Margaret, a 29-year-old married mother of two preschool aged children, starts in therapy at the insistence of her husband, Jason, who wants her to stop drinking and popping pills. In the first session, she tells you there is nothing wrong with her behaviors, and it’s her husband who’s off-base. “He expects me to be this perfect little 1950s housewife. He doesn’t understand that women like that just don’t exist. I’m only coming to therapy to get him off my back.” And quietly, just before the session ends, she says, “You can refill my valium prescription, right?”
Three months later all are frustrated. Margaret is not making progress. Her substance abuse issue is readily apparent, but whenever you broach the topic she deflects and avoids, placing blame on her husband. So far, you’ve been walking the therapeutic tightrope, trying to hold onto a relationship with her while helping her to recognize and address her substance abuse issue, but also trying to not push too hard lest you send her into a tailspin and/or out the door. You are feeling ineffective, even though you know that you’re operating “by the book” and doing a good job.
Last night you received a telephone call from Jason begging you for help. It seems that when he got home from work he found Margaret passed out on the floor of the living room. The children had not been fed, and both were crying. The youngest had a badly soiled diaper that had leaked all over the house. Once the children were calmed, cleaned, and fed, the oldest told him, “Mommy got really sick and then went to sleep, and we couldn’t wake her up and we were really scared.” Jason, too, is scared, because he can no longer trust Margaret to care for their children.
Seeking Outside Help
As therapists, we sometimes like to think that we can do it all, that we can solve any problem for any person. And for the most part this is a nice attitude to have. It keeps us solution-focused in our sessions, and it also provides motivation to continue trying when we are working with difficult clients. (And how many of us have seen a client make a breakthrough just as we were ready to finally give up?) Nevertheless, there are times when it is in the best interest of everyone involved to bring in a specialist. In Margaret’s case, if she was still able to care for her kids, then you could probably rely on your hard-won therapeutic alliance to eventually bring her around. But her children are now in danger, so a more aggressive approach must be taken, meaning this is a case where outside expertise is definitely needed.
The simple truth is that addicts sometimes don’t see anything wrong with what they’re doing, and even if they do see the downside they may still willfully insist that it’s not a big deal. This is their denial. They craft intricate lies to make what they do OK (in their own mind, if not in the minds of others). Typically, each lie has its own rationalization, and based on that imperfect foundation the addict’s behaviors can seem utterly reasonable to the addict. Yes, everyone else can easily see through their smokescreen, but addicts either cannot or will not. Instead, they repeatedly defend their lies, rationalizations, minimizations, and justifications (no matter how ridiculous) until their functional world disintegrates into divorce, disease, job loss, arrest, etc. As a result, it’s incredibly difficult to get addicts to admit to their problem and accept assistance. The good news is that there are “interventionists” who can facilitate the process of breaking through denial and getting an addict into treatment. The Association of Intervention Specialists is an excellent referral source for these individuals.
How Does Intervention Work?
The primary goal of an intervention is to get the identified patient – in this case Margaret – into treatment. The addict is told that he or she is loved and supported, and that his or her family members (and possibly friends) are united in their desire to help. The addict is also told that everyone present has been educated about the nature of addiction and the pathway to recovery, and they will no longer do anything that supports the addict’s addiction. If, however, the addict chooses recovery, then they are 100 percent committed to helping. An intervention is NOT an angry confrontation or a listing of grievances. Instead, it is a rational, relationship-based interaction that gives the addict a way out of his or her addiction.
That said, addicts, when entrenched in their addiction, are not exactly rational beings. Sure, they may put up a great façade, feigning sanity, reason, and responsibility, but when it comes to their addiction their thinking is distorted, their priorities misdirected. They keep doing the same stupid, awful things over and over, expecting different results. They drink and pop pills and forget to feed the kids and then pass out – and the next day they drink and pop pills once more, somehow thinking they won’t forget to feed the kids again. And when confronted about their addiction, they deny there is a problem. They may even lash out, blaming their issues on the people who love them. As such, talking to an addict about his or her problem can feel a bit like talking to an angry bulldozer.
So what is the point of having a rational conversation (an intervention) with an irrational person (an addict)? Frankly, there isn’t much point unless the interventionist is armed with as much information as possible. As such, interventions don’t just happen (as certain TV shows might lead us to believe). For an intervention to be even remotely effective, a great deal of preparation must take place before the addict is confronted and hopefully steered into recovery.
Perhaps you are now beginning to see that an intervention is not a singular event. Instead, it is a process built upon the following steps:
- Information gathering (pre-intervention interviews with family and friends)
- Educating and unifying the addict’s family and friends about addiction and the recovery process
- Engaging in a loving confrontation with the addict (sometimes more than once)
- Guiding the addict into treatment
- Guiding family and close friends into a process of change
- Following through with aftercare recommendations
The Full Family Approach
Intervention doesn’t end once the addict enters treatment. It also involves routing the rest of the family into therapy or treatment as needed (at the very least Al-Anon and/or CODA meetings), and following up with all parties to make sure that when the addict is released from treatment the environment that he or she comes back to is not the same place that supported, facilitated, and condoned his or her addictive behaviors in the first place. In other words, an intervention is a process of change that involves the entire family on a long-term basis. Thus, getting Margaret into an appropriate rehab facility is only the tip of the iceberg. Others must be willing to engage in the family portion of the program, and, more importantly, they must be willing seek help for their individual problems. In short, even if Margaret goes to the best treatment center in the world and willingly gives recovery her best effort while there, if she comes home to the same dysfunctional atmosphere she left, her odds of maintaining sobriety diminish significantly.
This full-family approach to intervention and recovery takes into account the growing body of scientific evidence that defines addiction as a chronic disease rather than an acute illness. (Everything we know about chronic diseases tells us that effective treatment is a long-term process that involves family and sometimes friends, as well as the identified patient.) And yes, there are extremely effective treatments for many chronic diseases – diabetes, hypertension, and addiction, to name just a few. However, the efficacy of these treatments depends in large part on the willingness of the identified patient to participate in his or her recovery. For instance, if a diabetic is unwilling to change his or her diet, to regularly monitor his or her blood sugar level, and to take insulin when needed, then treatment is not effective. This is where family comes in. Usually the entire family must eat differently. Usually the entire family must stress the importance of checking blood sugar and injecting insulin as prescribed. Etc. And the same is true with addiction!
Most of the time an interventionist remains involved in the addict’s (and the family’s) recovery long after the addict enters treatment. They support/supervise the addict and the family with aftercare (agreed upon before the addict leaves the treatment facility), individual therapies, 12-step support groups, and more.
What Happens When the Addict Says No to Recovery?
Interventions don’t always meet with full success. Sometimes an addict recognizes what is happening during the confrontation phase and simply storms out of the room. Other times the addict listens to what is said and then says, “Thanks, but no.” When this occurs, the intervention is not a failure. At worst, the addict’s family and friends all know exactly what is going on and have formed a united front. Probably they are seeking help for themselves. In other words, the full-family approach to recovery is underway, even if the addict is not participating. Perhaps more importantly, the addict knows the game is up. There are no more secrets, and (hopefully) none of the people who previously enabled/cosigned the addict’s problematic behaviors are going to continue. Usually, if everyone remains united in their quest to help, another confrontation can take place at a later date, and the addict might agree to treatment then. That said, nobody can force an addict to get well. No amount of external love and care will get or keep an addict sober. Ultimately, sobriety and recovery are the addict’s choice to make. If the addict chooses otherwise, at least everyone else can get well.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. He is the author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships.