What is intervention?
There is no universally accepted classification of addiction and substance abuse intervention. However, it is useful to begin with a distinction between brief (sometimes called simple) intervention and formal or structured intervention. This second category can be subdivided into direct and indirect interventions. Although structured interventions were introduced in the 1960s as a method of moving alcoholics into treatment, these intervention models have been increasingly used in treating such behavioral problems as sexual addiction, gambling or shopping addiction, and video gaming addiction.
The term brief intervention is sometimes used to include informal attempts by family members or friends to confront the addict or to coax him or her into getting help, but it is more often applied to short, one-on-one counseling sessions between the addict and his or her physician, psychotherapist, social worker, or religious leader in a setting familiar to the addict. Brief interventions in primary care settings are considered to be most appropriate for persons who are not dealing with an immediate legal or social crisis caused by the addiction, are not intoxicated or high at the time of the office visit, and do not have a coexisting major psychiatric disorder. Brief interventions in emergency departments or trauma centers may be helpful, but only with patients who are open to counseling after an alcohol- or drug-related accident or injury.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) have published pamphlets for physicians, psychotherapists, and other helping professionals on conducting brief interventions. Possible settings for such interventions include prenatal care, primary care, emergency care, and college health centers.
The first step in a brief intervention is screening the patient for alcohol or drug use. NIDA has drawn up a “screener” called ASSIST that can be filled out by the patient in the doctor’s office on paper or on a computer. After the screener is scored, the doctor then discusses the results with the patient, giving personalized advice according to the patient’s likelihood of developing a substance use disorder. NIDA recommends referring high-risk patients to an addiction specialist for further evaluation and treatment, counseling moderate-risk patients to lower their drug or alcohol intake, and advising low-risk patients to continue to be responsible and moderate in their use of alcohol.
After the initial brief intervention, the primary care physician then schedules follow-up visits with ongoing support. Office handouts and other printed educational materials are often given to a patient as part of a brief intervention.
Structured interventions have become increasingly familiar to the general public through such media as reality television shows, popular magazines, social media, and personal memoirs. In a structured intervention, the addicted person is confronted in one of two ways: directly by concerned family members, friends, and possibly employers or religious leaders or indirectly through a professional interventionist’s work with the addict’s family.
The first type of structured intervention is known as the Johnson model; the second type is variously known as the invitational or family systems model. In actual practice, however, a structured intervention may incorporate features of both the Johnson and the family systems models. The reason for the overlap is that structured interventions are highly individualized; that is, they are tailored to the addict’s age, gender, occupation, drug or addictive behavior of choice, living situation, and extended family structure or friendship network.
The goal of a structured intervention is to persuade the addict to enter treatment at once. Plans include transportation to the treatment center and caring for the addict’s children, pets, and residence to lower his or her resistance to accepting treatment.
The Johnson model is named for Vernon Johnson (1920–1999), an Episcopal priest and recovering alcoholic who pioneered the use of structured interventions in alcohol rehabilitation in the 1960s. In the Johnson model, also known as the confrontational or direct model of intervention, those closest to the addict form a team that will confront him or her under the guidance of a trained interventionist. Johnson believed that a confrontational approach is necessary to break through the addict’s denial and other psychological defenses.
Members of the team have a pre-intervention meeting in which they learn about the disease model of addiction, decide on treatment options for the addict, and prepare letters or statements in which they describe the effect of the addict’s substance abuse (or behavioral addiction) on their lives. They also may prepare a list of the addict’s behaviors that they will no longer tolerate, along with specific consequences if the behaviors continue. The statements are written in a straightforward but caring tone that avoids judgmental expressions or accusations.
The actual intervention is usually a surprise to the addict, who may be told that he or she is being taken to lunch or to some other get-together but is instead confronted by the interventionist, family members, and other concerned persons. Following an introductory explanation by the interventionist, the members of the team take turns reading their prepared statements. At the end, the addict is offered the option of immediate treatment.
The family systems model of intervention, also known as the indirect or invitational model, focuses on the addict’s family rather than the addict alone. The theory underlying this model is that changes in the family system—the behavior patterns and interactions of family members—will affect the addict also and will reduce the severity of his or her self-destructive behaviors. A common form of this type of structured intervention is to hold an educational workshop for family members, to which the addict is invited; however, the workshop takes place as scheduled even if the addict refuses to attend.
The workshop, which typically lasts for two days, is led by a professional interventionist and includes discussion of intergenerational patterns of addiction and enabling as well as the biological and medical dimensions of addiction. Each family member is helped to understand his or her role within the family system and how his or her behavior may have enabled the addict. The participants may be asked to read some educational materials before the workshop. During the workshop, the various treatment options—including codependency treatment for family members—are explained. If the addict has chosen to attend, treatment is offered to him or her at the end of the workshop.
The general atmosphere of a family systems intervention differs from that of the direct model in that it is nonconfrontational. Interventionists who use this model usually maintain contact and follow-up with the family for as long as one year after the intervention.
While structured interventions can be led by an addict’s friend or family member, the chances of success are low because the addict has already had considerable practice in manipulating those close to him or her. Most treatment centers recommend consulting a professional interventionist when brief interventions have failed and when a structured intervention is necessary.
A professional interventionist—who may be a physician, psychotherapist, social worker, nurse, psychologist, or member of the clergy—is a person who has completed training programs and field supervision approved by the Association of Interventionist Specialist Certification Board. After two years of experience in the field, the interventionist may be licensed as a board-certified interventionist, level one. Level-two interventionists have had an additional three years of field experience and have completed an oral or written examination. Lists of certified interventionists can be obtained from treatment centers, community mental health centers, or the Association of Intervention Specialists.
Johnson, Vernon. Intervention: How to Help Someone Who Doesn’t Want Help: A Step-by-step Guide for Families and Friends of Chemically Dependent Persons. Minneapolis: Johnson Inst., 1986. Print.
Morgan, Oliver J., and Cheryl H. Litzke, eds. Family Intervention in Substance Abuse. New York: Haworth, 2008. Print.
Recovery Connection. Intervention: A Free Resource for Addicts, Friends, and Family. Pompano Beach: Recovery Connection, 2010. PDF file.
Substance Abuse and Mental Health Services Administration. Brief Interventions and Brief Therapies for Substance Abuse. Washington, DC: SAMHSA, 2012. PDF file.