How do you Intervene with people in active addiction?

Many of us think of an "Intervention" as bringing a group of friends and family into a room with the person who is using drugs or alcohol and pressuring them into detox or residential treatment.

I was sitting with a beautiful young lady last night who had an Intervention. She said that early one morning her family and the Interventionist came into her apartment. She was in her bed, half-dressed, her drugs laying out on the table when her family with a stranger walked into her place. At first, each family member started telling her how much they loved her and how badly they wanted her to go to treatment. The Interventionist referred to "treatment" as a gift they were offering. Still in shock, half-asleep, and feeling humiliated, she politely told the Interventionist, "thanks, but no thanks," she didn't need the "gift of treatment."

The young girl said after she turned down their "gift," she politely asked them to leave so she could put on some clothes. They refused. Then standing up holding her sheet around her half-naked body, she made a dash for the door. Before she could get across the apartment the Interventionist blocked her exit. She started to feel like a prisoner in her own apartment. She sensed the group getting more determined and trending toward hostile. The Interventionist explained that her parents were prepared to immediately shut down her phone and have her removed from her apartment in the next hour. Threatened, scared, and unsure what to do she agreed to go to treatment.

On the day of the Intervention, she was taken by the Interventionist to a thirty-day program in Arizona. She was not allowed to pack. They packed her clothes for her. She was not allowed to let anyone know where she was going. The young lady detested the Interventionist for his threatening approach. She walked into the Arizona program angry and rebellious. She lasted three days in treatment before they threw her out for breaking the rules.

Over the next three years, this young lady went to four different programs in three different states. She spent two out of three years in "treatment." Her family spent a small fortune on rehab and she resented her parents for the intervention and being forced into rehab.

What is an Intervention? I went up the National Institute of Health website and started looking around. I found a report entitled, "Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards." According to study, a psychosocial intervention includes interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors with the aim of reducing symptoms of these disorders and improving functioning or well-being. It appears any number of different approaches would be considered an intervention if the goal is to help a person improve any of the essential areas of health and wellness.

Why do many people believe that doing an Intervention with the goal of getting the person into a hospital, detox or residential treatment center is the best course of action? Different people may provide different answers but I'll throw out a few that I've heard over the years:

• We're afraid the person is going to hurt themselves or someone else
• We've tried everything else and nothing has worked
• The person has been arrested and could face stiffer consequences unless we get him into treatment
• The judge will look favorably on a person who is in treatment
• The person is likely to be arrested unless we get him or her into treatment
• The person is going to lose their job, reputation, career, family, etc.
• We are going to go broke unless the person stops their reckless spending
• We can't stand the mood swings, hostility, depression, etc
• We don't want the kids to be subjected to their substance use or behavior
• We want the person to stop using or drinking or we want the person to drink or use "normally"
• We want the person to be like they were before

Let's review the economics of the style of intervention and its single objective of pressuring the young lady into treatment. (I live near Beverly Hills so prices in other areas may be different):

• Intervention - $5,000 to $8,000 per intervention
• 30-Day Treatment - $30,000 to $50,000 per treatment per month
• Misc. Costs - (broken lease on the apartment, transportation, loss time at work, storage, moving, etc.)
• Total Cost - ($5,000 + 24 months of care at $30,000) = $800,000 to $1,208,000

If getting a person into treatment had a high percentage of helping a person achieve long-term recovery there would be some justification for this style of intervention. However, given the fact that the chances are low that a person will achieve long-term recovery from "going to treatment" the model is broken.

Why is substance abuse and other mental health issues so hard to treat? A treatment center is nothing like a car wash, you can't put a person into a treatment center and expect that the person will come out the other side "clean and sober."

Here's an anology that may help. People refer to addiction in a similar way that people speak about cancer as if they are "one" thing.

However, there are 34 major types of cancer including lung, breast, liver, prostate, stomach, thyroid, pancreas, lymphoma, Leukaemia, kidney, brain, etc. Treating the different types of cancer requires radically different approaches, which or may not include vastly different kinds of treatment, lengths of care, cost, time of recovery, etc.

Addiction is similar, we find many different types of addictions alcohol, opiates, meth, cocaine, benzodiazepines, THC, sex, food, shopping, gambling, video games, work, etc connected to people who are bipolar, depressed, anxious, traumatized, physically ill, injured, hopeless, bored, homeless, curious, adventurous, spiritual, or religious. Understanding a person's addiction requires knowing how addiction is connected to a person's mental and physical health, lifestyle, and preferences. Many factors will change the assessment process, kind of treatment, cost, length of care, time of recovery, etc.

This is where the analogy of cancer treatment is helpful. Some cancers are treated with a single medication or with a simple surgery while others require months of years of treatment with outcome predictions like 5 out of 100 people with your type of cancer live five years or more. Some cancers are not treatable. Other cancers go into remission, and may or may not return. People refer to cancer treatment as life-saving, expensive, experimental, invasive, debilitating, life-changing, incredible, unpredictable, or ineffective.

Addiction treatment is similar to cancer treatment. Some people never go to treatment and find recovery, other people require years of treatments and still don't make it. You may know a person who went to a hospital, detox, or residential treatment center and instead of the treatment being "successful", the person completed treatment and within a short time, their addiction got worse.

Over the years, I've tried to understand why treatment centers are designed the way they are? I don't like to disparage a whole segment of the industry but by and large, I believe the typical hospital, detox, or 30, 60, or 90-day residential treatment center are poorly designed and ineffective. It seems like the research, recommendations, and best practices made by outstanding organizations and institutions like SAMSHA, NIDA, NIH, Columbia, UCLA, and more have been largely ignored by the treatment industry.

Therefore, if most of the hospitals, detoxes, and residential treatment centers are not going to effectively treat a person with substance abuse disorder than why hire an Interventionist who whose primary purpose is to get a person to go to treatment. I'm sorry but it just seems like too big of a risk to spend the time, money, and energy to get someone into "treatment" if the outcome will most likely not be achieved.

My suggestion, hire an Interventionist who will build a relationship with your loved one, stay connected, provide resources and referrals, educate, and most of all love and care for the person and their loved ones. If the Interventionist and your person are a good match, and the Interventionist has the skills and experience to help you build a recovery team around your person. Have the interventionist help your loved-one build their team. The recovery team will include an addiction trained-integrative psychiatrist, a trauma-trained psychotherapist, an attachment-focused client advocate (sometimes referred to as a "case manager"). At times, the recovery team may include "specialists" and a life coach. Specialists may be a person with knowledge in a particular addiction, mental or physical health disorder, nutrition, fitness, mindfulness, religion, etc.

Your loved one's recovery team may stay with him or her for a year or more. This is a marathon and not a sprint. This team will attach to your loved one and stay attached through thick and thin. A good team and the person will collaborate, meet regularly, and have a game plan in case of relapse. If a residential or outpatient treatment center is recommended it would function as a community center where your loved one will be inspired to live life to the fullest, in the lifestyle of their choosing, with purpose and passion, surrounded by supportive and loving people, helped by evidence-based best practices for the treatment of addiction and mental health. I'd love to hear of professionals and centers that you think highly of; I know they are out there! With gratitude, Alex Shohet