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.)

Sunday, January 11, 2009

How Complicated Can You Make a Supervisor Referral...Let Me Count the Ways

I have absolute faith in the future of the EAP profession because a great idea will always carry it's weight and move forward, so don't take the following the wrong way. I thought I would just have some fun with creative writing this morning. =======================================

Hey, why is the EAP field and its processes so confusing after over 30 years of being an established and legitimate occupational pursuit?

Answer: A lack of detailed and enforced standards and sanctions for misapplied EAP core technology priniciples that hurt employees, cause loss of jobs, and dismantle the EAP profession. I am convinced, anyone can call anything they want an EAP and recognized associations, even if you are a member of them, won't give a hootily. Just pay your dues on time.

When I get the inkling to discuss this topic, I only have to Google a specific term and up pops a great example of what I am talking about.

Here's today's wonderful (not) illustration. Here is how one HR benefits firm with an "EAP product" discusses their procedure for making what they call a "SUPERVISOR REFERRAL TO THE EAP":

STEP 1: HR (not the supervisor!) calls _________EAP to discuss the purpose for the referral and requests a blank Supervisory Referral Form if needed.

STEP 2: HR and employee discuss Job Performance Problem and determine deadline by which employee must contact ____________EAP and have an initial EAP assessment. Supervisory Referral Form is then signed by both the employee and HR/Supervisory Representative

STEP 3: Supervisory Referral Form is faxed to ______EAP attn: Clinical Manager

STEP 4: Employee calls ________EAP intake operator and requests a referral to a provider

STEP 5: Employee calls provider and schedules an appointment as per agreement

STEP 6: ________EAP Clinical Manager contacts provider and HR/Supervisor to begin the process of mediation between the provider and HR regarding the employee’s treatment plan and progress.

I don't know if you were counting, but there are a total of 8 humans involved in this referral not counting the employee. If you missed the person who is assigned to email or fax the supervisor form, you're simply not on your toes.

How many supervisor referrals to you think this provider receives as a percentage of total referrals to the EAP during the year?

True confession: I worked for a company for 11 months in 1995 (I won't mention the name here, but you can visit my resume to find out.) and they had an almost identical process. That organization's supervisor referrals were close to ZERO!

A supervisor referral is a simple thing. And, it's powerful. But add in bureaucratic hoops and fire rings to create a circus and your utilization rate will flop. Worse still, behavioral risk with the folks that might go "postal" or have other problems that cause financial loss will increase.

Here is what a supervisor referral is (I am going to be a little cynical and expansive in this paragraph to emphasize my point.)

STEP 1: A supervisor referral simply uses the application of authority or leverage of job security to motivate a troubled employee to accept the exciting opportunity to be accommodated and assisted by the EAP to get help for a possible personal problem in lieu of the possibility or immediately pending disciplinary action for documented job performance or conduct problems.

STEP 2: The EAP is notified, preferably, but it won't and can't interfere with the supervisor referral and the employee's responsibility to act. Documentation is given to the employee and the EAP, and a release is requested to be signed by the employee to verify participation and cooperation with whatever is going on at the EAP.

A release is essential to good EAP work, but what if you can't get it? Remember, EAPs are voluntary. Well, answer: It isn't needed or necessary if the employee doesn't want to verify attendance and cooperation (which can easily be explained by the EAP or the supervisor as not a smart choice.) Verifying attendance and cooperation is to the employee's benefit. No organization is handicapped without a release.

That's the sum and substance of a supervisor referral. One human involved, plus the employee being referred will make it work beautifully with an EA professional at the other end.

The key is making the employee responsible for change and accountable for change. Supervisor follow-up is key. A breakdown in communication and bureaucratic snarling in supervisor referral process translates to an erosion of the employee's perception of accountability for change.

Wednesday, January 7, 2009

Addiction Intervention Consulting for EAPs

Should you offer intervention consulting to employees who have family members or close friends with alcoholism or drug addiction problems?

You may mistakenly believe that intervention consulting requires going to where the intervention is being held, and passively being available in case expert guidance is needed at the event. The intervention industry, which is fraught with rip-off artists has promulgated the belief that intervention requires highly skilled professionals who show up on a Sunday morning after a pancake breakfast to surprise the alcoholic with a loving and supportive surprise meeting.

Nothing could be further from the truth. Intervention guidance does not require "specialists". The evidence for such an observation is in plain site. Addicts are admitted to treatment programs every day with only the hip-shot pressure placed upon them by family members or employers who accidentally, on purpose, said the right thing for the right reasons to motivate an addict to accept help. No intervention expert was present. And, I would imagine 95% of admissions to addiction treatment programs happen just like this--influence and leverage of those in relationships with addicts effectively applied.

Most admissions to chemical dependency treatment programs occur without an interventionist guiding the process, which is usually very expensive. The call to "have an expert" present effectively eliminates many people from the opportunity to ever consider an intervention. This not fair. To say to a family that they can't be just as successful without an intervention is one of the greatest disservices ever to be levied on addicts and family members.

How do you help these people? Despite attempts by interventionists to claim a high levels of artistry and to promulage fear if an expert isn't present, the reality is that the basic principles of successful intervention can be easily taught.

And, my argument is that success rates are higher if this "empowerment model" is used. That's because family members can try again if the first intervention fails, and they can become determined engines of change until it happens.

Most interventions (althought not called that) are completed by insistent family members with no interventionist present. In other words, people do say the right thing, perhaps accidentally, that motivates an addict to enter treatment. Usually these are family members who have decided to make treatment “non-negotiable.” The result is admission.

So, how do you add this expertise to your EAP?

The logistics. Such a meeting to educate an employee should include at the most four or five persons who have significant influence or leverage. More than that, and too much cross talk emerges dragging out the training of these individuals. (From experience and having done as many as 11 trainings in one week, the two major tools of intervention are helping family members IDENTIFY and USE tools of "Influence" and "Leverage".

Influence is the value or weight assigned to the relationship one person has with the addict. Leverage is something that can be given or taken away, which the addict greatly fears. Each of these are crucial tools in interventions, and they are used differently, and at different times, as I will explain. My argument in this blog of course is to argue that addiction intervention training skills should (and I would like to argue must) be a part of your scope of service. It is perfectly within bounds of the EAP Core Technology.

The instructional meeting will last about two hours. (This is not treatment or group therapy, although I know many therapists who have illegally/unethically bill for it through 3rd party reimbursement.)

A person with addictive disease has a medical illness. You are providing common sense principles of constructive confrontation to help family/friends motivate the addict to accept help. This is not therapy.

Your first task is to get information about the addict. Get the family to tell you the whole story. Get a feel for the situation. Next, enter a discussion about addictive disease. You must determine each of the participant’s knowledge about the disease and ensure that each of them understands the biogenic nature of the illness. Educate as you go. Any participants with “psychologically oriented,” or “willpower” models about the disease will sabotage the intervention.

Ultimately exclude such persons if they can’t come around. Coach them out of the intervention. Next, you must deal with guilt. Each of the participants will feel guilty about the intervention to some degree. These persons will also sabotage the intervention if they can't get past it. Help them see that they are not going “behind the addict’s back”.

Most of this guilt is based upon an enabling dynamic fueled by the addict’s direct or implied demands for loyalty in order to avoid confrontation over a period of years. Explain this to erode their mistaken beliefs. My next blog note: The Intervention Training Meeting Part I.

I know this is a bit gutsy, and that I am going against about 30 years of convention, but people need to hear the message. By the way, the movie "I'll Quit Tomorrow" will get your company sued fast if you ever try to duplicate what promotes--bringing the family into the workplace and surprising the employee in the office of the company's president to be confronted about their alcoholism. Burn the film if it is in your midst.

Feel free to e-mail questions or rebuttals as I continue this blog. I would like to respond to your comments: