I am excited to share a preview of my latest book, The Definitive Guide to Addiction Interventions: A Collective Strategy, as shown in the September 2018 edition of Recovery Plus.
As a clinician and interventionist, I work directly with families and their loved ones on alcohol and other drug misuse and abuse, process disorders, mental health, and chronic pain issues (see the summer issue of Recovery Plus for an overview of all family intervention techniques). To unpack and address the complex nature of these issues, I find it helpful to use what I call a Collective Intervention Strategy.
It is collective in that we need a team of families, friends, colleagues, associates, business partners, managers, or co-workers to work together towards change. It is an intervention, in that we seek to move (motivate) a person to a place of change. And it is a new strategy, in that nothing is set in stone; we can adapt the process as needed. CIS will offer you protocol, process, tools and ideas. The interventions that you will facilitate will require that you think on your feet. You will need to be flexible and contextual. So we encourage all clinicians willing explore the domain of interventions to adjust the Collective Intervention Strategy to their own practice.
We also we know that one form of addiction bleeds into another: co-occurring mental health disorders such as depression, anxiety, personality disorders, juxtaposed with medical problems such as chronicpain, legal or school issues. The complexity of what’s really going on is a mystery to most families. That’s why they usually call you in the first place. Sometimes it’s complex even for addiction-treatment professionals – you will be called on because theyhave not been able to “close” or gotten an identified loved one (ILO) to commit to a “Yes”.
Core collective intervention skills.
A good intervention includes much advance preparation. Coaching is ongoing as we work to develop and implement a change plan. In order to get to “Yes”, an interventionist must be able facilitate and guide the following:
Retrospective bio-psycho-social analysis Â Case strategy
Treatment planning and placement
Family engagement in the healing process.
The CIS approach uses evidence-based approaches that includes qualitative research interview methodology called Portraiture,
as well as Cognitive Behavioral, Motivational Interviewing, Solution-Focused, 12-Step and Mindfulness Modalities in an invitational Team- Systems framework. Communication skills are also essential to interventions, as are interviewing skills and solution focused skills. Throughout the process, the interventionist manages all team and third-party communication. S/he serves as a liaison. For example, individual phone interviews with prospective team members might be needed. Or an interventionist might provide safe escort or transport to a treatment centre.
Case management is also required. Treatment centre matching and referrals are necessary. Likewise, follow-up and regular case management with treatment centres while clients attend rehabilitation programmes is critical. Finally, consultation and coordination of aftercare as
well as solution-focused family recovery coaching for all team members ensures lasting change.
CIS basic anatomy.
The basic anatomy of the Collective Intervention Strategy can be split into three main phases: Agreement, Research and Implementation. Throughout, the interventionist provides education, support and guidance.
Phase 1: Intervention agreement and initiative. The process begins when the client/family agrees to the terms of a working relationship, or clinical engagement. Clinicians must have buy-in from the families that they work with. So, we generally work with a first caller who’s going to
set a path forward. For example, it is crucial that clinicians uncover the nature of the serious problem at hand from the beginning. The main problem can be diagnosed as a substance abuse disorder (alcohol, legal drugs, illegal drugs) or a process addiction disorder (food, internet, sex, gambling, debt) or a mental health disorder (depression, bi-polar, mania, borderline). You’ll need to determine the exact nature of the problem before moving forward. Additionally, clinicians need to identify the key stakeholders in the group and create an initial genogram, or family map during this phase. The family map will evolve during the process but this first baseline diagram provides a clearer picture of what is actually happening in the family system. This is the starting point for defining the family group, the members of which we call the “accountability team”.
This phase of the intervention concludes with coordination and agreement of all group members. The clinician helps moves the accountability team to be united on key decisions. In determining what it takes to reach group consensus, clinicians help fashion and establish group boundaries. From there, the interventionist helps define and develop the group’s motivational strategy.
Phase 2: Education, information gathering, and assessment. Now clinicians share their knowledge about the brain disorder of addiction. I use the ASAM definition of addiction; you can also use DSM-5 or ICD-11 definitions. Clinicians could also teach about the process disorders of sex, gambling, shopping, digital or exercised addiction. Where appropriate, clinicians can shed light on disordered eating, mental health issues, chronic pain syndrome… and how these all interface. Then accountability team members review the overall process, ask questions and learn more about addiction. Through this practice, everyone learns more about what is going on, what the disease of addiction looks like, and how the team is going to get healthy together.
Phase two also includes learning more about the ILO, their lifestyle and the most significant relationships they have. Collaboratively, we identify the most appropriate people to be part of the intervention meeting and accountability team. Information gathering comes from a variety of sources: family members, friends, partners, employers, treatment professionals and others. Everyone paints a portrait of the ILO. The goal? Through triangulation of data, a clinical assessment can be gleaned through a retrospective analysis. By obtaining a good bio- psycho-social history and combining this with the generational map from the first phase of an intervention, a clinician can determine many complex factors, including if there is an underlying mental-health disorder.
This phase also continues to evaluate treatment options and potential aftercare programmes specific to the client’s needs and situation. The right approach will be based on the unique circumstances and mental and physical health conditions of the people you are working with.
Phase 3: Implement, review and follow up. Ultimately, a plan is created in Phase 3. It is during this phase that you set a date for a pre-intervention meeting and the intervention meeting. The Intervention itself is a well- orchestrated event, a drama that is created and stylised. The main goal of the intervention is core to our work: interventions help move the identified loved one to change and to accept treatment. Some interventionists stop there.
Some interventionists are interested only in moving or getting someone to treatment. But dropping the case at this point can result in many negative outcomes, such as complications, financial problems, increased complexity, legal problems, relapse and/or treatment drop-out. What happens after the intervention is equally important. You’ll have to help the family navigate through treatment, support group attendance – 12-Step work, AlAnon, ACA, open AA meetings or Smart Recovery are most often used – and possibly dealing with refusal for treatment. You’ll need to continue working with families to teach them how to take care of themselves as they deal with substance abuse, process disorders, physical issues, and mental health issues in the system.
Families will need to learn to set healthy boundaries, for themselves and their loved ones. Family members might be referred out for care to family counsellors, individual therapists, recovery coaches, or other behavioural/mental health care providers. The key point is this: follow up is crucial to the success of developing healthy family systems.
Families struggling with complex substance abuse and mental-health problems are
behavioural systems in which the illness-related behaviours have become the central organising structure. Over time, an identity is forged round this. The family accommodates unconsciously to the special needs of the person diagnosed with the substance or mental
health behaviour. When recovery begins, this identification of the client as a the “troubled one” must be altered for success. Each family member must pivot and take on a new persona and a new way of evaluating the ILO in treatment. The idea is to support systemic family health through personal behavioural change.
Meanwhile, families also contend with legal issues, physical issues and family history.
This is the reason why a true Collective Intervention embraces a systemic approach which includes case management and active coaching over time. From experience, it can take many months for a family to actually become “collective” and to operate in harmony again. For example, siblings often take a different stance when person enters treatment. They might be jealous or resentful that their sibling gets all the attention and they are left to fend for themselves. In this way, the healing process and relationship renewal with a sibling can take longer to build than a mother-child relationship.
Everyone in a family accepts that possibility and goodness is possible for the loved one
in treatment at different times and ways. Indeed, each member of a
family is unique and will have their own trajectory of healing. So, working with family members over time as
they come to their own understandings and healing is the best way to proceed.
Furthermore, continued case management allows for motivational and solution-focused approaches with key family members so that they can express their feelings, their hopes, and their concerns with you, the clinician.
This continued engagement with a professional clinician allows people to work on themselves. Used in this way – as solution-focused family recovery coaching – clinical involvement serves as a grand augment to a treatment centre’s family programming and/or family therapy.
In short, Phase 3 of the CIS aims to create a three-legged stool in which the treatment centre clinician, family programme manager and you as a case manager work in harmony to help the entire family heal. Just as people have differential reaction to death and loss, so family members have different reactions to a loved one’s addiction and concommitment issues.
Remember: Recovery begins when treatment ends. Engaging the accountability team in the recovery process leads to positive outcomes! Weekly coaching calls are a superb way to do this. Also, clinicians can liaise with the treatment facility and help with aftercare. Each plan is designed to ensure that the client’s process is beneficial for all involved.