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.”