Thursday, October 22, 2009

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.