Celebrating Intervention (Globally Defined)

“Individuals who enter treatment under pressure have outcomes as favorable as those who enter treatment voluntarily”

National Institute on Drug Abuse, 2009

I watched another “Intervention” episode last night on A&E. You’d think I would avoid it after working in the recovery field for over four decades, but it’s hard to take your eyes off of it: the seemingly hopeless drug or alcohol dependent person, life spiraling out of control, supported by the enabling family members who are watching their bank accounts drain and their valuables walk out the door, every day wondering if this is the last time they will see him or her alive. Then they import a skilled interventionist, who organizes the family, harnesses their love and concern, structures an effective and compassionate confrontation, rehearses it, then…Bam! The intervention. 

Although these can often be characterized by anger and shock on the part of the person at the focus of the meeting, and can even “go off the rails,” more often than not they end positively, with the individual getting in a car with a chaperone, heading to the airport, and off for a pre-arranged treatment admission. Many times, this is the beginning of a happy ending and the start of long-term recovery (sometimes the road ahead is bumpy, but that’s addiction). With this exact strategy over 30 years ago, I organized the intervention that resulted in my mother going to treatment, never drinking again, and dying sober, 12 years later…the greatest gift I could have ever been given: all resulting from a Sunday morning family “ambush” in my parents’ den, the whole family with shaking voices and palpitating hearts. You don’t have to twist my arm to make me a believer in this effective approach to interrupting the long-term spiral downward into oblivion.

But it’s important to understand that the great majority of people who go to treatment for addiction do so because of some form of intervention, BUT an intervention that seldom looks like the one we conducted with my mother, or the ones you see depicted on TV (evolved from a very specific therapeutic concept, pioneered by Vernon Johnson, MD). Most interventions are much less dramatic, and they might look like this:

• The judge (or probation officer, or court referral officer), who says, “this is your third impaired driving arrest, and I am requiring that you complete a treatment program.” You may think ordering someone to treatment is pointless, that you can take a horse to water, etc., but most people go to treatment leveraged by an external crisis of one type or another, not because of some flash of spontaneous insight.
• The employer, who says, “Robert, we like your work when you’re focused and on task, but you’ve missed 5 of the last 6 Mondays, and your outbursts in the office are causing a lot of concern from management and your peers. We’d like you to get an evaluation by our EAP.” This evaluation may or may not result in Robert going to treatment for a drinking or drug problem…the performance problem may have a different origin, but again, the principle is the same: there is a crisis motivating someone to do what they almost certainly would not otherwise do if left to their own devices: address their problem.
• The spouse, who says, “I need you to get treatment if we are to have any chance at saving our marriage.” Clear as a bell: it’s me, or your drug of choice.
• The child welfare social worker, who says, “You cannot regain custody of your daughter until you go to treatment, and show evidence of _____ months drug free.”
• The physician, who says, “I will not continue to prescribe Benzodiazepines for you…I strongly recommend you get treatment. If not, your memory and cognitive abilities are both at risk of long term damage, and I can no longer provide care for you.”
• The ER nurse, who asserts that the real reason a patient is in the ER (once again) is not the broken leg from the car accident (with the .20 blood alcohol level), or the chronic gastritis, or the impacted bowel from years of constant opiate abuse, but insists that he/she seek help for the root cause that’s creating all these symptoms, the addictive use of their drug of choice, and takes it a step further and guides the patient in treatment options.

These are some of the typical scenarios that create motivation for treatment with FAR greater frequency than the professionally managed intervention setting we’ve all seen on TV. I guess a probation officer saying, “your urine was dirty again, I’d like you to go to treatment,” doesn’t exactly constitute riveting television.

Most individuals entering treatment do so because of a crisis in their lives. You can say that they are there because of an external “push.” It’s the job of treatment professionals, their peers in treatment with them, and the influence of others in recovery who may be volunteers, or people they meet at 12 Step meetings, to begin to convert that external push into an internal “pull.” The opening motivation (“I guess I’ll go if it will get me out of this pickle I’m in”) must ultimately convert to the lasting, internally generated motivation that will be needed to sustain and fuel a lifetime in recovery (“The man who spoke at the meeting I went to last night…I haven’t been able to stop thinking about him. I want what he’s got…the peace, the spirituality, the sense of comfort in his own skin that he seemed to have…I’ll do whatever I need to do, starting right now, to get that”). Voila: the beginning of a spiritual awakening, and of true recovery.

To the lay public, the fact that many people in treatment don’t particularly want to be there, at least initially, can be discouraging. To the new patient, it can be even more confusing when they realize that many of their peers in treatment have very mixed motivations. The truth, though, is that it has always been this way. The transformative event is when the strong desire to attain a peaceful and solid state of true sobriety, one day at a time, overcomes the temporary motivation of pleasing whatever third party initiated the movement towards treatment in the first place. The best treatment professionals are Zen masters at orchestrating this transformation from “push” to “pull.” When it happens, when the light bulb turns on, there is nothing more inspiring to witness!

So, this is my small way of paying respect to those people who take the risk of saying the difficult thing to someone who badly needs (but doesn’t want) to hear it. They often take this risk quietly, without fanfare, in the privacy of their workplace, health care setting or home, without a TV crew present, or anyone to thank them for the courage to initiate this never-comfortable conversation. The low road taken by most is to remain silent, continue to enable, treat the revolving-door symptoms, and kick the can down the road one more time. The low road is waiting for the individual to hit bottom, which may never happen…he or she may very well die first. The high road is stepping up, stepping in, interrupting the free-fall, and leveraging the presence of a crisis in hopes of finding a way for the bottom to hit the chemically dependent person. The people that orchestrate this miracle are nothing short of life-saving heroes.

Dr. Bob Hinds