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By Daniel A. Linder, MFT
An intervention is a step-by-step process that gives significant others the opportunity to confront their loved one about his/her addiction and the impact it's having on them, and to be an impetus to seek treatment or help. Above all, it's a process that gives the family an opportunity to have the pink-elephant conversations that have long since been avoided, and to speak candidly — being honest and real with each other, perhaps for the first time ever.
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:
It's the job of the interventionist to keep the process moving forward, everyone focused and on track.
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 are also 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 the addict 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? The intervention will fail if the addict doesn't take the significant others seriously or doesn't believe they will follow through on their ultimatums. If they're acting codependently, s/he will respond accordingly — resume using and continue to use until s/he absolutely has to face the consequences of the 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. The goal is to unite the family in a team effort.
Perhaps the most important part of the intervention 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 fixate on the addict as the only one who needs help and treatment.
Wherever there is an addict, there is a codependent. There is always someone feeding the addict and someone being fed by the addiction. 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.
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.
The disease concept provides a solid foundation on which to build. Addiction needs to be explained as a human phenomenon — an emotional involvement with a means of relief, and as a relationship, not a disease per se. We can better understand the emotional and psychological dynamics and behavioral effects: loss of control, powerlessness, becoming obsessed and consumed, being in denial and rationalizing these behaviors, as well as dealing with the weight of shame associated with the addiction.
To be deemed a disease, pathological dependence, or pathological relationship, the following conditions must apply:
The relationship is primary. The relationship with the means of relief becomes a secret lover — the addict's primary relationship, rendering all other relationships secondary. The addict's life revolves around this relationship as if it were a top priority, rendering all others peripheral.
The relationship is progressive. Over time, the addict is becoming more addicted and the relationship more entrenched, and we see 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 without the looming risk of relapse. There will always be susceptibility and vulnerability to relapse.
The chemical effect is irreversible. That is, it 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 is 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.
Loss of control. The first two of the 12 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. 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. We see a shift in their relationships: limiting relationships only to those that accommodate the addiction, and withdrawing from those that do not.
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 the addiction and from recognizing that s/he needs to seek help.
The codependent may perceive the addict as needing or deserving special accommodations — either because on some level s/he feels responsible for the situation the addict is in, or believes that s/he could somehow change it for the better (that is, get him/her to stop), or else the codependent thinks the addict needs him/her, couldn't make it without him/her.
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.
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 favorably 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 or her childhood. She can't be addicted, she's 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 or 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 counselor extracts specific information — irrefutable evidence — that becomes the scripting to be rehearsed.
Every participating significant other recalls events and situations that impacted them in a big way. Common examples include: an argument in which the addict behaved irrationally; exhibited angry and threatening behavior; 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.
During recollection, the significant others usually see how ineffective or exacerbating their codependent perceptions and communication were in those situations. They begin to see the difference between those perceptions and their perceptions when they are more objective and detached, and how much more effective they could be if they made the addict responsible for him/herself. They will learn to distinguish between codependent and natural responses to seeing a loved one in peril, even self-destructing.
After everyone is clear on what happened — what they saw their loved one do that rang loud alarm bells, and the ways their relationship with their loved one was impacted (lies, broken trust, disconnection, loss of the relationship they had, etc.) — the next step is rehearsal and action planning.
The participants need ample time to practice what they're going to say, how they're going to say it, and to get comfortable within themselves to speak their truth from their hearts. The key is to make sure their love gets expressed — how much they care, how much they value the addict and their relationship with their loved one.
You must always be assessing the participants' physical and emotional readiness for the rigors of the intervention and ability to be outside their comfort zone. 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 for the counselor to decide that a significant other is not fit to participate in a productive manner, and therefore must exclude him or her 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 the tone or content of communication during the rehearsal phase. Rather than being objective and holding the addict accountable for the consequences of the addiction, the codependent will feel sorry or make excuses for the addict and remain in an unalterable rescuing mode.
Once you're confident the family is ready for showtime, the next step is going to be challenging — nailing down the plan. Beginning with the communication that informs their loved one that they want to have a family meeting, and how they're going to introduce me as the counselor who will commandeer the process. All the logistical details must get hammered out: the dates and times that must work for everyone is often a bumpy process. Then the treatment plan itself must be laid out — selecting the treatment facility, ideally a Plan A, Plan B, and Plan C that will be awaiting the addict's arrival — and answering any other final questions. That is, Murphy's Law: whatever can go wrong will go wrong.
Usually determining whether the intervention was successful or not is a matter of whether their loved one ends up in treatment immediately following the completion of the process. Earmarks of success: the family's influence in their loved one's decision to pursue treatment, that they convey consistent messages explicitly or implicitly, and present a solid, unified front that serves as a reality check against the addict's masterful denial.
Some examples of family messages:
At the arranged time and place, with the addict present, the significant others will proceed with the intervention. The hope is that the addict — their loved one — is humbled by the process, feels the caring, and recognizes there is a problem that needs to be reckoned with. That is the point where treatment begins.
However, even if Murphy's Law goes into effect and for some reason the addict doesn't go immediately into treatment, it's still a no-lose situation. The long-term effects of the intervention on the family and everyone who participated, including the addict, may not manifest until long afterward. Anyone, at any time thereafter, could have a revelation.
Effective interventions require commitment from both the individual and their support system. While this intervention achieved emotional connection and clarity about the problem, long-term recovery depends on collective action, continued therapy, and the loved one's internal motivation to change.
The family must recognize that addiction recovery is a shared process, not solely the addict's responsibility. Without ongoing family therapy and mutual support, the risk of relapse remains high.
"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 one has to say, and when they're done, you'll have a chance to respond."
"I feel sad, powerless, shocked, and angry when I look back on the relationship we used to have, the kind of person I remember. Those memories are in stark contrast to where you are now, and that 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, the 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 10 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. You weren't showing up; your boss called 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 best interest 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. I doubt that if you weren't drinking you would 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 you were quite hung over that next day, in an extremely foul mood. I had never seen 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. I'd like you to be moving to greater independence, get a job that you keep, and for us to be a family again. The only way I can see this happening is by your getting some help in remaining clean and sober."
"I feel I've lost you, and I 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 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, the 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 — some yard work for you to do, so that you could 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 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, becoming 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."
"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 your 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 at Lake Coeur d'Alene, 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 Naval 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 to 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 because you never got out of bed to make it 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."
"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 believe 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, but I still did not kick you out. Instead, I gave you yet another chance in hopes that you would rebound on your own.
Since then, you got a job and are still working as a junior varsity ref. You told me yourself that in order for you to be able to make it to the games on Saturday mornings, you would have to refrain from drinking and partying the night before. It was only this past weekend that you missed Saturday's games because you were unable to get out of bed, as you were out late partying the night before.
So where I am right now is, after all of the fighting that had taken place between us over the last several weeks, I've grown afraid of your angry outbursts and swearing. I've lost the trust, respect, and love that were there before all of this and wish were still there. I'm fed up and reached my limit. I can no longer tolerate this living situation. It's not good for me, our relationship, or you. I want to like you again and be able to support you. It's clear to me that the only way you could continue living with me is if you go into treatment. Right now, you are not able to adhere to the rule that you do not drink alcohol or smoke pot on the premises ever. You cannot interview, get, or keep a job. The situation has gotten far worse than you realize or can admit. However, I love you, always loved you, and will always love you — but I'm not going to want you in my life living in my house until after you've gotten treatment."
The recollection phase of Nick's intervention was chock-full of examples providing indisputable evidence that Nick had severe alcohol and marijuana dependencies that severely impacted his life and relationships. Each significant other was relieved to have the opportunity to address his or her longstanding concerns openly and directly to Nick. This process was not only self-affirming — it also gave them each an avenue to express their genuine concern and love.
The events they highlighted included a deterioration of relationships (lack of contact and withdrawal), a history of substance abuse problems with previous treatment attempts, numerous hangovers that resulted in lost jobs, missed opportunities, appointments, and family gatherings, other instances of irresponsible behavior, embarrassing and abusive outbursts of anger when under the influence, times when he had been sick (vomiting), and finally a loss of respect and trust that characterized their perceptions of Nick.
It is easy to see that the events discussed were powerful and the implications self-evident. Nick's significant others made it clear that treatment was necessary, that changes needed to occur, and that there would be consequences if Nick didn't get the help he needed. They also put other rules in place to which he would have to adhere if he wanted to continue living with his aunt.
When Nick had a chance to respond, he initially expressed resentment at having been lied to, set up, and attacked. But after a while, he seemed to recognize that the intervention was long overdue, that he did in fact have a substance abuse problem (which he had minimized or underestimated), and that there was pain associated with the deterioration of relationships with the people in his life whom he loved. He acknowledged that he didn't want to hurt or disappoint these significant others, nor did he wish to remain estranged from them. Everyone who participated in the intervention ended up in tears. They had finally been able to connect, to express genuine caring, and achieve a mutual understanding that hadn't occurred for several years, if indeed ever.
Despite these positive factors, however, the prognosis afterward was guarded. While some of the objectives had been accomplished during the intervention, others were not.
What was accomplished was an emotional outpouring and a family that had been broken apart coming together again. Prior to the intervention, no one had discussed these events, how they were affected by them, and specifically what they expected of Nick now that his problems were clearly identified. They were no longer attributing his problems to other causes or making excuses for him as they had done in the past. The theme and emphasis on continued sobriety was a clear-cut bottom line, which helped significantly in terms of Murphy's Law. The family had laid out their priorities and requirements: continued sobriety, getting a job and/or going to school, and ongoing treatment.
In this case, Plan B or Plan C might never come to fruition. Plan A, on the other hand, could — sometimes. Despite a well-executed intervention, sustained benefits and recovery ultimately rest on the whole family continuing in recovery. Follow-through on everyone's part is a Murphy's-Law risk factor. It is impossible to control complex and dysfunctional family dynamics, and deeply entrenched codependency undermines the family's stated commitment to Nick for treatment and follow-through as necessary.
Continued family therapy sessions, which would provide ongoing support and therapy to the whole family in recovery, were recommended but declined. There were severe marital issues between Nick's parents. Their marriage was in fact over, although they continued to live together for the sake of convenience. Tremendous hostility seemed to rage beneath the surface, and they continued to blame each other for Nick's problems. Continued family therapy was out of the question because they would have to be in it together.
Given that Nick had already been in treatment before, there was a pervasive sense of hopelessness, a sense of the inevitability of defeat, with the family thinking that no matter what they did, Nick wasn't going to ever stop smoking marijuana. Nick seemed to accept that alcohol was indeed a serious problem, but he didn't make that same connection with his dependency on marijuana. He didn't see that marijuana had caused any of the negative recollected events.
Moreover, there wasn't a consensus in the group that Nick needed treatment, nor that he would respond to treatment. Nick's significant others believed instead that what he really needed to do was take responsibility for getting his life back on track — that is, get a job and/or go to school — even though he would not be able to do so until and unless he was actively on a path to recovery. Perhaps most noteworthy was that the family had not embraced the notion of being a family in crisis, a family needing recovery. In their minds, Nick was the one with a problem needing treatment, not them.
In regards to Nick's intervention, the prognosis remains guarded because Nick didn't have the insight or clarity to accept that he had a problem, that he needed help, or that he could benefit from help. He needed his family to get that across to him, not just by talking about having a problem, needing help, benefiting from help, etc., but by their actions. While there was agreement that he would pursue 12-step support and seek outpatient therapy, the actual follow-through never translated to either action or duration.
We have to conclude that the operative word in our title, "Mastering the Art of Intervention," is, in fact, art. Mastering doesn't mean that every intervention goes according to plan. When people adhere to the guidelines, most of them end the intervention with their mission accomplished, and the addict ends up in treatment.
What happens after that, however, can vary. An addict's family might agree in principle that it is not just the addict with a problem who requires treatment and aftercare support. They might in fact understand that it is the whole family that requires services. But in the period between the end of the intervention and continuing care, there is nearly always one thing or another that gets in the way. They procrastinate their involvement in treatment or revert back to old behaviors.
When this happens, the burden of responsibility in taking ownership of the addiction falls solely on the addict's shoulders. Whether the addict realizes that s/he has a problem and is motivated to seek support to resolve it depends on being internally motivated, on having an inner purpose. Some people fortunately realize that they want recovery, a higher quality of life, and to be healthier just for themselves — regardless of whether or not significant others are on board.
Daniel A. Linder is a licensed Marriage & Family Therapist, a Self and Relationships-based therapist and Addiction specialist with more than four decades of experience with individuals, couples and families. He can be reached by email at dlindermft@gmail.com.