Following are a pair of brief online articles summarizing the major models and methods of addiction intervention. They are not comprehensive, but do provide newcomers to the topic with a basic sense of how interventions are prepared for and conducted.
I do have a single -- hopefully relevant and useful -- comment:
Many -- though far from all -- substance and behavioral process abusers developed dense compensatory narcissistic ego defenses before and/or during their active addictions. Others have developed equally dense, "negatively narcissistic," "learned helplessness & victim identities." And still others -- owing to what personality expert Otto Kernberg called "borderline organization" -- are ardently "righteous" in both manners, albeit at different times, as they appear to flip back and forth from active, assertive and "positive" to passive, submissive and "negative" narcissistic identities.
All three of these types are very difficult subjects for even the best of professional interventionists, and are usually the sort of addicts who will have to hit what the various 12 Step addiction programs call "very hard bottoms" before they experience sufficient motivation -- if even then -- to submit themselves to any form of control by others. The first type above is usually too self-obsessed to move out of the first of the five stages of addiction recovery, the second is usually too ashamed, and the third is too confused, cognitively dissonant (or even dissociated) and too conflicted to move to the third of those five stages and remain there long enough to build the platform for the fourth.
BTW, the intervention models I use the most when I encounter those who show up with severe depression or anxiety accompanied by substance abuse are NA's "Am I an Addict?" and AA's "Twenty Questions" lists... both of which I find to be very -- if not always immediately -- effective.
Five Addiction Intervention Methods
Johnson Model
Widely recognized more than any other method, the
Johnson Model is a direct form of intervention that focuses on getting the
addict into treatment by way of personal confrontation. Loved ones often make
the mistake of assuming the addict doesn’t care about their feelings. Most of
the time, the substance abuser is just distracting himself from focusing on
what he is doing to everyone he cares about, because it is painful for him to
think about and leaves him feeling guilty and ashamed. The Johnson Model forces
the addict to acknowledge his behavior and its consequences.
Known in many circles as the surprise intervention,
this model requires those who care about the addict to gather and attempt to
get him to seek treatment on his own by telling the addict about the pain his
addiction has caused. It is best suited for individuals who are not likely to
shy away if they feel abandoned or isolated from their loved ones. In fact,
relapse is of specific concern among Johnson intervention subjects, with InformaHealthcare reporting
relapse rates of 38 to 79 percent among five types of treatment referral
methods, with the Johnson model being the second highest in the group.
Most often, the person who has been the primary
caregiver in an addict’s life serves as the facilitator of the Johnson
intervention, with the help of a professional interventionist to strategically
plan the event. The Johnson Model utilizes direct threats of consequences if
the addict refuses to get treatment. For example, a wife may tell her alcoholic
husband she will leave him and take the children if he doesn’t get help. The
hope is that the addict will become willing to seek help — even if he doesn’t
want it — because he so badly does not want to face the stated consequences.
The good news is that it often works.
The Johnson Model intervention is most likely to be
successful when more people are involved. The caregiver is responsible for
gathering as big of a support group together for the planning and intervention
process as possible. Generally, the interventionist meets with this group a
couple times before the actual event takes place. The purpose of this is to
iron out details of what to say, what not to say, and how the intervention
should be carried out.
While this model is straightforward, it isn’t cruel.
Addicts are never belittled or put down for their behavior, but loved ones are
encouraged to be honest about the choices they will have to make if things
don’t change. Often, the threat of losing their friends or family members is
enough for many to willingly seek the help they need.
Field Model
A former professional golfer, Jane Mintz, developed
this method of intervention following her own stint in rehab for treatment of
alcoholism. Knowing she wasn’t the only one struggling – the National Institute on Alcohol
Abuse and Alcoholism reports that there are 17 million
alcoholics in the United States – she was determined to formulate a new kind of
intervention that was geared toward addicts with more than one factor at play.
It’s not just substance abuse that’s a problem for
these addicts. Many are mentally ill, too. Others are suffering from polydrug
abuse, or they might be victims of childhood neglect or abuse that still
plagues them in their adult years. Mintz views the Field Model as being like a
subsidiary of the Johnson Model but with a more precise focus. A trained
interventionist in this genre knows how to predict the actions of an addict and
how to handle problems when they arise unexpectedly.
Case in point, if an addict becomes violent during an
intervention, the professional Field interventionist knows how to subdue her
and get things back on track. Many naturally assume these are techniques all
interventionists learn for all methods, but they aren’t, and Mintz recognized
that in her pursuit of developing the field model. One of the ways Field Model
interventions manage to prevent more disasters during intervention is by
starting off on the right foot and making sure everyone involved is on the same
page and feeling good about the task at hand. After all, it only takes one
party feeling left out or unheard for the whole intervention to come unraveled.
Systemic Family Model
The systemic family intervention focuses on treating
the entire family unit, not just the substance abuser. In this model, it is the
interventionist’s role to educate the family on why they will have to change
their lifestyles, too, if they want the addict in their life to get better.
This method of intervention has become common
knowledge in American households due to the popular A&E television show,
aptly titled Intervention. The show boasted an alleged 71 percent success
rate, per the Daily Beast, and
allows loved ones to express to the addict what their behavior has done to
others. Often, family members will be asked to write letters ahead of time that
can be read to the addict during the intervention.
This model recognizes that the addict isn’t the only
person getting hurt by drug and alcohol abuse. Likewise, the addict isn’t the
only individual perpetuating the behavior either. Siblings, spouses, or parents
may be fueling the fire, and often they don’t even know they’re doing it.
Unresolved issues in the family unit that are allowed to fester frequently end
up being discovered at the root of an addiction problem.
The typical ways that families deal with an addicted
relative are often quite contradictory to what they should be doing. While
families certainly have the best intentions, punishing an addict for using
drugs doesn’t encourage him to stop, nor does praising or rewarding him if he
does stop using. One of the biggest complains addicts in recovery have is that
their family won’t stop treating them as though they are still using drugs or
drinking. The systemic family intervention works on communication within the
family unit and rebuilding bonds of trust to prevent suspicions or mistrust on
either end. Addicts are much more likely to be honest and stay sober when they
feel respected and valued by their friends and family.
With this form of intervention, the process doesn’t
end after the addict enters treatment. Instead, the focus remains on healing
the whole family and preparing them for when the addict returns home. This may
include taking mild precautions, such as not drinking around an alcoholic
relative, or it might be more intense, such as seeking weekly counseling with
the addict to work on behavioral modifications or communication skills.
One of the biggest differences between other
interventions and this one is that the addict is invited to partake in the
intervention process from the start. There are no surprises or hidden agendas.
Of course, the addict must be willing to take part in it, which is a potential
drawback of the systemic family intervention.
Crisis Interventions
Crisis interventions are set in motion for individuals
who are in dire need of immediate treatment. Addicts who are battling comorbid
mental health and substance abuse problems are prime candidates for this type
of intervention, which is often used during breakdowns and times when the
addict is vulnerable and has little leverage. The National Alliance on Mental
Illness reports 53 percent of drug addicts and 37 percent of alcoholics have
one or more serious mental illnesses. Other crises warranting intervention
include:
Financial troubles due to drug or alcohol abuse
Legal issues, such as jail time for substance abuse or
possession
Deteriorating family relationships
Illness stemming from substance abuse
Caregiver/parental-child neglect issues
Not only can crisis interventions urge the addict to
seek treatment in a time of desperate need, but in some situations,
professional interventionists can also get substance abusers committed — even
against their will — if they are a threat to their own well-being or to someone
else’s well-being. The biggest and most common reasons for this are violence
against others and attempts at suicide. According to a report from the Nation’s Health, 78
percent of violent crimes involve drugs or alcohol. In substance abusers who
fail to get the help they need, the suicide rate is as large as 45 percent,
Psychology Today reports.
The crisis intervention process is carried out in a
very direct manner. Usually, there is little time to waste sugarcoating the
situation. In many cases, the addict is confronted about her substance abuse
behaviors and the side effects of such. Then she is given the choice to proceed
to treatment or face more dire consequences.
A crisis intervention is most often not a lengthy or
planned event. Rather, an interventionist is brought in when things are at
their worst and the addict has hit the infamous rock bottom. This may be at a
police station, at a bail hearing following an arrest, or even in the hospital
following a drug overdose, something 38,329 people died from in 2010, per
the Centers for Disease Control and
Prevention.
Love First Model
This approach is more emotional and attempts to appeal
to the addict’s feelings toward his loved ones. These interventions are carried
out in places that the addict will feel comfortable and find non-threatening,
such as his childhood home where his parents still reside. Knowing that
families often disagree in these situations, especially in environments they
feel safe in, the interventionist serves as a mediator and guide during the
process.
The Love First method doesn’t involve accusations or
negative statements. Instead, family and friends gather in support of treatment
and express their unconditional love for the addict. The goal of this method is
to encourage the addict to want to seek help for himself once he realizes the
support he has and the many reasons he has to get better. At the same time, the
support network learns how to be positive and encouraging, rather than placing
blame and arguing. At the root of the Love First method, it is believed that
some addicts can enter treatment without being pushed or bullied into it.
Getting Help
Many concerned family members and friends of addicts
are inclined to try and cut corners by performing interventions themselves. The
problem with this is that the intervention process is usually too harsh, most
likely due to inexperienced laypersons attempting to practice the professional
trade of intervention with no knowledge on how it really works. There is a
psychological process involved that requires solid education on the process.
Watching videos on the Internet and television shows detailing other accounts
of the intervention process cannot be directly translated to another person’s
situation.
The National Institute on Drug Abuse notes
8.9 percent of the American population needed help for a drug or alcohol abuse
problem in 2012, and only 1 percent got the help needed. You can help your
loved one become part of the 1 percent. The end result hoped for in any
intervention is seeing the addict accept help and enter treatment. While each
method is different, one factor remains the same — the sooner the addict is
placed into treatment following the intervention, the better. For this reason,
a bag should be packed and travel arrangements should be made ahead of time in
most cases.
Four
Common Models of Addiction Intervention
Johnson Model
The Johnson Model of Intervention was coined by a
pioneer in the industry in the 1960s. Vernon Johnson, who earned the nickname, “the
father of intervention,” believed addicts built up walls of denial so
impenetrable that they could only be broken down when confronted with the
crises addiction created in their lives. This is perhaps the most recognizable
form of intervention, in which a family, guided by an interventionist,
confronts an addicted individual without their prior knowledge of the meeting.
The Johnson Model is grounded in the assumption that
addicts cannot see how their substance abuse negatively affects them and those
around them. It also assumes that these individuals will remain in denial until
they hit rock bottom. It’s important to realize this is not the result of
stubbornness, but rather an elaborate defense mechanism that the brain creates
to justify their addiction. The aim of a Johnson Intervention is to encourage
addicts to agree to treatment before they hit rock bottom on their own, which
can be life-threatening. The timing of the intervention is referred to as “raising
the bottom.”
If a family chooses to pursue a Johnson Model
intervention, they should get in touch with an interventionist who will guide
them throughout the process. An addict’s close friends and family members will
prepare for the intervention by learning about addiction as a disease. They
must also consider how the addict’s drug abuse has affected their life. They
will also come up with a list of potential treatment options. A family prepares
for an intervention without the addicted person’s knowledge or approval.
What Happens During an Intervention?
A member of the intervention team will arrange for the
addict to meet at a specified location, where the confrontation will begin.
During the course of the intervention, friends and family will present a
detailed account of an addict’s behavior and the negative consequences
associated with that behavior. While this is referred to as a confrontation,
members of the intervention must present the facts in an objective,
nonjudgmental manner. The ultimate goal of the intervention is to present the
reality of the affected person’s addiction in a way he or she can accept. When
done successfully, an addict can accept help and decide on a course of
treatment.
In the Johnson Model, an addict’s loved ones form the
foundation of the intervention. These interventions are rooted in caring and
compassion, not malice or accusation. A proper intervention encourages affected
individuals to seek treatment not only for themselves, but for the network of
loved ones who surround them.
Invitational Model
Developed by Ed Speare and Wayne Raiter, this method
of intervention is also referred to as the Systemic Family Intervention Model.
This model also takes a family-oriented approach rather than focusing solely on
the addicts. The theory of the invitational model is rooted in the idea that,
if the system of addiction changes, so will every individual within that
system, including the addict.
How the Invitational Model Works
In a systemic family intervention, an entire family or
support network is invited to come to a two-day workshop led by an
interventionist. Throughout the course of the workshop, the addict and the
family are coached on the disease of addiction, including its pathology and how
it affects a family. Specifically, an interventionist helps the support network
understand the concept of enabling and how it affects the addict and the family
as a whole. Each family member must understand the role that he or she plays so
everyone can begin the road to recovery as a unit. When every family member is
committed to healing, the hope is that the addict will accept help and begin
his or her journey to sobriety.
An invitational intervention begins when a concerned
member of a family contacts an interventionist about a loved one with a
substance abuse problem. Once they make plans for a workshop, a designated
member of the family is coached on how to invite the addict to participate.
Once the entire family system is at the workshop, they learn about different
treatment options for the addict.
Treatment and Follow-Up
Ideally, an addict will agree to seek treatment at the
conclusion of the workshop, which is often multidisciplinary in nature. An
interventionist using an invitational model will usually follow up with the
family for up to a year. The main difference between the invitational model and
others is it’s not confrontational in nature and it recognizes the family’s
role in aiding and effectively treating addiction.
Field Model
Jane Mintz is a former professional golfer who became
an interventionist after successfully winning her own battle with alcohol
abuse. A competitive high-achiever by nature, Mintz studied every intervention
model and addiction process in painstaking detail. In response to her years of
research, she developed her own model, the Field Model of Intervention. Unlike
other intervention models, the Field model does not replace other models.
Rather, it is complementary.
How the Field Model Works
The field model is based on the Johnson model, so it
has many of the same properties. The reason the Field model is complementary is
because it specifically prepares the interventionist for handling crises during
the intervention process and after. For example, Field model interventionists
are trained to assess suicide risk or predict potential for violence. Using the
field model can be especially beneficial for those families who believe an
addict is a danger to themselves not just because of their addiction, but also
because of co-morbid conditions such as depression or bipolar disorder.
Bringing Families Together for Interventions
Mintz likens families of addicts to herds that aren’t
always moving in the same direction. Addicts often look to the strays of the
herd to enable their addiction. When all family members are moving in the same
direction, it’s easier for the addict to realize the depth of their addiction
and its negative consequences. Part of the field model is educating families
and helping them realize when they’re part of the problem – and how they can be
part of the solution.
Family Systemic Model
The family systemic
model of intervention is often referred to as the invitational model, though
the two methods do have minor distinctions. While a classic intervention
involves a confrontation without prior knowledge of the addict, the family
systemic model is completely different. In a family model, the addict comes to
all planned meetings
with the interventionist, including the first one.
Instead of a one-way conversation in which family members discuss how one
person’s addiction has negatively affected their lives, the family unit has a
collaborative discussion about how addiction, as a disease, has affected the
family unit.
Time Frame
The biggest difference between an invitational model
and a family systemic model is the time frame for intervention. While an
invitational intervention usually concludes with a two-day immersive workshop
and periodic follow-up, a family systemic intervention can last for months at a
time. Meetings can be several times a week or until the family decides on an
appropriate treatment plan to which the addicted individual agrees. In the end,
the addict and the family unit agree to counseling. An addict will seek
treatment and then join the family later for group therapy. In essence, the
family commits to rehabilitation together.
Published References & Resources
