Part V of V - What If the Addict Says, "No!"

(Note, this post has four previous parts.) I will make all parts available in a downloadable document (grammatically proofed) at a later date.)

If the addict says no, intervention participants should be ready to act on the leverage they have previously decided to use. However, it is extremely effective to give a deadline for the addict to accept the offer of help if he or she says "no."

The recommendation is no more than one day. This gives the addict time to think about treatment and feel in control of the decision to accept it.

Many people argue only for an immediate transport to the treatment facility. I disagree from personal experience. Addicts babies. Don't treat them as such. You must guess that the addict is motivated and willing to follow through.

As a director of a 25-bed adolescent drug and alcohol treatment unit in 1982, I once convinced a teenager to enter treatment after attending an Ozzie Osbourne concert. This kid never would have entered treatment. I guessed I could make the deal. He shook on it and entered treatment two days later.

The desperate act of “forcing” the addict to decide upon admission within minutes of the intervention is linked to the intervention consultant’s role and the implication that the intervention can’t be repeated later when the interventionist does not come back.

Using an intervention consultants is almost entirely viewed as a “one shot” opportunity. It is a disservice to families and the patient to view interventions in this manner.

Virtually all interventions will succeed. That's a bold statement isn’t it? But if you understand the nature of addictive disease and its progression, you know that this statement is essentially true.

Helping intervention clients understand this reality is essential because it provides motivation to practice new behaviors that stop enabling and facilitate crises that can lead to admissions. The goal is for co-addicts (persons in relationships with addicts) to act in tireless and aggressive ways against disease until the addict accepts help at a future point, if not right now. That day will come with a new attitude and a watchful approach to stopping enabling. Alanon is extremely useful for this purpose, but the Alanon sponsor must not be a individual who sends the message of "do nothing", simply live detached. Alanon's message is powerful, but some individuals interpret Alanon principles as avoiding intervention--forever. So, be careful of this message.

There are essentially three reasons all interventions will eventually succeed, particularly if they are "family-managed” rather than intervention consultant-driven. (Family-managed means that the intervention becomes a process, not a one time shot event that is declared a failure on the first try if does not work.) Again, no intervention consultant is used with the family empowerment model.

Reason #1: The reality of the progression of incidental, serial crises until death or sobriety. As the disease worsens, crises continue unabated with only an unpredictable amount of time that separates them. Each one becomes an opportunity to initiate an intervention.

Reason #2: Denial and alibis of the addict diminish and this leads to a rapid progression of the illness’s symptoms. Addicts practice defensive mechanisms to avoid confrontation and consequences for their behavior. If an intervention at first does not succeed, drinking or drug use will increase, although there may be a short-term attempt to reduce consumption in a vein attempt to demonstrate control over the illness by practicing abstinence or moderation. As drinking continues or resumes, problems increase and interventionists (family and friends) need only await for the opportunity to try again. The mission: Make acceptance of treatment non-negotiable as before.

Reason #3: Addicts will sicken as their illness grows worse, making sudden medical crisis an eventual certainty if they do not kill themselves first either by accident, medical event, or suicide. This may take weeks or years, but medical symptoms will almost certainly emerge requiring sudden and acute intervention. Again, this is an incidental crisis as I have defined it earlier, and it is therefore another opportunity to make another move to intervene.

It is a medical fact that two-thirds of addicts die of the medical consequences of alcoholism left untreated. One-third die of calamities of one sort or another. Before death, intervention opportunities are numerous, not one shot. Obviously, no intervention consultant can return for a second, third, and fourth try at the intervention. Subsequent interventions do not require much planning. The addict is "directed" to treatment in the aftermath of each crisis.

Magic in Non-Disciplinary Corrective Letters

I have always been amazed at how supervisors chase employees to improve performance, stomp their feet to get them to work on time, or scold workers to curtail their inappropriate behavior. When none of the usual, emotional wrangling to to correct employee performance works, and a major incident occurs, out come the big guns - disciplinary action. What happened to the art and science of managing employees with an effective non-disciplinary corrective letter?

The missing piece of armament that very few supervisors seem to ever master well is the non-disciplinary corrective letter. A non-disciplinary corrective letter is a management tool and supportive measure to call an employee's attention unsatisfactory job performance and motivate him or her to make corrections to satisfy standards. These tools can salvage employees, reduce risk of behavioral issues and acting out, and help preserve a more effective relationship with the supervisor.

Effective corrective letters utilize potential reward and fear of loss to match the motivational psyche of the employee. (Some employees become motivated by reward. Other by fear of loss. It is the equivalent of being either left handed or right handed. And, of course some employees are both -- call it "motivation-ally ambidextrous."

Here is a "classic" non-disciplinary corrective letter. Print this model, because it can be a good one in your desk draw to share with supervisors in your one-on-one consults with them.
=============================

To: Sally Smith, Machinist
From: John Doe, Supervisor
Subj: Attendance and Performance Problems
Date: 1-1-2006

Last week I reviewed the sick leave records and discovered that you have taken nine days of sick leave in the past year. Each of these days occurred on a Tuesday following a holiday weekend, or on a Friday preceding a three-day holiday weekend. I discussed my concern about this pattern with you last August 12, 2005. Since then, I have grown increasingly concerned. Your last such absence was on Dec. 27, 2005.

As you know, sick leave is a benefit to be used when necessary. The frequency of your sick leave is too high and affects your ability to perform essential functions. On February 15, several overdue widget projects caused a loss of their sale the day you were out. This cost the company $50,000. Your absences also negatively affect clerical staff. I would like to see your performance improve and your absences reduce.

You have excellent skills, and are a valued worker on the assembly line. But, if your use of sick leave remains high I will take additional steps to intervene, which could include administrative or disciplinary action.

Please provide verification of any future illness in which you lose work time. Please see me if you have any questions with regard to this request or the contents in this memo.

Thank you for your attention to this matter. As you know, the EAP is always available to assist you in the event a personal problem is contributing to your attendance problem. You can reach the EAP confidentially at 555-1234. I will review your use of sick leave in one month on Tuesday, February 1, 2006. Please plan to meet with me at 3:00 PM on that day.

cc: next level supervisor

Workplace Violence and Problematic Relationships with Supervisors

I wanted to talk with you about workplace violence and supervisor relationships.

EAPs routinely help resolve problematic relationships that employees have with their supervisors. If you haven't worked with this type of issue yet, you will.

I believe this intervention activity that HR managers, EAPs, and even OD people sometimes tackle has the most potential to improve productivity, reduce risk of violence, and help insulate the company from lawsuits -- big ones. The role EAPs play in helping resolve employee-supervisor conflict should get more attention in the literature.

I have always believed that effective EAP models reduce the number of potentially violent acts that, as a result, never happen. The question is, do companies appreciate this enormous benefit that can't be easily proven?

Many of these cases begin with employees who have problems with supervisors. These problems don't just create conflict and distraction. They can lead to death by a violent act. The subject of violence and improving relationships with supervisors is so critical to safety that I always include articles about it during the year when writing WorkExcel.com\'s newsletters. I so badly want to produce 7-9 minute Flash movie on "Best Tips for Reducing Supervisory Conflict with Subordinates" I think this would prevent violent acts more than the usual "know the nearest exit to your office if your employee explodes."

Employees love tips for improving their relationships with supervisors. There are huge payoffs for providing them, and top management will love you for doing so. That's because management can't rally employees to improve their relationships with their supervisors. The dynamics of paycheck-driven relationships simply makes it impossible. Your newsletter is a perfect medium for doing it.

Here are a few topics to consider for your next newsletter and those down the road. Chase after your newsletter company to write about these topics. If you are in a pinch, have them send me an e-mail and I will reply with my thoughts. They shouldn't have any problem if the writers possess an EAP background, of course.

Topic ideas

* Improving channels of communication and increasing frequency of
communicationSpeaking with your boss freely about concerns early on, before
problems arise
* Asking for advice about problems that you are experiencing on the job
* Writing down your concerns and sharing them; helping plan your evaluation goals
* Asking for feedback -- going to the boss and not waiting for it
* Considering your boss's perspective -- not just your own; how to do it and why
* Using tact when discussing differences
* Figuring out what your boss really wants from you, without asking
* Understanding that your supervisor is probably not "out to get you"

Don't just make a newsletter entertaining for employees. Make it a loss-prevention tool for the company. These tips will reduce conflict, improve program utilization, and increase top management's awareness for your true value.

Employee Newsletters for EAPs and Workforce Productivity

Helping Employees with a Wage Garnishment "Fishing Net"

Garnishments are court orders for the employer to cut a check, mail it to the creditor or entitled party, and along with it process a bunch of paper work every pay period, sometimes for a long period of time. Employers must follow court orders to garnish wages or face paying the entire amount to the creditor themselves. They are a nuance for any hard-working payroll department and they cost the company money. EAP utilization can be boosted dramatically if you make arrangements with your organization to have management make supervisor referrals for employees whose wages must be garnished. The performance basis of the referral is the financial burden on the organization resulting from issues within the employee’s personal life adversely affecting the workplace. Like any management or supervisor referral, the garnishment referral is not a punitive act.

Wage garnishment judgments may or may not be deserved sometimes, but they are almost always symptoms of larger problems in the employee’s life in addition to the debt and credit problems the employee is experiencing. That’s because psychosocial problems frequently produce financial problems. Garnishments could be symptoms of drug problems, marital crisis, depression and mental illness, and of course, compulsive shopping or gambling. It isn’t easy to arrive at the point where one’s wages are finally garnished. Many threatening letters, phone calls from creditors, and the like arrive first. A year or two could pass before a court case becomes a garnishment judgement.

Most organizations have considered referring employees with garnishments to the EAP, although historically such referrals were commonplace among core technology EAPs of the past. Breathe new life into your utilization rate. Set a meeting date with human resources and discuss the practice of employees being referred to the EAP as a result of wage garnishments. There are many ways to do it—from a simply mention in a letter, to a more formal management referral. Like any supervisor or management referral, be supportive when making employee wage garnishment referrals to the EAP.

3. Get your organization to refer such employees and you'll get the business and your utilization rate up. Draft a model letter for the employer(s) you serve, justify the rationale, and start getting these referrals.

Improving EAP Orientations

Every effective EAP conducts new employee orientations. It can be your one clean shot at having new employees understand the services you offer because there is no guarantee that you will ever have them as a captured audience again.
You want it to count.

Here are a few tips to improve the referral-pulling power of your employee orientations and make the right impression so your EAP utilization stays high.

Provide a More Detailed List of Problems, Issues, and Concerns
Many EAPs only provide only a brief list of the types problems and concerns their program will address. Typically these are broad categories of problems such as substance abuse, mental health issues and stress, health care concerns, financial or legal concerns, family/personal relationship issues, work relationship issues, concerns about aging parents. They aren’t specific enough. Such broad categories require the employee to consider whether their unique problem fits. Make them think less by offering rich details about what falls into these categories.

There is an important adage in marketing that goes, “Don’t Make Me Think”. It means that if the customer has to figure out what you are trying to say, you’ve lost them.

What’s missing is a more detailed list of problems that would increase the likelihood of an employee spotting the specific issue that troubles them. create 6-7 specific examples for each of these areas of concern, and you will promote your program more effectively. This is pure marketing, and the term is called “message to market match”.

Here’s an example of such a list:

Life management issues----marital and couples conflicts, sexual and intimacy issues, parenting skills, social and relationship issues, financial issues (credit problems, debt collections, loss of income, budgeting, and conflict over money.); legal problems; fear and anxiety over medical conditions; eldercare issues and caregiver stress; loss of a loved one and bereavement/grief issues. Landlord, tenant issues, homelessness or threatened homelessness; relationship conflicts, domestic/partner abuse, and victimization.

Emotional problems and mental health issues----depression, anxiety, medication management issues for psychiatric conditions, eating disorders and compulsive eating, social issues and relationship problems, adult child-parent relationship issues, and parenting concerns over teenagers.

Alcohol and drug-related problems----alcohol-related problems, drug-use problems and drug addiction, family members affected by the drug or alcohol use of another family member, relapse issues or maintaining or re-establishing an abstinence program and/or program of recovery from addiction and codependency; teenage substance abuse.

Job-related problems----getting to work on time, coworker conflicts, issues in working with your supervisor, performance concerns, career counseling, difficulties making decisions, stress, exhaustion, work pressures, being affected by downsizing, pre-retirement planning and related concerns, difficulties of a new position.

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.

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.