What Is the Purpose of an Intervention?
In the United States today, our goal is to shunt the troubled/addicted individual out of the home and into treatment. By itself, that doesn’t work.
What is the purpose of an intervention? In the United States, members of a family get together to bombard the target individual with all of the accumulated evidence that his/her life is failing, combined with providing instant access to a treatment facility.
Does that work?
It contradicts the motivational interviewing model, found to be the most effective form of treatment, in which individuals conclude, based on their own values and decision-making, to change their behavior. Indeed, MI doesn’t require a separate treatment component. The decision-making is the therapy.
It may be the case that an individual is so harmful to the household, or such a threat to themselves or other family members, that the person needs to be removed from the home. But that is a long way from guaranteeing that the person is on the road to recovery, meaning becoming a successfully functioning human being in a family, community, and work setting.
Think back to Chris Christie’s viral video describing his mother’s and his law school friend’s addictions:
“She tried everything she could to quit: she had the gum, the patches, hypnosis. She got cancer at age 71. No one came to me to tell her not to get treatment for cancer. Yet, somehow, if it’s cocaine or heroin, or alcohol, we say they’re getting what they deserve.”
So Christie wants to provide everyone with treatment, which he says needs to be made far more widely available.
BUT CHRISTIE’S MOTHER HAD EVERY KIND OF SMOKING TREATMENT THAT THERE WAS — nicotine gum, patches, hypnosis. In what way was she deprived of addiction treatment?
The second case Christie described was of his fellow law student who became addicted to the opiate painkiller Percocet, following which his wife kicked him out of their home. She asked Christie and other friends to perform an intervention, which Christie did: “That started a ten-year odyssey of him being in and out of rehab.” Christie then describes how the man died with a bottle of vodka and a vial of Percocet by his side in a motel, at age 52.
Christie’s final word: “He was a drug addict and he couldn’t get help and he’s dead. We need to start treating people in this country, and not jailing them. Give them the tools they need to get better.”
BUT CHRISTIE’S LAW SCHOOL FRIEND WAS IN AND OUT OF REHAB FOR A DECADE — how could he have received more treatment?
Was being alone in a motel a good route to recovery?
Failed Treatment vs Absence of Treatment
These are actually stories about failed treatment, not the absence of treatment. Especially in the case of the dead law student/lawyer; he was isolated from his family and friends. Does treatment of the individual in isolation from the family produce the best outcome? Not according to that case.
Of course, Christie’s mother wasn’t expelled from the family. But the change efforts Christie describes are entirely about external therapies—nicotine replacement (the patches and gum) and hypnosis. They didn’t work.
What might have worked for Christie’s mother and friend? A therapy that was directed at the family as a unit—that is, which helped the family to reinforce sobriety and discourage the addiction. The best such treatment is known as Community Reinforcement and Family Therapy, or CRAFT.
As described at the web site of the Center for Motivation and Change:
Community Reinforcement and Family Training (CRAFT) teaches family and friends effective strategies for helping their loved one to change and for feeling better about themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her. It is designed to accomplish three goals:
- When a loved one is abusing substances and refusing to get help, CRAFT helps families move their loved one toward treatment.
- On its own, CRAFT helps reduce the loved one’s alcohol and drug use, whether or not the loved one has engaged in treatment yet.
- CRAFT improves the lives of the concerned family and friends.
Drs. Robert J. Meyers and Jane Ellen Smith of the University of New Mexico developed the CRAFT program to teach families how to impact their loved one while avoiding both detachment and confrontation, the respective strategies of Al-Anon (a 12-Step based approach), and traditional (Johnson Institute-style) interventions in which the substance user is confronted by family members and friends during a surprise meeting. CRAFT has proven significantly more effective in engaging loved ones when compared with the Johnson Institute Intervention or Al-Anon/Nar-Anon facilitation therapy.
There is no therapy that does not impact the entire family—only therapies that recognize and accept that fact and those that do not. And not acknowledging it fails to address the problem.-Stanton PeeleOf course, even if the individual enters therapy (as did Christie’s friend) that person must return home and conduct a sober lifestyle in interaction with other family members, which Christie’s friend apparently never did. In other words, the same need remains to change the “loved one’s behavior by changing the way the family interacts with him or her” after rehab.
There is no therapy that does not impact the entire family—only therapies that recognize and accept that fact and those that do not. And not acknowledging it fails to address the problem.
If Christie’s proposed addiction program is to increase the number of 12-step rehabs of treatment centers that treat addicted individuals with drugs — which I think is what he means — the results will be no better than they were for his mother and friend, both of whom succumbed to their addictions.
Nonetheless, this is how addiction treatment is conceived in America: as a separate activity performed by medical and addiction specialists on individuals extracted from the family and placed in a therapeutic setting, there to be fixed so that they can return home as well-functioning individuals.
Only that doesn’t work, and having more and more of such treatment is futile.
Tell me, do you think the problem in the United States compared to other countries — think of Canada, Britain, Spain, Italy — is that we have far too few rehabs a-la The Hazelden Betty Ford Center. Think of the rows of treatment centers in Santa Monica and Florida, as depicted for the latter on the accompanying map.
Is what we need that the map have many more red dots and rehabs?
I don’t think so.