Friday, March 20, 2009

Part IV of V: Leverage

Leverage is “part B” of any intervention process. (Influence is part A.) Leverage, however, we discover is frequently not necessary in interventions because the front-end of the intervention where use of influence is dominant, along with the synergist impact of the group presentation, works to motivate the addict to accept help.

Participants breathe a sigh of relief, but nevertheless they were prepared and empowered by their decision to use leverage. (Leverage is something given or taken away from the addict that he or she greatly fears.) Therein lies the power of leverage. Participants know what they will do if the addict does not agree to admission or other treatment option. They act to make treatment non-negotiable in their relationship with the addict. This attitude and willingness to act is crucial to success, and intervention participants must commit to the concept of “non-negotiability” of treatment.

Leverage is used when influence does not work. The participant with the most leverage goes first. Frequently, this is the participant with the closest relationship with the addict, and hence, is historically the greatest enabler.

Often leverage constitutes separation, divorce, removal of children from the relationship, willingness to call the police when the addict drives under the influence, separation from financial means, and other severe measures that the addict greatly fears or finds distasteful.

Leverage has another benefit: It gives the family member relief from the enabling, which causes stress, worry, and continued fear. One family member once said she would call an Army general (the alcoholic’s commanding officer) and notify the general of this drunk behavior when it interfered with work rather than enable him any longer. This was all it took for the admission.

Some spouses obviously "go for it" and are willing to live with exposing the addict for all to see. Once all participants are done presenting their leverage, another discussion takes place to "argue" for the admission. The impact of the leverage is discussed with the addict. (Reality check time.)

Most addicts by this time will go along with admission. There may be some bargaining so the addict feels in control of his or her decision, but if the details are minor like a.m. or p.m, decide if it is worth arguing over. I once made a deal with a 15 year old to enter treatment two days later after an Ozzy Osbourne concert he had planned to attend for six months. Don't ask me why, but after shaking hands and agreeing on it, I believed he would come back two days later. He did.

No person should present leverage that they are not prepared to use. Doing so will harm the intervention severely and it will appear. This is called "buying the addict’s next drunk," because dysfunction increases with no perceived consequences to the continued drinking. And denial is reinforced. This happens with family members torn by guilt or those who have alcohol or drug problems themselves. These persons must be screened out of interventions or re-educated so their beliefs change about addiction and addictive disease treatment. When the addict agrees to the treatment option - action takes place without delay to make it happen.

Tuesday, March 3, 2009

The Presentation (Part III of V)

Each person in the group presents his or her personal experience with alcoholic or addict explaining two experiences directly related to the use of alcohol/drugs and its effects on their life without blaming the addict (it's the disease and drug affected behavior damaging the person and the relationship.) Natural emotional emotional pain will be experienced and demonstrated. That’s appropriate. I statements must be used. Describing experiences their associated emotional pain in the relationship is key. If any participant is so angry that he or she can’t describe their pain and get vulnerable in front of the alcoholic, more work with that person should be considered, or their participation in the intervention should be questioned. Before describing the negative events above, each person affirms how important and valued their relationship is with the addict or how they want to return to what that value relationship once was.

When describing negative events, the key to success is not focusing on the addict's need for treatment. That comes later. Instead, have family/friends focus their experience and feelings associated with hurt and pain caused by the alcohol-affected behavior or its outcomes.

Participants describe in detail two events and their impact. A key element in interventions in having family members acquire the ability to consider within their stories the difference between what the relationship is like now as a result of the use of alcohol or drugs and what a vividly imagined and described picture of what it can and should be if only person's behavior was not affected by alcohol.

This is powerful. No presenter should discuss another participant's experience or attempt to point out what he or she thinks the alcoholic can’t see or doesn't understand. This triggers the use of defense mechanisms and sets the intervention back. The group’s goal with the serial presentations is to create a phenomenon called synergistic remorse.

Each person's presentation causes the alcoholic to re-experience feelings of remorse or guilt--originally felt at the time an incident originally occurred. These feelings of remorse are often short-lived, but they are a open window into which the group will insert a treatment solution later. The goal is to have the addict begin to feel a sense of urgency and determination to deal with the drinking problem/drug problem in some way he or she thinks might be effective. (Willpower is usually what's being silently considered.)

At the end of the last story, the group moves quickly to request admission to an addiction treatment program knowing that at the end of a series of effective presentations the synergistic remorse effect is in play and peaked. An attempt to bargain by the addict is the usual response, and then an gentle persuasion experience on the part of the group begins.

The group asks and presses the addict to enter a treatment program immediately. Each participant presses for this decision.

The goal is to successfully urge the addict's acceptance of the treatment recommendation and reject effectively ideas offered by the addict that will certainly be minimal and half-measured attempts to abstain. Participants MUST be effective with their language at providing non-agitating and non-provocative responses to the addict's "better idea". The following is a resource (sorry it is not well proofed, but I can't edit these blogs and information very effectively so bare with me folks.)

Try this document I wrote to help my own intervention clients: “Effective Responses to Defensive Statements Made By Addicts in Interventions". I think it does a pretty good job at educating participants with “what to say” and “how to say it” in response to twenty classic objections addicts use interventions. Language is disease model based and I think you will get the point of why it is effective to marshal support and confidence in family members prior to an intervention.