Helping a Loved One

helping-loved-one

When you first realize your loved one may be addicted, you may fear losing someone very precious to you to this scary, confusing and overwhelming disease. Addiction is all of those things, and it’s also something that’s too big to face on your own. So the first thing you should know is that with treatment and help, recovery is possible.

It can be hard, though, to know where to start. What you’ll need to do first is formulate a plan that will set into motion the process of pulling your loved one out of a life of active addiction and closer to one of health, recovery and sobriety. It won’t be easy, as you likely already know. But information is a powerful tool and you should take comfort in the fact that you’ve already taken a giant step toward helping your loved one by caring enough to recognize an addiction and beginning the research you’ll need to be an effective helper and source of support. Here’s a five-step action plan you can start right now to turn your worry into meaningful help for the person you love:

  1. If you’re in a medical emergency, take action.
    First and foremost, if you think your loved one needs immediate medical attention now, call 911. If you suspect he/she has overdosed or is having unmanageable symptoms due to intoxication, withdrawal or side effects from a food disorder, again, be sure to seek medical attention ASAP; addictions – especially substance use disorders and food addictions – can be life-threatening. If your loved one is experiencing any suicidal thoughts or taking action to kill themselves, again, call 911 right away. Emergency medical attention and hospitalization can provide needed help, but on their own they are not treatments for addiction.
  2. Research treatment options.
    By the time you’ve come to wonder whether someone you care about might be addicted, there’s a good chance they already are. Addiction treatment can help whether the problem is mild, moderate or severe; a person doesn’t need to “hit bottom” for treatment to be effective. A great research tool is the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator, which can also be reached by calling 800-662-HELP (4357); this resource can help you find treatment centers in your area and across the country and you can search for facilities that accept private insurance or Medicare/Medicaid and ones that offer sliding-scale fees, meaning your loved one pays according to his/her income. You may also want to reach out to your friend or family member’s physician, who may ask you to bring your loved one in for a check-up, to make a diagnosis and to recommend a course of treatment, if necessary. For more information on choosing a treatment center, go to How to Choose Treatment for Your Loved One.
  3. Call treatment centers.
    Once you have a list of treatment centers (whether inpatient, outpatient or day treatment facilities) you think might work for your loved one, ask him/her if they’d you to call several to find out more. You can also ask them to check your loved one’s insurance benefits (they will typically do this at no cost to see how much care will be covered and how much he/she will need to pay out-of-pocket). Ask questions, including whether the facility treats the addiction(s) your relative or friend has and if they currently have space for new clients/patients. For more essential questions to ask, go to How to Choose Treatment for Your Loved One.
  4. Talk to your loved one.
    This can be the hardest part: telling your loved one that you believe that treatment is needed and that it’s essential for him/her to go as soon as possible. Caring enough to recommend treatment is definitely not easy, but it’s often necessary.Because addiction is a chronic disease and a progressive one, it will continue to worsen over time, in most cases, if nothing changes. The addict will continue to hurt him/herself and many others in the wake of their need to use. Just as you’d be quick to help a loved one with another chronic disease, such as cancer or diabetes, if they were unable to make good decisions about their care, sometimes those who love an addict must step in and persuade the person that care is needed, and quickly.When it’s time for these difficult conversations you should also take into consideration how likely it is that your friend or family member will leave or become violent. If this is the case, you might want to ask for more support from extended family, friends and your broader social network. If you’re considering an intervention find a professional interventionist (log on to the Association for Intervention Specialists’ member database to locate ones near you). An interventionist is trained to meet with an addict, usually along with loved ones, and persuade him/her to enter treatment.  An interventionist can often help you not only stage the intervention, but offer advice on a specific treatment center and plan or provide transportation to the treatment center.Know that even if your loved one isn’t completely ready for treatment, it can still work. According to the National Institute on Drug Abuse, treatment doesn’t need to be entered into voluntarily for it to be effective.
  5. Be supportive.
    If your partner, relative or friend goes into treatment encourage them to follow the treatment plan the center has created for  him/her; this will likely include abstaining from the substance(s) and/or problematic behavior(s), counseling and possibly attending mutual support self-help groups (12-step or SMART Recovery, for example). You should let your loved one know he/she has your complete support and love. There are any number of ways you can show your support: by attending family weekends when your relative or friend is in rehab; offering to drive him/her to meetings post-treatment; taking care to avoid anything that might trigger a relapse; and attending support groups like Al-Anon that will also help you take care of yourself, enabling you to be there when your loved one really needs you. Support groups and family counseling sessions are invaluable for caregivers; they’ll teach you how to stop enabling relative or friend’s addiction, as by, for example, stopping offers of money or housing if the person is still using, or changing long-standing family dynamics that help perpetuate addiction.

Be sure, though, that if your loved one decides to leave treatment; fails to comply with the conditions of treatment (yours and/or his/her health care providers’); doesn’t work toward recovery; and/or continues to use, you should talk to the care coordinator at the treatment facility a counselor or the interventionist you’re working with, if you have one. In some cases, for example, an interventionist or therapist may use a model of intervention that has families work together in specific ways to stop enabling an addiction. They may tell you to cut off financial support, stop making excuses for the one you love or to hold your loved one accountable for managing his or her own life; it all depends on your unique situation.

Intervention

When you think of an intervention, what probably comes to mind is a dramatic confrontation (as seen on TV) in which an addict is bombarded with accusations by tearful family members and friends who force the addict into a waiting car, bound for a detox center.

In reality, interventions can be many things. There are brief interventions, which may last for five minutes to a half-hour, during which a doctor screens a patient during an appointment for a substance use disorder and then advises the patient to stop using to see if the patient can do it on his/her own.

Or an intervention might be a series of mini educational sessions or workshops which family members invite the addict to attend; everyone then  gathers over a period of a couple of days to learn more about addiction and how it’s affecting the family. The result may be that other family members, not just the person with the addiction, are asked to enter counseling or support groups for their depression, addiction or enabling habits. An intervention can be, too, an intimate, heartfelt, out-of-the-blue talk with a small group of family and friends (even co-workers). At work, it could even result in treatment becoming a condition of employment, as when an executive is approached by the CEO with a written ultimatum: Go into treatment now, or you’re fired.

An intervention can be so many things because there are a number of different methods (more on those below). Experienced interventionists, whose job it is to guide an addict into accepting treatment, often use a mix of methods they’ve found work best for getting their clients into treatment and sustained recovery — the ultimate goals. Keep in mind that interventionists can help with any number of addictions, including a wide variety of substance or behavioral addictions, like alcoholism, drug addiction, gambling disorder, video gaming addiction, food addiction, sex addiction and related mental health issues.

By and large, the confrontational intervention in which the addict is humiliated and forced into treatment is not the norm. Addiction is now better understood as a chronic disease, so a respectful, loving, informative intervention that doesn’t put the addict on trial is what leading interventionists say works best. As Bill Maher, CIP, a Virginia-based certified intervention professional, puts it, “There are no kidnappings, no angry dumping on the patient.” He subscribes to a gentler, information-focused tact himself. “In my experience, it is not necessary to surprise them to intervene on them. I like to truly educate the whole family,” which includes the addict, says Maher, who’s also a certified alcohol drug counselor with over 25 years’ experience.

No matter which method you choose, an intervention is not recommended as something to DIY; enlisting the help of a pro is a smart idea for everyone involved. “The outcome of this particular event is going to affect a whole family,” says Earl Hightower, CIP, a Los Angeles-based certified intervention professional. “To base this process on things you read in a book or on the Internet and to not have real life experience in the room when you begin this process is a terrible mistake,” warns Hightower, who’s also a certified chemical dependency counselor who has been an interventionist for 30 years. “An intervention brings you face-to-face with the disease.”

To find a professional interventionist, contact the Association of Intervention Specialists (AIS) or the Network of Independent Interventionists (NII); their websites contain member directories. Even if you don’t see an interventionist there who’s located near you, don’t worry; most are willing to travel long distances to help families in crisis. Anyone you choose should be a certified intervention professional (CIP). Those with this certification typically also have other credentials as well such as certified chemical dependency counselor (CCDC), certified alcohol and drug counselor (CADC) and/or psychologist. Don’t forget to consider their years of experience doing intervention work, too.

The person you decide to hire may also bring his/her own experience of addiction to share. This can be useful in helping this stranger to connect with the addict (though you should, of course, choose someone who is solidly in their own recovery). “Calling an interventionist indicates a loved one has quite a bit of pain and their level of concern has pierced their own denial,” says Maher.

Rates for an intervention vary widely across the country and depend, too, on the experience of the interventionist and if flights, accommodation or other travel expenses are necessary. Fees range from as little as $1,500 up to $10,000 and are paid up-front; the cost is not covered by insurance. While an intervention may seem costly, when considering what’s at stake and the potential costs that can be incurred when a loved one isn’t treated (illnesses, injuries, hospitalizations, car accidents, lawyer fees, bail, even funeral expenses), many families decide to give professional services a try, especially when an interventionist claims high success rates in getting patients into treatment. You should always ask an interventionist his/her success rate, and also inquire about and check references, contacting families they’ve helped.

Hiring a pro will only work, though, if there’s follow-through. According to a 1999 study in the Journal of Consulting and Clinical Psychology, 70% of spouses and parents planning an intervention didn’t go through with it. However, 75% of those who did hold the intervention were successful in getting their loved one into treatment; more parents than spouses were able to sway their loved one to get help.

The purpose of an intervention is to show the addict how destructive their behavior is to themselves and those they love. Interventions are typically planned in advance, and whoever you hire to run yours will meet with the family or friends of the addict ahead of time to do an assessment of the situation,  which includes whether there’s a history of co-occurring disorders (meaning a mental health issue(s) in addition to the addiction), says Hightower, who follows this five-part progressive plan based on the Johnson model (see below) for interventions: assessment, coordination, preparation, intervention and post-intervention. “This pre-intervention information helps me identify the road map for the best opportunity for success,” says Hightower, who adds that he often has to slow down families who are in crisis mode and want to rush to the intervention stage. “You get one first, best shot,” he tells them, so planning is essential.

Next comes the coordination meeting during which the interventionist selects the group of people most likely to assist in getting the addict to accept treatment. These are people whom the addict most respects and with whom he/she has the closest bond.

Then there’s a preparation meeting at which everyone reviews the plan and their roles in it. An escort team is selected (these are the people who help take the person to the treatment facility if he/she agrees to go), and the group strategizes on what to say and do if the addict doesn’t cooperate.

Lastly, the group comes together for the actual intervention. The key here, stresses Hightower, is for the entire group to remain calm and flexible. “When you are intervening, the addict can get quite agitated,” he says, “and it’s important that the family not escalate the situation and remains quiet.” What if the addict leaves? “We have a plan for if the addict walks in, looks around, knows it’s an intervention and just walks out,” says Hightower. “Addicts are experts of compartmentalization,” he explains. “When everyone important in their life comes together, the addict realizes, They all now know!” The addiction is no longer a secret, and, generally speaking, the addict will return to the intervention even if he/she initially walks out.

Following the intervention — which, Hightower says, typically ends with the addict going into treatment, albeit sometimes begrudgingly – he debriefs the group during the post-intervention phase, remaining a source of support for the family.

There are a variety of intervention models in use. And while some research has looked at success rates for some of the models below, there are no studies that have compared all the intervention models to one another. You should also know that the success of any model also depends largely on the expertise and skill of the interventionist who uses it. If you’re looking to intervene on a loved one, here are some of the most common intervention models you’re likely to encounter:

Johnson Intervention Model: This is the most widely known type of intervention, developed in the 1960s by Episcopal minister Vernon Johnson, a recovered alcoholic. With this model, the focus is on the five-step plan described above and on confronting the addict as early as possible, before the disease progresses, and persuading them into treatment.

Invitational Intervention Model: This model focuses on the addiction, not the addicted individual. The addict is considered to be simply a participant who’s instrumental in helping the entire family recover from the disease of addiction. Family members and friends who may also have chemical dependence issues, mental health challenges or enabling issues develop coping and treatment plans for themselves, too, in an invitational intervention. While most of the time the addict may enter treatment as a result, this isn’t the only goal of this type of intervention.

Brief Intervention: When someone is screened for substance use and found to be at risk for a problem, a doctor or nurse may make brief attempts during an office visit to try to change drug or alcohol use or refer their patient to treatment. A study led by Richard Saitz, MD, MPH, chair and professor, of the department of community health sciences at Boston University School of Public Health, found that brief interventions may have some merit for certain substances but not others. “The best evidence now suggests that brief intervention for drugs has no efficacy among people identified by screening in primary care settings,” says Dr. Saitz. “On the other hand, for smoking, it does have some efficacy, and for excessive drinking it does, too, though not for people with alcohol disorders. It is important not to confuse what brief intervention might work for – its potential is for people who do not have addiction but instead for those using in a way that risks health consequences.” For some, it may take several conversations to have an effect.

Family-Focused Intervention Models: Several types of distinct intervention models have at their core an effort to educate family members (which can include friends as well) — in specific, changing how they interact with an addict:

  • Community Reinforcement and Family Training (CRAFT): Family members are trained in communication skills, getting the addict to enter treatment and motivating their loved one to remain in recovery. One study randomly placed family members into either a 12-step or CRAFT program. Those in the CRAFT program for drug addiction were more likely to have their loved one enter drug treatment (a 64% entrance rate versus 17% for those who attended a 12-step program for family members of addicts).
  • Systemic Family Intervention (SFI):  This model is similar to CRAFT, says Maher. SFI views addiction as a family disease.
  • ARISE® Intervention: The ARISE® method relies on two consultations with family members before an intervention. The family lays out consequences if the addicted individual does not enter treatment.
  • Unilateral Family Therapy: According to the American Psychological Association, in this type of intervention, family members learn to stop nagging, enabling and acting in negative ways that feed their loved one’s addiction.
  • Pressures to Change Procedure:  Loved ones are educated on how to encourage alternative activities to drinking, to stop enabling the alcoholic or drug addict and to apply pressure to the person who’s using to get them to stop or moderate their drinking or drug use.

When you are thinking of hiring an interventionist, be sure to ask which model(s) he/she will use. While Hightower uses the Johnson Intervention Model, Maher says the combination of the Invitational Intervention and Systemic Family Intervention models have worked best for him. “In my experience, most [people] intervened on will voluntarily transport and admit themselves into treatment, and the whole family enters into the recovery process,” Maher says, which translates into better odds for a successfully recovery.

Understanding Addiction

It can be hard – nearly impossible even — to understand how your loved one became addicted to a substance or behavior or comprehend how deeply addiction is now affecting his/her life. Part of the reason addiction is so puzzling is because too often we still believe in old rhetoric and mistakenly think that if our loved one was  only had more willpower or tried harder or had better morals, then he/she could give up this behavior and all the damage that it does. If only treating addiction were so simple.

Addiction is now understood by experts as a chronic brain disease. Other chronic diseases include asthma, hypertension and diabetes, and just like these illnesses, addiction requires ongoing treatment and vigilance. Addiction affects brain circuits that are responsible for releasing dopamine – a neurotransmitter that helps control our movement, our emotions and our ability to feel pain and pleasure. Addictive substances and behaviors stimulate the reward center of the brain in such an intense way that an addict will seek out the sensation or “high” again and again, trying to get the same response. The craving for the feeling brought on by the substance and/or is so great that using becomes compulsive, so addicted individuals seeks it out again and again – no matter how much the addiction hurts them or those around them. The brain’s decision-making ability is also affected by drugs, and so are the bodily systems that control serotonin, a chemical that regulates mood and sleep, as well as glutamate, which is involved in learning and memory.

So what your loved one may need most from you right now is your understanding. That you know that the disease they’re struggling with is just that: a disease, and one that is not only chronic, but progressive, meaning that it is very likely to get worse if the person doesn’t change in some way.

What you say and do now can make a big difference in how much your partner, friend or relative will trust you. And you may well need that trust if you want to persuade your loved one to enter and stay in treatment, and then to maintain their sobriety later.

But the addicted person isn’t the only one that could benefit from support and help, typically. As someone who cares deeply for a person struggling with addiction, you, too, may need counseling and/or the help of a support group in order to handle your own disappointment, anger and fear (among other emotions) over your loved one’s addiction. Getting this sort of help is essential to your own health, but it also enables you to be that source of support and strength. The demands on the family and friends of an addict can be intense, not least because your loved one is exhibiting unhealthy and unpredictable behavior that is leading him/her further away from being the person whom you know and love.

Good places to turn in your quest to better understand the disease of addiction are family counselors, licensed marriage and family therapists, addiction counselors, social workers and certified intervention professionals. All can help you learn coping strategies and ways to handle your loved one’s addiction so that the disease doesn’t overtake your life and your own health. Reach out to your insurance company for referrals to mental health professionals who can help you in one-on-one counseling sessions or in family or couples therapy. Ala-non is another invaluable resource for families struggling to understand the roots of a loved one’s disorder. There are meetings held in cities and towns across the country (and the world) at which you can commiserate with other families facing this debilitating disease.

When the realization that addiction is now part of your family’s life sets in, it can be difficult to plan how you’ll get your loved one to accept treatment. Many addicts are unwilling or unable to recognize that they need help. It’s worth contacting a professional, certified interventionist to get professional guidance when you and your loved one’s other friends and family decide to approach your loved one with the idea that you want him/her to go into treatment, or even that you’ve arranged to have a bed ready at a treatment facility. The guidance of someone who’s been there and helped to guide numerous families into recovery can be comforting and reassuring during such a difficult time. For all you may feel that you’re losing right now, bear in mind that recovery is possible, and with time, hard work, support and love, you are likely to get back the person you love.

Sources: American Psychological Association; ARISE® Intervention; Association of Intervention Specialists; Earl Hightower, CIP; Frontiers in Psychiatry; Journal of Consulting and Clinical Psychology; Bill Maher, CIP; National Institutes on Drug Abuse; Network of Independent Interventionists; Richard Saitz, M.D., MPH; Substance Abuse and Mental Health Services Administration

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