Planning and Staging an Intervention

Popularized by various TV shows, films, and other aspects of the popular media, the notion of an intervention has been somewhat misconstrued. This page will go over what is and isn’t part of an effective intervention.

What is an Intervention?

An intervention often takes place when a person who is engaging in a specific type of self-destructive behavior, or a behavior that is potentially damaging to others, is confronted in a non-threatening manner by friends, family members, and other individuals who are close to the person, with the goal of assisting the person in seeking some sort of professional help.

For individuals with substance use disorders, an intervention is primarily designed to get the person into some type of treatment program. This goal is accomplished by pointing out how the individual’s behaviors related to the substance use disorder affect not only them, but other people who are concerned about them.

What an Intervention Is Not

Because of the many different presentations of interventions presented in the media, there is a misconception of what interventions are supposed to accomplish and how they are supposed to achieve their goals. A formal intervention is not:

• An ambush designed to catch the target individual off guard
• An authoritarian and coercive approach to force the individual into some type of treatment program (although there are some models that attempt this approach)
• A venue for individuals to vent their anger, frustration, and accusations at the subject of the intervention
• Designed to induce shame, be accusatory, or attempt to overwhelm the person

The overall goal of intervention is to foster awareness in the person in need regarding a substance use disorder, help the individual understand how their behavior is affecting them and those around them, and get the individual to consider seeking formal treatment for the substance use disorder. There are some instances where the substance use disorder may be so severe that imposing specific demands and contingencies may be the only way to resolve a potentially harmful situation. The general approach should be founded on honesty, concern, and love for the person.

Who Should Be Involved?

Because of their goals and the nature of the processes that should occur during an intervention, only people who are very close to the individual should be involved in the intervention. There should be no casual acquaintances, friends of friends, or other onlookers. This point cannot be stressed strongly enough. The participants in the intervention should consist of only close family members, close friends, close coworkers, and other individuals who are extremely close to the target person. It is probably best not to include very young children or other very young relatives in the process of the intervention, although this is a decision that can be made on a case-by-case basis.

In addition, interventions have a greater chance of being successful if at least one professional, such as an intervention specialist, professional healthcare worker specializing in substance use disorders, or even a senior member of a social support organization such as Alcoholics Anonymous or Narcotics Anonymous, is included in the planning, organizing, and overall process of the intervention.

The professional guidance person should be the only person who is not involved in a close relationship with the person who is the focus of the intervention. If a professional interventionist or addiction specialist who is closely involved with the person can be included, this is the preferable course of action.

When Should Interventions Be Used?

Interventions should be reserved for instances when it is clear that the person’s substance use is leading to severe negative consequences that affect the person, the person’s family, and the person’s close friends and other associates. Just intervening because someone is drinking too much, or someone in the family feels that someone should not be using alcohol or other drugs, may not be sufficient grounds to confront the person in this manner. Even though intervention should be designed to be as nonconfrontational and non-accusatory as possible, it may be perceived that way by the individual. Initially, the individual will feel a little overwhelmed and defensive. Not having a sufficient basis of factual instances that indicate that the person is engaging in extreme self-destructive behavior will only make the intervention less effective. Information provided by the National Institute of Drug Abuse (NIDA) for deciding what criteria to use for planning an intervention include:

• The person is failing to fulfill major obligations as a result of the substance use disorder, such as work duties, childcare duties, etc.
• The person’s substance use is associated with a significant decline in performance at work, school, or other important activities.
• The person’s relationships are seriously affected by their substance use.
• The person spends significant amounts of time using their substance of choice, and this leads to negative outcomes in other areas of their life.
• The person is becoming more and more isolated as a result of their substance use.
• The person continues to use their substance(s) of choice despite obvious negative ramifications, such as a decline in physical health, loss of a job, loss of friends, and so forth.
• Recurrent legal issues or financial issues as a result of substance use.

The goal of the intervention is to make the person aware of the negative ramifications of their substance use and to get them to realize that they need to engage in treatment. 

Types of Interventions

The basic types of interventions include:

• The simple intervention which is a simple one-on-one meeting with the person in need. Most often this is performed by a family member or close friend. The chances of increasing a successful outcome in this approach are far better if the person consults with a mental health care treatment professional or an intervention specialist prior to engaging in the intervention. This can help give the intervention some structure and focus.
• The intervention model most people are familiar with is the classic intervention. Typically, this is an intervention where family members and close friends or coworkers get together and discuss their concerns with the individual. The chances that this type of intervention model will be more successful can be increased if the group meets prior to the intervention to discuss goals, outlines each individual’s role in the intervention process, develops different responses to possible reactions of the individual in need, and consults with an intervention specialist or mental healthcare professional before actually performing the intervention.
• In some instances, there may be more than one individual with a severe substance use disorder or issue. One or more family members may be displaying these issues or have relationship issues that foster substance use in one family member. A specific type of intervention known as a family systems intervention is designed to be used to address this situation when multiple family members have substance use disorders or the relationships between family members interact to exacerbate substance use in one or more members. This type of intervention should only be attempted with the assistance of a mental healthcare professional or intervention specialist.
• Even though it is preferable to plan the intervention ahead of time and to have a structured and organized approach to the intervention, there are times when someone who has a substance use disorder engages in potentially dangerous situations as the result of substance use, and this needs to be addressed immediately. In this type of situation, an on-the-spot or crisis intervention can be performed by individuals who are in the immediate vicinity of the person in need. This type of intervention aims to get the individual to see the issues, realize the potential dangers associated with the substance use, and immediately get them into some type of treatment program.

Some Formal Intervention Approaches

There are some formal approaches to an intervention that deserve mentioning:

• In the confrontational approach, the focus is to force demands on the individual that will result in the person going into treatment. The individuals in the group lay out clear consequences for not complying with treatment participation. This is the approach that most people associate with the notion of an intervention for substance use disorders; however, this approach also has the least probability of being effective in the long run.
• A variation of the confrontational approach known as the Tough Love approach has received some popularity due to media exposure. The Tough Love approach is simply a confrontational approach where individuals who are participating in the intervention first state their concern and love for the individual, and then make demands with consequences for noncompliance in order to get the individual to go into treatment. A subtype of this approach known as the Love First approach uses a more structured method in expressing concern for the individual. This typically is achieved by each member of the intervention group writing a letter that expresses their concern and love for the individual, and then reading the letter verbatim during the intervention. Then, the group makes demands of the individual regarding entering treatment and outlines the consequences associated with the individual’s refusal to enter treatment. Most often, consequences include things like withdrawing contact with the person, withdrawing financial support, and so forth. Again, these types of approaches are not generally successful.
• A formalized method for organizing and implementing an intervention known as the Johnson Model utilizes a team of family, friends, and a healthcare professional or intervention specialist. The group meets together prior to the intervention to define the goals of the intervention. This meeting also results in the identification of at least three different treatment options to present to the individual during the intervention. This is a non-confrontational approach that has demonstrated some success when it is actually implemented; however, this specific model appears to frequently not progress past the initial planning stage.
• The ARISE intervention model (Albany-Rochester Interventional Sequence for Engagement) is a very complex model of intervention that utilizes multiple levels of approach. There are planning sessions, intervention meetings, and a final meeting, presenting consequences to the target as a result of not seeking treatment. Unlike other models of intervention, the target is actually encouraged to attend all meetings, including the initial planning stages. The goal is to expose the person to multiple levels of understanding. This model is recommended by the Association of Interventionist Specialists, a national organization that provides training and support for individuals wishing to become intervention specialists. There is some research to indicate that this model has been successful; however, there is a lack of independent empirical evidence regarding these approaches.

While the notion of intervention has received quite a bit of popularity in the media and in lay circles, there are quite a few unanswered questions regarding the effectiveness of interventions in actually achieving the goal of getting someone with a substance use disorder off drugs or alcohol. One study published in the American Journal of Drug and Alcohol Abuse examined the effects of the Johnson Model and found that individuals exposed to this intervention actually had higher relapse rates than other methods of outpatient treatment for substance use disorders. The number of current independent research studies regarding the effectiveness of interventions in helping individuals to successfully engage in treatment is quite limited. This may be due to the private nature of these interventions and the lack of a formalized approach to them. Thus, the empirical evidence for the effectiveness of interventions remains scant at best. Nonetheless, interventions do provide an opportunity for concerned family members and friends to try and assist someone suffering from the effects of substance use.

Conclusions

An intervention is a formal approach used by concerned family members, friends, relatives, and other individuals who have close personal relationships with someone who is suffering from serious issues related to substance use. Interventions should not be confrontational. The goal is to try and get the individual in need to begin addiction treatment.

Interventions cannot diagnose, treat, or otherwise attempt to change the person. Interventions that are focused on the goal of assisting the individual in seeking treatment should be nonconfrontational, well-organized, and recruit the assistance of a qualified professional, such as an intervention specialist or a licensed mental health professional who specializes in addiction.

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