When Should an Intervention Be Performed?

An intervention occurs when someone with a substance use disorder is confronted in a nonthreatening manner by family members and friends, in an effort to motivate that person to seek treatment.
Individuals performing an intervention attempt to point out the person’s destructive behavior associated with substance abuse. By pointing out this destructive behavior and how it affects the individual’s friends and family, it is hoped that the person will see the need to engage in some form of treatment and agree to participate in a treatment program.

Different Types of Interventions

interventionThere are several different types of interventions. First, interventions can be classified by the number and type of people actually performing the intervention:

A simple intervention occurs when one individual, most often a friend or family member, confronts the person with the substance use disorder in some kind of neutral environment. The person performing the intervention will have better success if prior to actually doing the intervention, a professional is consulted. A professional interventionist (people who have training in performing interventions and how to organize them), a therapist or substance abuse counselor, or another person who has experience/expertise in substance abuse can be consulted for advice. The person performing the intervention can discuss concerns with this individual and develop a plan. The goal is to confront the person with the substance use disorder in a nonthreatening manner, point out what the person organizing the intervention observes regarding the negative aspects of the subject’s substance abuse, express concerns for the subject, and suggest that the subject of the intervention seek treatment.

A classic intervention occurs when a group of individuals, again mostly family and friends, who are concerned about the substance abuse issues of the subject get together and confront the individual in a non-confrontational manner to explain how that person’s substance abuse affects them and the need for that person to seek treatment. Typically, there is a group meeting prior to the intervention without the subject present to plan the event and to allow the members to define their goals and functions. In the planning session, team members develop different courses of action to address the potential reactions of the subject (e.g., if the subject denies using substances, gets defensive, etc.). During this planning meeting, an addiction professional or professional interventionist may be present to make sure the goals of the intervention are met. Often, the addiction professional or interventionist attends the actual intervention to run the event.
A family systems intervention is designed to confront the members of the family system that are somehow either contributing to substance abuse issues in one member, or in some instances, all members have issues with substance abuse. The goal here is to get the members of the family into treatment either individually, or as a group, to address the particular issues that the individuals with substance abuse problems and other family members face. Because of the complex issues involved, family systems interventions will require professional assistance in their planning and organization. While it is always advisable to consult with a professional interventionist or mental health professional who specializes in addiction before implementing an intervention, it is crucial to get outside help from a professional source when organizing a family systems intervention.

Crisis interventions occur more or less on the spot when the subject’s substance abuse has resulted in some potentially threatening or dangerous situation. The individuals who are present during this time immediately confront the person with the substance use disorder and attempt to get the person to commit to a treatment program.

Interventions can also follow a specific approach. These approaches require some intensive planning and organization. On the other hand, crisis interventions, because of their very nature, are typically not planned. They may, or may not, involve the use of an interventionist who is contacted at the last minute.

The following approaches can be utilized in classic and family systems interventions, and to a lesser extent in a simple intervention format:

  • The confrontational approach is often what the media or entertainment industry depicts an intervention to be.  The subject of the intervention is often chastised, confronted in an aggressive manner (as the approach title suggests), and demands are made regarding entering treatment. Consequences for not complying with the demands of the intervention are made clear. The confrontational approach has the least chance of being effective and is generally not a recommended approach.
  • A softer version of the confrontational approach is known as the tough love intervention. Typically, this is a classic intervention where the group meets before the actual intervention to discuss the goals of the intervention, the role of each member, and the demands and consequences of the subject not taking the advice of the group. The intervention is then implemented in a surprise manner. Each member of the group expresses concern and love for the subject, details how the subject’s substance use is affecting them, and the specific consequences that will be placed on the subject if treatment is not sought. Most often, these consequences will range from a lack of support (emotional or financial support)to participants stating that they will no longer be involved on a personal level with the subject if treatment is not sought. The intervention is an attempt to shift the power from the person with the substance use disorder to the members of the group, and to use coercion to get the subject to change. Research indicates that coercion is not the most effective form of persuasion when trying to institute change in an individual.

The Love First approach is a softer version of the tough love form of intervention. It too is a classic intervention model. Members meet prior to the intervention with a therapist or interventionist to develop the plan for the intervention. Depending on the situation, there may be more than one such meeting. Each member of the team is instructed to write a letter to be read in the intervention. There are three components to each letter:

  • The introduction discussing how the two people met and their experiences together
  • The body that expresses the affection that the team member has for the individual who is the subject of the meeting
  • A conclusion section that explains that the author will be available to help the person throughout recovery
Group TherapyThe team makes a proposal to the subject to seek treatment. If the person agrees, the intervention is a success. If not, the team resorts to a backup plan that is developed in the planning meetings. This plan consists of a number of consequences that will occur if the subject does not seek treatment. If the person still refuses to seek treatment, it is understood that the team will implement whatever consequences have been explained. There is very little empirical evidence to suggest that this approach is more effective than the tough love approach.

The Johnson Model of intervention consists of the usual team of family and friends and a therapist or interventionist. The team has an initial planning session where they decide what it is they want to explain to the subject, and the interventionist helps the team develop these goals. This is a nonconfrontational approach that focuses just on the facts regarding the individual’s substance use, the concern that the team members have for the subject, and real evidence (this can also include statistical information from research studies) as to how the individual’s substance abuse is detrimental. There is no expression of anger or blame allowed. The team also decides on a minimum of three treatment options to present to the subject. These treatment options are most effective if they cover a range of different types of treatment as opposed to three separate types of the same treatment. The research indicates that when a Johnson Model intervention is implemented, it can be successful; however, the majority of individuals who attempt this approach actually did not fully complete the intervention.

The Albany-Rochester Interventional Sequence for Engagement (ARISE) model is a complex model of intervention that has three levels to its approach. It was developed as a functional alternative to the Johnson Model.

Level I begins when a prospective member of the intervention team contacts a certified interventionist to help organize an intervention. The interventionist organizes an initial meeting with all members of the intervention team, and the subject of the intervention is encouraged to join the organizational meetings.

Level II occurs when the actual intervention meetings take place. In this model, there can be more than one intervention meeting. The subject is encouraged to get help at these meetings and often enters treatment.

In level III, the subject is presented with serious consequences if treatment is not chosen. This is a last-resort meeting.

The ARISE model has empirical research to support its use and is the model developed by the Association of Interventionist Specialists to get individuals with substance use disorders into treatment.

Who Should Perform an Intervention, and When Should One Be Used?

Because of their very nature, interventions need to be performed by people who are close to the subject. The intervention will not be as effective if the group consists of many acquaintances who have only superficial relationships with the person. Effective interventions are typically performed by individuals who share a strong bond with the subject and care for that person. This brings the intervention to a close and intimate level that has meaning for both the people performing the intervention and for the subject of the intervention. Typically, close family members, close friends, and close coworkers are involved in the intervention. Friends or acquaintances of family members and others who do not have a solid relationship with the subject should not attend.

In addition to including only individuals close to the subject, the chances of performing a smooth and successful intervention will increase if a professional interventionist is present.

Interventions should be performed when it is clear that the substance use of the subject is leading to a number of negative consequences for that person and the person’s family members and close friends. Many times, individuals with substance use disorders do not conceptualize the ramifications of the substance use and engage in a number of subjective explanations and perceptions that continue to foster the substance abuse. The goal of the intervention is to make the person aware of the negative ramifications of the substance abuse and encourage the person to engage in treatment.

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