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.