What to Expect with a Drug/Alcohol Intervention

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It makes for dramatic television: the tough-love style intervention, where loved ones leverage the authority of a treatment specialist to aggressively confront an addict or alcoholic.

But is this effective? Is that what an intervention is in real life?

A Psychiatrist Weighs In

In this short clip, psychiatrist and addiction specialist Dr. George Northrup tells us that a couple of important steps are missing from the televised version. First, a kind and caring conversation, in which help is offered, should take place. This is a simple expression of concern about the person without any push toward action. If this doesn’t get the ball rolling, a second conversation, in which the harm an addict is doing to themselves, is next. He calls these two first approaches “friendly measures.”

Getting More Aggressive

In most interventions, the agreement of the addict to seek treatment is the goal. Without legal authority to enforce treatment, only the willingness of the person to take action can lead to any change at all. Getting that agreement isn’t easy, however.

Interventions are confrontational. The idea is to impose the will of a group of concerned acquaintances and loved ones on the addict. This is done first by planning the intervention with those who will be present, excluding the target. There are logistical matters – time and place – as well as information to pass along. What will be each participant’s role? What may happen and how should the group react? Will there be a professional there to guide the process and what is the ultimate goal?

Only when everyone understands his or her part should the intervention move forward.

The purpose of the confrontation is to present the addict or alcoholic’s behavior in such a way that he or she will be unable to deny it. The focus is on the harm the addict is causing him- or herself and others present. This is a very powerful tool based on the nature of peer pressure. Each person there (except perhaps the therapist) brings some influence, and it is the aggregate—when everyone is communicating the same message—that brings the most pressure to bear.

Practical Matters

According to the Mayo Clinic, after basic planning, the intervention team has to decide on specific consequences each will impose if the person decides not to seek treatment. These are often very serious, including moving out, denying support or cutting off contact.

It is also recommended that each participant write down what he or she will say to the target of the intervention. Having written material to refer to will serve as a structure and fallback when the intervention isn’t going well. Quite often, emotions rise and tempers flair. Having a document in hand to read from helps neutralize these outbursts.

The addict or alcoholic is invited to the meeting without being made aware of the purpose. There is an element of trickery here which has to be overcome right away. Usually, the meeting starts with a round robin of expressions of caring and concern. After this, the loved one is offered a previously arranged treatment option. If he or she refuses, a second round of messaging and outlining of consequences happens. The target then gets another opportunity to choose to accept treatment.

Criticisms

Ideally, an intervention leads to the person accepting the depth and nature of his or her problem and seeks help. But often, matters are made worse when the addict either doesn’t want to change or sees the intervention as an emotional ambush and attack.

There is a real risk that the target will rebel and up the ante by accepting whatever consequences will be imposed. In some cases, this can lead to long-term destruction of the relationships. The addict or alcoholic can even be driven deeper into his or her addiction as a kind of retreat from what he or she feels is betrayal.

These very real, very painful and negative consequences have to be understood going in. The risk of further relationship damage has to be weighed against the current situation. For this reason, interventions are reserved for the worst cases.

One other serious criticism of interventions is that they force a decision when a substance abuser may not be ready for change. It is possible that he or she will agree with the treatment offered and then quickly relapse when it ends. Critics point out that treatment under forced conditions (interventions or court order) have a much lower success rate than when addicts seek help themselves.

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