Thursday, January 22, 2009

Family Empowerment Model Intervention: Part II of V

Part II of IV (See first installment of this article a couple days back)

Family Empowerment: Instruction in the Leverage and Use of Influence.

After instruction in the disease orientation to addiction, participants in
intervention training should be instructed in understanding the use of
influence in the interventions.

Influence is the value or inherent worth that can be subjectively assigned to the relationship a family member or friend has with the addict. All attendees in the intervention should have some influence.

Negative influence equates to provocative relationships of any kind,
including drinking buddies, etc. Such persons should not participate.

Obviously the amount of influence will vary among participants with some, say
a close friend, having a lot, and others say, a cousin or neighbor having

One member of the group must accept responsibility for being
the leader of the intervention group. This person's responsibility is to start the
intervention meeting when it occurs and guide the structure since there
will be no "professional intervention consultant” present.

All members of the group must adhere to strict communication boundaries between training
and the day of the actual intervention. Addicts (as a result of the
disease) become hyper-vigilant and will easily detect subtle mood
differences or behaviors of participants that can tip off to the plan for an

The structure of any Family Empowerment Model
intervention includes: Introduction, Use of Influence, Pushing for
Admission, Use of Leverage, Pushing for Admission (second try),
Conclusion, the Admission, and Next Step for a Refusal Outcome.

Eighty percent of interventions that I have arranged never had to use leverage,
but it is critical for it to be present in case it is needed. Leverage
provides intervention teams with psychological power and confidence, which
can be felt by the addict intuitively.

This is the value of leverage. Leverage is something given or taken away from the addict that he or she greatly fears. Next, the group should discuss where they intend to meet the
addict for the intervention.

The group should approach the intervention when the addict is most likely to be least affected by toxcity. Morning hours are frequently better than evenings, for instance, but there is no
hard and fast rule to this step.

Discussion will produce the best time and place. The group must buy into making treatment nonnegotiable. This concept refers the absolute belief by the participants that treatment is necessary to save a life and that the status quo with the practicing addict will never
return unless they fail in their determination for change. Any other type of relationship enables the addict to get sicker.

Until the addict is in treatment, the only practical relationship with the addict is the one that facilitates admission to a treatment program as soon as possible. This is particularly true if the intervention is not successful at its conclusion.

Such an understanding will maintain a state of inertia necessary to act at the next opportunity or incidental crisis associated with the drinking or drug use. This is a key point, because such a crisis will come. It is only a matter of time. When this happens, the group will act to encourage admission and will probably be successful.

This is how virtually all interventions successfully occur not led by a professional become successful. A quick attempt to directly facilitate admission will succeed eventually.

Starting an intervention is always a bit difficult, but a plan should be in place for precisely how it is done, and it should practiced. The leader starts by saying something to the effect that "we are all here because there is something very important that we have to tell you. We need you to hear it. This is very personal for each of us and each of us has something we need to say.

There are obviously many variations on this wording. A fair guess, however is that 95% of addicts will cooperate with the intervention at this point. Few guess what is happening and get up and leave. But there is plan in place in the event that happens.

Participants should rehearse their presentation at least twice. Until the day of the intervention, it is important that participants “carry on as usual” and not “alter suspiciously” their relationship with the addict. A crisis caused by drinking or drug using behavior, however, pushes the intervention date forward to NOW.

Prior to the intervention, participants must make preparations for the following: admission after the intervention (or outpatient intake, or evaluation, etc. You can help them decide which is
best.); logistical considerations that could cause the addict to back out -- money, job issues, pets, vacations, bills, child-care, etc. All bases must be covered.

The intervention begins by the leader talking first. Every participant will talk using the following rules: (1) Avoid blaming; (2) Speak only about your own experience; (3) Do not refer to other people in the group; (4) Avoid shaming; (5) Avoid using the terms "you should"
"can't you see what you've done" or other language that moves away from the participants "first-person account of their personal experience associated with the addict's behavior.

The group is also instructed in the "sandwich technique". The sandwiching technique is an interviewing manuever designed to confront a person with negative facts associated with their
problem while blunting the impact with positive statements that validate the person's worth.
In interventions, this means validating how important or how loved the addict
is by each person.

Each person rotates through the confrontation presentation and speaks about their personal experience with the addict. (Next, blog note, I will discuss the outline of this presentation.)