Getting a Loved One Started in Recovery: Invitational Intervention

There are many examples of how families positively motivate and influence individuals to make productive and lasting changes. Among them was former First Lady Betty Ford, who was faced with a decision related to her drinking and prescription drug abuse. Her family met with her to discuss their worry and concerns. She had to make a difficult choice to stop these practices and get the needed love and support from her family for a lasting recovery or face the consequences of continued use. She chose to start recovery.

Firefighters/first responders and our families, who are also high-profile within communities, can positively invite a loved one to stop using. These are two high-profile examples of how families can positively influence a loved one to stop using.

The key ingredient in each story is that the family became motivated to change. No longer was the family going to be controlled by the disease of addiction. No longer was the family going to “walk on egg shells” and be controlled by the guilt and blame used by the substance abuser. The family hits its own “bottom” and gets sick and tired of being sick and tired. It takes only one in the family to start meaningful change. One person is capable of mobilizing others to join in stopping the destructive impact of untreated addiction on the family. This process is called Family Motivation to Change. The initiator mobilizes others for support, which is the next step. The “Invitational Intervention” builds on the strengths and commitment of the Family Motivation to Change. In this method, the efforts of the family are matched to the resistance of the substance abuser.

Studies show that most substance abusers are willing to participate in a family meeting centered on the topic of their use when invited in a loving and direct manner. Staff members of organizations like Rosecrance Health Network in Rockford, Illinois, are trained to coach family members in how to best approach the affected family member. These professionals are aware of the long-standing investment the family members have made in their loved one’s well-being and don’t want to do anything to jeopardize that relationship. Addiction, on the other hand, can often tear a family apart if it goes untreated.

A Drinking Problem

When an alcoholic seeks treatment, a family member, friend, or professional is typically the driving force behind the decision. Most alcoholics are reluctant to face their drinking problem. In fact, most alcoholics start treatment with a nudge, on the order of a judge, or with a grudge. Their reluctance at starting treatment or lack of initial motivation has no bearing on the eventual outcome. It may be up to you to break through the denial and start the recovery process for someone you know. It will not be easy to intervene constructively, but it can save the life of your friend or relative. The ARISE Intervention is a respectful method of breaking through the denial system.

“In most cases, a spouse or close relative knows enough about a person’s drinking pattern to recognize when it is a serious problem and possibly alcoholism,” says Robert M. Morse, M.D., a Mayo Clinic psychiatrist who specializes in the diagnosis and treatment of alcoholism. Alcoholics and alcohol abusers are not the only ones who may use denial. Their family members or friends may use denial as a coping mechanism, too. Over time, denial is destructive for all involved.

The National Institute on Alcohol Abuse and Alcoholism estimates that 14 million Americans-one out of every 13 adults-either abuse alcohol or are alcoholics. Dr. Morse says alcoholism is “horribly underdiagnosed.” The risk of developing alcoholism is present at any age. Teenagers may be especially vulnerable, but you can become an alcoholic much later in life as well.

Alcoholism

Alcoholism is an addiction to alcohol. It is often progressive and can be fatal. Alcoholism is marked by the following signs:

  • Periods of preoccupation with alcohol (for example, “I can’t wait until after work to get out and have a drink”).
  • Impaired control over alcohol intake.
  • Continued use of alcohol despite adverse consequences or problems caused by drinking.
  • Distortion in thinking (most notably denial, minimization, and rationalization).

Alcoholics also develop a “tolerance” to alcohol, meaning they must drink more alcohol to feel its effects. They also may experience withdrawal symptoms such as shakiness, a more rapid pulse, sleep problems, and even seizures when they try to stop drinking.

Talking to an Alcoholic or an Alcohol Abuser

The first crucial step is to help alcoholics or alcohol abusers recognize that alcohol is at least a part of many of their problems. Here are some time-tested suggestions that are components of the ARISE method:

  • Raise the subject. There is no perfect time or place to bring up the issue, but do not do it while the person is drunk or drinking. Wait until he or she is sober. Sometimes a confrontation is more productive when facilitated by a professional who is knowledgeable about alcoholism and alcohol abuse and who can arrange a therapeutic “intervention.”
  • Explain the consequences. The following message should be kind but firm: The alcoholic or alcohol abuser needs to get help or suffer the consequences. Such consequences may include the loss of a job; chronic diseases; divorce; breakup of the family or friendships; and, most importantly, losing the messenger as a cover-up.
  • Don’t be brushed off. If you are seriously concerned about a person’s drinking, do not allow him or her to distract your concerns. If you are constantly bailing the person out of trouble or giving a “second chance,” an alcoholic or alcohol abuser is likely to interpret this pattern as permission to keep drinking.
  • Blame is counterproductive. Someone with an alcohol problem is likely to feel misunderstood. Try to put blame aside because it only feeds such feelings. Remember that alcohol addiction is a disease, not a moral weakness.
  • One-on-one, the alcoholic always wins. It is very common to become isolated in the effort of trying to get the alcoholic help. Once you are isolated into one-on-one confrontations, the alcoholic almost always wins. The alcoholic, in one-on-one interactions, has the power to manipulate with promises, short-term efforts to improve, and blaming you as the cause of the problem. It is important to build a support network, such as an intervention group, to avoid the pitfalls of getting caught in a one-on-one confrontation.
  • Don’t wait until it’s too late. Putting off the discussion or confrontation increases the risk of serious health and social problems. As with any disease, the earlier the treatment, the better. The alcoholic does not have to “hit bottom” to get help.
  • Don’t neglect your own needs. It’s easy for the alcohol problems of one person to overwhelm an entire family. Often, a series of family or personal stresses show up in emotional, economic, physical, and social functioning from living with alcoholism. You may feel anger, resentment, depression, betrayal, and disillusionment. Counseling may be necessary to help you understand alcoholism and learn appropriate actions for your own well-being. Intervention is a proven method to get you support and to help a loved one get started in treatment. One way to help the alcoholic or alcohol abuser is to attend to your own needs and those of other family members. Going to alcohol-support groups such as Al-Anon can be very helpful.

The Invitational Intervention builds on the above points. Working with an “Invitational Interventionist” will support you in building an intervention group (so you are not going at it alone) and to successfully help your loved one get started in treatment. The above points can be applied to all addictive behaviors, including drug abuse, sexual addiction, Internet addiction, and eating disorders. The focus on alcoholism is meant as an illustration using the most common addiction.

Common Myths and Stereotypes about Addiction

The following myths and stereotypes about addiction sometimes stop families from intervening with a loved one:

  • Coercion, persuasion, and mandated conditions are long-held and practical referral components of substance abuse treatment. All are designed to work with a system with which the substance abusers have contact and that has some meaning in their lives and some leverage to motivate change and the potential for consequences.

We now accept the importance of employee assistance programs, drug courts, and impaired professionals programs as successful vehicles for getting addicted individuals started in recovery. None of these vehicles start with the premise that the individual must want help to start treatment. We believe that families are another vehicle to get an individual started in recovery. Families have a long-standing relationship with the addicted individual and are invested in helping that individual get well.

  • When looking at treatment outcomes related to completing a 16-week intensive outpatient program, which referral source do you think had the highest completion rate, the lowest completion rate, and why?

Research we have done and published demonstrates that the lowest rates of successful treatment completion are with voluntary self-referrals. These individuals might start treatment with earnest motivation and desire to stop using, but without any accountability to the treatment system, they fall prey to the cunning, baffling, and powerful messages from the disease of addiction. The disease tells them that they are better now, they don’t need treatment, and they can use again as long as it doesn’t get out of control. Family involvement builds in accountability. Our research shows that 90 percent of the individuals who entered treatment as a result of a family intervention completed it. The accountability to the family and ongoing involvement of the family in treatment are critical factors in treatment completion.

  • Recent findings related to addicted brain neuro-chemistry and neurological functioning point to structural changes that result in irrational thinking and a disease base for the loss of control. Families have often witnessed the changes in their loved one because of this addiction process. Families often feel as if the person they are now living with is not the same person they once knew. Families often want guidance and support to “get their loved one back.”

The “old-timers” were right when they set down the tradition of doing 90 meetings in 90 days. Critical brain-chemical and neurological changes take place in the first 90 days of recovery. We now have scientific evidence that the denial, irrational thinking, and loss of control are neurological dynamics triggered by the action of the alcohol or other drugs in the addicted person’s brain. These addiction neuro-pathways are so “hard-wired” that the individual is not able to see reality in an objective manner. This is another reason family intervention is so important-the family members are the eyes and brains for the addicted individual until that person has successfully stopped using.

  • Family motivation to change is a dynamic similar to the individual motivation to change. Family motivation to stop the addiction from infiltrating rituals, functioning, and communication can influence the substance abuser to change.

Family motivation to change is a powerful and influential force when it is harnessed. Much like a flowing river, when the water is channeled, it can be converted to life-enhancing energy. The process of change starts when any one family member decides that the addiction with which they are living is creating pain they can no longer live with. The addiction has made family interactions too controlling, too chaotic, too isolated, too filled with emotional ups and downs, too filled with anger and resentments, and too controlled by fears. Our research has shown that a family member can be successfully coached in the best way to invite other family members to participate in an intervention. Our research shows that this coaching is also 60 percent successful at getting the addicted person to attend the first family session designed to get this individual started in treatment.

  • Many individuals believe that a person must “hit bottom” to recover successfully. Waiting for an individual with an addiction to “hit bottom” is like waiting for a car to break down before taking it to a mechanic to get the problem diagnosed and fixed. Addiction treatment is much like other medical treatment: The earlier the problem can be diagnosed, the better the chance for recovery. Think of how the survival rates of cancer have increased because of the emphasis on early recognition and treatment. Addiction treatment is very similar. The earlier the addiction is treated, the more the individual has to work for because everything has not been lost. Looking at addiction treatment in this way helps us to see that there really is no “bottom” and no need to wait for a person to get worse before anything is done to help.
  • Living with projected resentments, blame, anger, excuses, and denial by the substance abuser results in self-doubt. Family members fall victim to dealing one-on-one with the substance abuser. One-on-one, the addicted person will almost always win.

Substance abusers are sick individuals whose behavior, attitudes, and thinking reflect the illness. If you are living with addiction, it is highly likely that you have been negatively affected by this disease. One of the destructive features of addiction is how masterful the addicted person is at splitting the family and getting individual family members to talk to the addicted person only on a one-on-one basis. The addicted person makes promises, uses guilt, and masterfully plays one family member against another. The end result is that family members living with addiction develop a pattern of dealing one-on-one with the addicted person. Our research shows that dealing one-on-one with the addicted person is seldom helpful or successful at getting the individual to stop using. In fact, this dynamic is the one most family members give as the reason for their getting so angry and frustrated and wanting to give up. Mobilizing other family members is a proven way to stop the destructive influence of addiction. There is strength in numbers. No longer does any family member have to deal one-on-one with the addicted person.

Author’s Note: The ARISE Invitational Intervention model was developed by Dr. Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI, a child, family, and community neuropsychiatrist and former professor of psychiatry and family medicine.

FATHER JIM SWARTHOUT, M.Div., MSW, CAADC, CIP, is a certified ARISE interventionist and the clergy community coordinator for Rosecrance Health Network. He is a certified fire chaplain with the Federation of Fire Chaplains and works weekly with firefighters with addiction and trauma concerns at the Rosecrance Health Network Florian treatment unit in Rockford, Illinois.

Father Jim Swarthout will present “‘Invitational Intervention’: Understanding Where Addiction and Hope Meet,” on Thursday, April 21, 1:30 p.m.-3:15 p.m., at FDIC International 2016 in Indianapolis.

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