The Changing Face of Intervention

How many times have you heard it said, “You can’t help alcoholics or addicts until they hit rock bottom on their own. They must ask for help themselves.” Unfortunately there are many addicts and alcoholics dying around us unnecessarily every day due to this old idea.

Growing knowledge and solid clinical experience in the chemical dependency field contradicts this previously accepted, outdated information. A professionally facilitated intervention can be done long before the alcoholic or addict hits bottom. In assessing success rates of such interventions, an informal poll taken at the National Association of Independent Interventionist Specialists (AIS) Conference in 1995 revealed that 90% of professionally facilitated interventions resulted in the identified patient entering treatment as a direct result of the intervention. Another research study published in 1996 (Treatment Today Magazine, 6-96, J. Fearing), which compared the inpatient treatment experience between self-referred patients and intervened patients provided additional insight into the validity of intervention. This study compared both groups of patients (self-referred and intervened) as well as polling the attending treatment staff. The results of this research demonstrated that the intervened patient has as great a chance of positively experiencing inpatient treatment, as the self-referred patient. This information supports the prospect of raising the bottom for alcoholics and addicts and breaking through their denial system via professionally facilitated crisis intervention.

During the early years of the practice of intervention, it was common to hear stories of interventions in which the facilitator or interventionist created a negative, shaming environment. This approach was often used in the name of “tricking” or coercing the identified patient into treatment. Unfortunately, this negative approach placed alcoholism into the good-guy-bad-guy category versus supporting the medical model or the disease concept. This harshness gave the intervention process a negative image, an image sometimes exaggerated by cavalier interventionists calling themselves bounty hunters or headhunters. One interventionist using the old model intervention printed “Have Net Will Travel” on his business card. This barbaric approach both sabotaged and minimized the legitimate therapeutic component found in the intervention process. It could, and often did, leave both the patient and intervention team participants with deep emotional scars.

Carefrontation Versus Confrontation

Throughout the past decade, professionals in the field of chemical dependency have developed the clinical framework for successful interventions, which are presented in the spirit of love, care and concern. This model of intervention is many times referred to as “carefrontation versus confrontation.” This strategy calls for everyone on the intervention team to speak from the “I” perspective and not the “You” perspective. It assigns any negative behaviors discussed throughout the intervention process to the disease and not the person. In many instances, upon meeting the identified patient at the crucial start of the intervention, the term intervention is not even used to describe the process. This is due to the aforementioned negative stereotypes the word intervention may have associated with it. Many times it is described as a family meeting or family consultation. Another key byproduct in using this caring approach is that it assists the patient in positively preparing them psychologically for the treatment process ahead. It also creates a safe and supportive environment for the start of the healing process for all intervention team members. This process gives family members a head start towards participation in the family program component of the treatment program. This is achieved through opening up healthy communications for the entire family system and establishing a solid foundation through educating everyone involved. In some instances, using this new model intervention, the interventionist will stay involved well after the point of admission into the treatment program. This process is called co-case management and positions the interventionist as a liaison between the treatment center, the family, and the patient.

Crisis interventions are now being used successfully for addressing many other destructive behaviors including gambling addiction, computer addiction, sexual compulsivity, eating disorders, and more. Another change seen in the area of crisis intervention has been the dramatic increase in number of corporate interventions being performed nationally. In the past few years, Corporate America has become more proactive in it’s handling of valuable employees whom are addicted. It is not at all uncommon to see an executive intervention done successfully in the boardroom using the same framework as the family intervention, which is done in the family room.

Qualifications of the Interventionist

Throughout the past decade, the percentage of difficult and complex clinical cases admitted into hospitals and treatment centers in the United States has increased dramatically. Many treatment providers state that the patients of today are “sicker” than the patients of the past. Informal estimates suggest that 50% to 75% of people in substance abuse treatment carry dual diagnoses. Many come to treatment with multiple addictions plus mental health problems such as depression, physical and sexual abuse trauma, personality disorders, mood disorders, and anxiety disorders. As a result, many treatment programs have found it necessary to strengthen their clinical staff with professionals who have the training and experience to treat people with dual disorders.

Likewise, clinicians who facilitate interventions must have an adequate level of training, experience and professionalism. There are many unexpected clinical challenges and surprises encountered during the pre-intervention training and intervention. Examples could include unresolved grief, sexual compulsivity, incest, physical and sexual abuse, illegal activity, sexual identity issues and more. If the person who is facilitating the intervention is working without the appropriate clinical foundation and training to handle the unexpected, there is a chance the intervention can end up in a disaster.
Understanding you will most likely have only one chance at intervening your friend or loved one in trouble, the importance of making good decisions in planning your intervention is extremely significant. One of the biggest decisions will be deciding which professional interventionist is most appropriate to facilitate your intervention. The following set of questions will help qualify the person (people) being considered.

1. What is their educational background? What level of education have they completed and what is their training in? Do they posses actual supervised clinical counseling experience in their training, or did they just take a 1-week course in intervention?

2. Are they certified in chemical dependency counseling? What organization is their certification from? (i.e., ICDP, State of Minnesota, etc.) What other professional organizations are they active members? (i.e., EAPA, MARRCH, NAADAC)

3. What is their experience in providing intervention services? How many interventions have they facilitated? How long have they been providing intervention services?

4. What are their fees? When are they paid?

5. What model intervention do they use? What does the intervention process itself consist of? What is their success rate? What population of clients are they most comfortable working with? How long after the intervention does the interventionist stay involved with the case, if at all?

6. Check with reputable treatment centers and ask for a referral for professional interventionists they are familiar with. They will have a short list of interventionists they are most comfortable in referring.

In critiquing the range of intervention specialists’ qualifications working in the addictions field today, there can be great deal of difference from one interventionist to another. There has been a national association started within the past few years called the Association of Intervention Specialists (AIS) who’s goals include bringing better organization and accountability to this segment of the chemical dependency field. Up to this point, there has not been a standardized competency test or an agreed upon certification process for interventionists. The responsibility of making sure the interventionist you choose is appropriately trained and competent falls on the shoulders of the participating family or organization scheduling the intervention.

In conclusion, I want to restate that the process of crisis intervention has changed dramatically throughout the past few years. It has matured and grown from its infancy. It is helping thousands of suffering addicts and alcoholics as well as their families find help and begin the healing process. Our research shows us that not only can we successfully “help people get help” through crisis intervention, but that the intervened patient has as good a chance of a successful treatment experience as the self-referred patient. The top clinics and hospitals around the country endorse intervention and are daily making referrals to trained interventionists. The days are over when friends, employers or health professionals need to sit back and wait for someone to hit rock bottom and ask for help on their own. Most importantly, we now have a clinical process, which is respectful, sensitive and caring for the entire intervention team as well as the identified patient.