job at Home Depot. There was opportunity for advancement. You kept the job for about six weeks. After you were repeatedly late, called in sick several times while you were on probation—either hung over or in no condition to work, you were fired. There is no doubt in my mind that you were capable and would have succeeded had you not been drinking as much as you were and smoking pot as often as you do, which I believe is every day. I remember how devastated and embarrassed you were.<