family intervention - fatherhugs.com · family intervention years ago i used to commiserate with...
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FAMILY
INTERVENTION
Years ago I used to commiserate with all people who suffered.
Now I commiserate only with those who suffer in ignorance,
who do not understand the purpose and ultimate utility of pain.
~ Bill Wilson, As Bill Sees It.
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The Problem
• 90% of those with the disease of addiction
never receive treatment
• 70% of the population is has a family
member or friend who needs treatment
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These other victims
• Have an array of social services to help them with the consequences of their loved one’s addiction
• Have Al-Anon – to help themselves
• Have counseling -- to help themselves
• But don’t have an answer to their most frequently asked question:
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How do I get him to stop?
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Can’t get the answer because
• Public funding goes towards primary
prevention and tertiary prevention (TX)
• Very little goes to secondary prevention,
and virtually all goes towards adolescents
• Insurance companies are useless
• TX community naturally focuses on TX
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They are told
• You can’t help him until he’s ready
• She has to hit bottom first
• Pushing him to get help will just make it
worse
• You can lead a horse to water…..
• He has to want help
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There are two problems with
these answers.
1. They condemn those with the
disease and their families to
continued misery
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2. It is simply not true
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Do we say such things about
other diseases?
No, we would use everything possible
to save a life of someone we love.
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Why do we do it with this
disease?
• People focus on the behavior
(consequences) of the disease rather than
the disease itself
• Don’t really believe the disease concept, in
spite of what they might say
• Addicts are a pain in the ass, and we judge
them by how they make us feel
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•Or is it because
down deep we
really don’t think
it’s a disease….
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So…Is It
•A disease
•or
•Kinda sorta like a
disease?
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•Better get this
clear or you will
be miserable
dealing with
addicts!
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The science is clear…
•It is a disease,
but one that tells
you that you are
not sick!
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Can you help
someone
who doesn’t want
help?
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YES !
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Patients don’t have to
“hit bottom”, admit that he/she
needs help, think it’s a good
idea, or even want to enter
treatment in order
for it to be effective.
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Recovery rates in
treatment centers are the
same regardless of why
the patient enters!
• Proven by repeated studies
• Confirmed by recent experience
of Drug Courts and Prop 36
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• Anything we
do in an
ethical way to
get people
into treatment
is a good
thing.
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The Problem:
90%
of
alcoholics/addicts
die before ever
getting treatment
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What can we do to
reduce
this number?
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Intervention
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In the helping professions
“Intervention” is understood as
• “A deliberate process by which change is
introduced into peoples' thoughts, feelings
and behaviors”
• This can range from putting up “Just Say
No” posters to putting a cast on a broken
arm
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In the addiction field
“intervention” can refer to
• Skills used by a counselor to persuade/ motivate a patient into modifying behavior or enter treatment
• Motivational Interviewing
• Actions used by an employer or the criminal justice system to benevolently coerce someone into treatment
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• An organized effort led by a trained counselor that seeks to break through denial and get someone into treatment
• When a circle of family and friends is used in the process is commonly called a
Or more commonly:
“Family Intervention”
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Intervention preceded AA
• In 1934 Roland H. and Cebra G. went to
court and got a judge to release Ebby to
their custody/Oxford group
• Ebby helped Bill Wilson
• Without intervention, AA might never have
existed!
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Intervention is compatible with
12 step programs
• When the DuPont company approached Bill
Wilson to ask him how AA could help their
employees, Bill told them that they would
have to come up with a way. EAPs
• Bill encouraged families to leave AA
literature around the house
• An “outside issue”
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The Inspirations for
Contemporary Intervention
• Lyndon Johnson
• Vernon Johnson
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“If you lead a man
by his testicles his
heart and mind will
follow”
Lyndon Johnson
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“Testicular Pressure”
interventions
• Not the preferred model
• Can be as simple as working with the
criminal justice system to offer treatment in
lieu of jail, or requesting prison sentences
include treatment
• Domestic violence / TROs / Divorce
• “Contract” interventions
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Even in all these cases the family
• Usually initiates the process
• Is most helpful in assessments
• Has the needed logistical information
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Preferred Model:
The
Family
Intervention
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• Developed in the
1970s by Vernon
Johnson, an Episcopal
priest
• Frustrated that he was
not successful at
convincing alcoholics
to get help
• Founder of the
Johnson Institute,
Minneapolis
• Studied alcoholics who
entered treatment;
realized that virtually
all entered because of
painful crisis
• What if we could take
existing pain and
present it to the
addiction person in a
loving, non-judgmental
way and convince them
to get help?
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So who can present the pain?
• The other victims of addiction
• The ones with the most to gain and the most to
lose
• The ones who can compete with the power of
addiction
• The ones wearing the ruby slippers
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Family Interventions
• The family is the agent of the intervention, not the
counselor
• The counselor/interventionist is the trainer/coach
• For the counselor the client is the family, not the
addict/alcoholic
• Critical that the counselor understand
co-dependency and family dynamics & roles
• Typical families are a jumble of anger, resentment,
blaming, and “doormatting”
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The Process
• Usually begins with a call from a desperate
family member who has “tried everything”
• Must do careful screening to make sure this
is addiction --- a life and death issue --- not
recreational use or situational abuse
• Goal with this call is to instill hope and get
the key person to gather a family group
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Next: What Kind of Intervention?
• Johnson Model no longer the automatic
choice
• A majority of families won’t follow through
with a Johnson style
• Some counselors have a problem with it
being too confrontational, inpatient
oriented, and don’t like the addict being left
out of the process
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So, the current, cutting edge
approach:
• FICS / ARISE (A Relational Intervention
Sequence for Engagement)
Garrett, Landau, Stanton, Shea
Rather than jump to the surprise party plan
right away, above seeks to use the least
amount of therapeutic and family energy.
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FICS / ARISE, cont.
• Invite the family and the addict in for counseling;
take the family if the addict refuses
• Look for easier ways (warrants, employer
pressure, P.O. problems, etc.)
• Discussion options with family; be supportive, get
them to buy into the process
• Use the Johnson confrontation as last resort
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Getting Ready
• Education
• PreparationAKA pre-intervention
• Dress Rehearsal
& Intervention
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EducationJohnson: 2 one hour classes
FICS: 1 three hour class
• Disease Concept
• Family disease concept
• Referral to Al-Anon, etc.
• Describe the
intervention process
• Get them to buy into it
• Homework
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Preparation pre-intervention
• Cohesive focused group; set aside other issues
• Reinforce the idea that they are NOT different
• Script Writing
• Several Meetings
• Practice Session
• Treatment Options
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Who comes to class?
a. key family organizer
b. reluctant-skeptic (“There’s nothing we can do until he wants to
change”)
c. angry moralist (“Just divorce the s.o.b.”)
d. denial (“Why are we here? I haven’t seen anything very bad”)
e. protector (“I could never kick him out”)
f. magic seekers (“If you go talk to him maybe he’ll accept help”)
g. cookie persons, detached friends, relatives, co-workers
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• Final prep for the
SWAT team
• Role play
• Test the room
arrangement and order
of readers
• Hand signals
• The “what if” part
Dress Rehearsal & Intervention
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The Intervention
• All arrive early
• Hide cars
• Have kleenex, props and suitcase ready
• Counselor meets addict outside the room if possible
• Get him in the car ASAP after the intervention
• Call the treatment center to verify coming
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Why haven't I heard about
interventions before?
• Hard to believe, since
it is so successful
• Mis-represented in
media
• No controls; some
interventionists are
complete Lone
Rangers
• No insurance or public
funding, so expensive
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Why do Intervention?• The alcoholism and drug
abuse counselor should… act to guarantee that all persons, especially the needy and disadvantaged, have access to the necessary resources and services. The alcoholism and drug abuse counselor should adopt a personal and professional stance, which promotes the well being of all human beings.
• CAADAC Code of Ethics
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So families need to hear, even
when they call the wrong number
• I can’t help you here, unless he calls.
• But there is a way you can help him
• Call the NCADD and get an
interventionist
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People at meetings
• AA, as such, should never, of course,
endorse Charle St, but we sure hope that
individual AAs send people there
• Al-Anon, as such, ought never endorse
intervention, but individuals should not talk
about intervention, or at least not downplay
it.