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How to intervene so an addict or alcoholic hears your message

What We Can Learn from Patrick Kennedy’s Failed Intervention

Patrick Kennedy’s account of the family intervention done on his father is one we have come to know well. Senator Kennedy wasn’t aware he was walking into a room where his family and a professional interventionist were gathered, ready to convince him to enter treatment. Senator Kennedy took one look around and walked out. So angered by this attempt to intervene with his drinking, he stopped talking to his son, Patrick.

A&E’s show Intervention is based on such confrontational approaches. But what can the science of intervention tell us about what could have worked better for Senator Kennedy?

What Studies Show Works Better than Confrontational Interventions

For the last 13 years, I’ve run a program for families of those addicted to drugs and alcohol. 40% of all American families are affected by addiction. And yet they are under-served and under-recognized. They are the unsung heroes in the “war on drugs” and are a critical source of influence on their loved ones who suffer.

In this article, and those to follow, I want to give you the “instruction set” you’ll need to unblock the situation and get your loved one to accept help. I will explain what the evidence is, and how it translates into practical skills. This approach gives you the best chance for success when faced with a loved one’s substance problems.

I’ll describe in detail:

  • the stance you should take as a family member,
  • how to react and respond,
  • what to say and do,
  • when to step in and when to step away, and
  • how to conduct a successful intervention

These guidelines will create the best immediate environment for your loved one to recognize their situation and motivate them to seek help. Then, I invite your questions or a comment about your personal situation in the section at the end. In fact, we try to respond to all questions with a personal and prompt reply.

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The New Kind of Intervention (that works)

So let’s take the topic of intervention. You may believe that getting your addicted family member into treatment would take a miracle. Or you may think it can only happen if a professional is brought in. When we imagine interventions, we tend to think of highly uncomfortable situations. But an intervention does not have to be a big dramatic family meeting with lots of tears and pressure. It can simply be a quiet moment at the kitchen table.

In fact, that quiet moment around the table has a much greater chance of succeeding than a grand surprise party or a dramatic showdown. In one controlled trial (1.), 130 family members of people struggling with alcohol and resistant to accepting help were split randomly into three groups:

  1. The Johnson Institute intervention (the type Senator Kennedy experienced),
  2. Al-Anon facilitation (where you learn what to expect and are supported to go to Al-Anon meetings), and
  3. Community Reinforcement and Family Training or CRAFT (skills training that includes communication, behavioral reinforcement, and intervention).

Researchers were specifically interested in determining whether the family member could successfully engage their loved one into treatment. Treatment engagement rates varied widely as the chart below illustrates.

Intervention treatment engagement rates comparison

How different types of interventions measure up

The Johnson Institute results were low, just under 24%. The authors explained that many families started out but did not follow through on the intervention gathering, which lowered the success rate.

Al-Anon is not designed to help family members engage a loved one into treatment, yet close to 14% did. The authors suggest that learning to detach from a loved one, an important skill taught in Al-Anon, can send a powerful message to the drinker, one sufficient enough to motivate them to enter treatment.

CRAFT got close to 2/3rds of loved ones into treatment. Studies of CRAFT since this initial one have included family members of those struggling with drugs (including cocaine and opiates) (2.) , families of Latino origins (3.), and family members of adolescents (4.). Engagement rates ranged from 71% to 74%.

There are three steps to a CRAFT-style intervention.

STEP 1. Create a list of treatment options.

This is done well in advance of a tableside chat. This is not about handing your loved one the HMO card and saying, “get help.”  Your loved one is in no shape to figure this out. You’ll need to make the calls, asking about insurance, availability, wait lists, and admission criteria.

STEP 2. Identify wishes or dips.

With someone who’s addicted to drugs or alcohol, there will always be glimmers of motivation for change. We call these either a wish or a dip. Learn to recognize these moments, as they will provide the ideal moment to gently bring up the subject of treatment.

An example of a wish might be when you may hear the person say, “I really want to go back to school,” or “I wish I had my own place.” It’s a wish for change in their life.

A dip conveys a sense of frustration, for example, “I don’t know what’s wrong with me, I just can’t seem to get off the couch and do anything.” Or they may express sadness, embarrassment or shame about something that occurred as a result of their drinking or drug use.

STEP 3. Practice what you’ll say.

We teach families how to communicate in a way that is gentle and positive. Step 3 is to take these improved communication techniques, script out what you’ll say around that kitchen table, and practice it.

An example:

“So you’re saying you feel anxious and depressed. That makes sense to me. The percocet and the booze can do that. Thank you for being willing to talk to me about it. I think you are at a crossroads. It’s time to choose how you want to live your life. If you’re ready, I have figured out a couple options for getting you help. Would you be willing to sit down with me and look at what I’ve come up with?”

If they say “no,” you accept that, back off, and just say something like, “Thanks for listening. We’ll talk about it another time.”

CRAFT is an approach taught to the family, delivered by the family, and one that can be repeated without cost, when, unfortunately for many, multiple treatment episodes are needed.

By communicating calmly and respectfully, detaching from your emotions, and being prepared with possible treatment options, your intervention will have the best chance of success.

As the family member of someone addicted to drugs or alcohol, you have the power to become a bridge to treatment and recovery. Look for these fleeting but absolutely key moments when you can make a real difference to your loved one.

Reference Sources: (1.) Miller, W.R., Meyers, R.J., & Tonigan J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three intervention strategies. Journal of Consulting and Clinical Psychology, 67, 5, 688-697.
(2.)   Kirby, K. C., Marlowe, D. B., Festinger, D. S., Garvey, K. A., & LaMonaca, V. (1999). Community reinforcement training for family and significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence, 56, 85-96.
(3.)  Meyers, R. J., Miller, W.R., Hill, D. E., & Tonigan, J. S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10, 3, 291-308.
(4.)  Waldron, H.B., Kern-Jones, S., Turner, C.W., Peterson, T.R., & Ozechowski T.J. (2007). Engaging resistant adolescents in drug abuse treatment. Journal of Substance Abuse Treatment, 32, 133-42.

Leave a Reply

3 Responses to “How to intervene so an addict or alcoholic hears your message
Blake C
10:06 pm January 25th, 2016

Thank you Dr. Simon-Levine! This is a fascinating Blog post, full of information, and truth!

I appreciate you taking the time to put this together

-Blake C.

Lesley
8:10 pm February 14th, 2016

my daughters been drinking since she was 15 shes now 33 and with pancritas still drinking she doesn’t eat doesont wash and wants to sleep all day saying she got no emerge she acted like a child confused carnt remember things I’ve been told the alcohol has to be addressed first but I’m concerned about her state of mind should I visit her doctor or mine thanks lesley

Lydia @ Addiction Blog
8:13 pm February 16th, 2016

Hi, Lesley. There is a lot going on for you. I suggest that you look into the CRAFT model for families and interventions. One NGO called Allies in Recovery has some online reading that can help: http://alliesinrecovery.net/about-craft/ Also, you may talk first with her doctor, and then look for a second opinion from yours.

About Dominique Simon-Levine, PhD

Dominique Simon-Levine is a Ph.D. substance abuse researcher, who is in long-term recovery. She runs an award-winning program for families called Allies in Recovery. Founded in 2003, Allies in Recovery has helped hundreds of families to climb out of the abyss of addiction. Her work is featured on HBO and on alliesinrecovery.net.

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