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Four Models of Intervention

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In 2013, the National Survey on Drug Use and Health (NSDUH) reported that 22.7 million Americans aged 12 or older needed treatment for an alcohol or illicit drug use problem while only 2.5 million received treatment at a specialized facility. Often, an intervention may be staged in order to convince a loved one to enter the treatment that they need in order to recover from substance abuse or dependency. An intervention is often perpetuated by family and friends in a group setting with the primary goal being to motivate the addicted individual to seek drug or alcohol treatment.

Interventions are usually planned ahead of time and sometimes without the loved one’s knowledge. Interventions may be either formal or informal. An informal intervention consists of casual conversations between friends and family members, and sometimes even coworkers or employers, in regard to drug or alcohol use. Formal interventions are planned in advance and more structured conversations that often utilize the help of a professional.

Mental health care professionals such as counselors or therapists as well as professional interventionists can help families stage successful interventions. When a professional interventionist is used, the National Council on Alcoholism and Drug Dependence (NCAAD) reports that interventions are successful at getting someone to commit to treatment 90 percent of the time. Intervention models typically follow a direct, indirect, or invitational model, or a combination of the models.

1. Direct Intervention

Known as the father of intervention, Dr. Vernon Johnson developed the Johnson Intervention Model, a confrontational and direct intervention method, in the 1960s. This is perhaps the most well-known method of intervention, gaining popularity in recent years through reality television shows.

With the Johnson Model, family members and friends meet with an intervention professional a few times in order to plan a surprise intervention for a loved one struggling with drug or alcohol dependency or abuse. Johnson interventions are scripted and address specific ways that drug or alcohol abuse has negatively affected members of the support network involved in the intervention. Everyone involved in the network will write letters detailing specific incidents as proof of how alcohol and/or drugs and addiction have had a negative impact on their lives.

This model hinges on the idea that addicts are in denial of how their drug or alcohol abuse negatively affects or impacts themselves or those around them, and the confrontation is an attempt to help them realize otherwise. Substance users are forced to hit rock bottom through the intervention, and loved ones will deliver an ultimatum if they refuse to seek treatment. The consequences for not seeking treatment may include loss of contact with family and/or friends or a lack of future financial support.

This method is generally considered successful at getting people into treatment, although the American Psychological Association reports that 70 percent of support networks who plan a Johnson Model intervention fail to follow through with the confrontation step. Confrontation, even when designed to be compassionate, may not be easy to accomplish and may not work for every family. Additionally, addiction affects entire families, and the Johnson Model does not address the overall health of the family unit.

2. Invitational Intervention

A type of intervention model that seeks to heal the family as a whole and does not rely on surprise interventions is the Systemic Family Intervention Model. This method of intervention seeks to educate and address addiction in relation to the entire family and not just the substance abuser. Families may intentionally, or unknowingly, enable an addict and the Systemic Family Intervention teaches families to better understand the role they play in their loved one’s addiction and how to prevent future destructive actions with the belief that if the system is changed, the addictive behaviors can be changed and improved.

Families contact a professional interventionist who leads them through workshops, classes, or therapy sessions as a unit, and the addict is invited as well. There are no secret planning methods during this type of intervention; rather, the substance abuser is involved in the process from the start. Even if they refuse to attend the meetings, families continue with the intervention model without them, which may still be effective in reducing substance abuse by changing the environment around the addict. Interventionists will likely keep in contact with families for up to a year either through follow-up phone calls or in person.

Community Reinforcement and Family Training (CRAFT) is an invitational intervention model designed by Robert Meyers, PhD, that teaches families how to talk about addiction and its effects on the family through multiple therapy sessions. Concerned family members may first seek out professional help for their loved one’s substance abuse issues and may be directed to the CRAFT model, which will facilitate 12 to 14 one-hour sessions twice a week for a month and then once a week for an additional six weeks. Addicts are invited to attend the sessions with their families, and the goal is that after the completion of the CRAFT series of sessions, they will choose to enter into treatment of their own accord.

Family invitational intervention models may take longer to get someone into treatment, but they may have better retention rates than traditional intervention models. One study reported in the Journal of Substance Abuse Treatment indicated that 71 percent of adolescent substance abusers who were considered resistant to treatment successfully entered into a substance abuse treatment program after parents completed 12 CRAFT sessions.Another type of invitational intervention, often considered as an indirect intervention, is called Motivational Interviewing (MI). This method is frequently utilized in medical settings, such as when someone is taken to an emergency department (ED) for an overdose or adverse reaction to drugs or alcohol. The Drug and Alcohol Abuse Warning Network (DAWN) reported that in 2011, approximately 2.5 million ED visits were related to drug abuse or misuse. MI may be used by medical professionals in this setting as a client-centered approach or assessment with the intention to motivate someone to seek treatment for drug or alcohol abuse issues. MI asks open-ended questions related to drug or alcohol abuse instead of insisting on treatment or pushing to admit that a problem exists.MI is also often used during drug or alcohol screenings, potentially after a positive drug test, in order to encourage someone to seek treatment on their own. MI is a non-confrontational and nonjudgmental approach designed to help substance abusers recognize that they have a problem, and overcome obstacles such as ambivalence and lack of personal resolve in order to commit to specialty treatment.

3. Combination Models of Direct and Invitational Interventions

Current intervention models that combine direct and invitational methods into a more comprehensive model are gaining popularity. The ARISE (A Relational Sequence for Engagement) Intervention Model is a collaborative and compassionate approach that has an 83 percent success rate at prompting drug or alcohol abusers to enter into treatment, as published by the American Journal of Drug and Alcohol Abuse. The ARISE Model is an evidence-based and tiered approach, and once an addict has agreed to enter treatment, the intervention is stopped. The stages of an ARISE Intervention are:

  • Step 1: initial call to a professional interventionist by a family or loved one in order to provide the tools necessary for an intervention and establish the support network
  • Step 2: intervention meetings are held with groups of the support network and the interventionist; between one and five meetings may be held; no single member of the support network is alone in the meetings with the loved one needing help, thus spreading out the potential burden
  • Step 3: a more formal intervention is staged with consequences put in place if treatment is not sought
  • Step 4: entrance into treatment for the family and hopefully the addict as well, usually lasting at least six months and typically encompassing involvement in a 12-step program

The ARISE Model involves the entire family and no secrets are kept; the addicted family member is aware of any and all planned meetings and invited to attend. ARISE is based on respect and principles of caring and love. The American Journal of Drug and Alcohol Abuse states that 55 percent of substance abusers seek help before the modified Johnson Model intervention, or more formal intervention, is held, thus precipitating it necessity over half of the time. Even when some refuse treatment after the more traditional intervention, families are still healed through improving individuals’ self-esteem and the family dynamic as a whole unit. The ARISE Model focuses on healing entire families and encourages long-term recovery with fewer episodes of relapse.

Families are heavily involved in the healing and recovery process. Since family members often have the best personal knowledge of the addict, they instinctively understand which intervention model may work best for the individual.

4. Love First Model

A Love First intervention, as the name implies, puts love first. This intervention model emphasizes staying positive and supportive. It structures interventions around the goal of treatment and is based on the idea that addiction is a medical issue. It focuses on the power of a family coming together to express their love and concern. So how do you hold a Love First intervention? Here are a few quick tips:

  • Come together as a unified group
  • Voice your concerns and get all the facts on the table
  • Create a shared goal and message of support
  • Prepare letters expressing love, appreciation and concern
  • Practice reading these letters and responding to any and all potential reactions
  • Ask your loved one to participate in treatment
  • Commit to walking through recovery with them
  • Create a positive affirmation or image of what life will be like after active addiction is over

Jeff Jay, co-creator of Love First, emphasizes that all of these steps should be done with love and in order to reach the heart, not the brain, of your family member. “Addiction takes over the brain, and you can’t argue, reason or negotiate with addiction,” explains Jay. “But the person you love is still there, and his or her heart is the battleground.”1 You can reach out with love, and you can make a difference.

A Love First intervention takes this fact into consideration. This intervention model is flexible. Group size, setting and specific approaches can be customized. Jay explains that, for example, a person with depression might benefit from seeing that they aren’t alone and isolated, and therefore might respond best to hearing messages of love and support from a large group of people. However, someone with anxiety may be best approached by just a few of his or her closest and most trusted family members.

Selecting an Interventionist

Someone trained in interventions and intervention methods may be able to help you determine the best way to proceed for you and your family. If you would like advice on selecting an interventionist or would like interventionist recommendations, we have worked with many we trust for several years and have a thorough vetting process before we are comfortable recommending anyone. Feel free to call us at 269.280.4673 and we’ll review your options together.