The patient must be ready to acknowledge the problem and want to seek help

To put it bluntly, an intervention will not be successful if the person cannot be convinced to go to treatment. While the need for change may be clearly apparent to everyone around her, keep in mind that her brain has been subjected to toxins that can temporarily (or permanently) reduce her mental abilities even when she is sober.

Intense or long-term ingestion of alcohol or drugs can have a profound affect on the brain of an alcoholic or drug addict. While a normal person can easily see the destructive behavior, connect the behavior to negative consequences, and conclude that stopping the behavior will alleviate the consequences, the addict may not be able to make such elemental connections. Addictive substances can affect reasoning and logic abilities and further destabilize the mental state of a person. She may not be able to see the seriousness of the problem.

It is also possible that the consequences are not dire enough yet encourage change. For instance, if an alcoholic has been able to maintain a job and keep a roof over her head, she may be less likely to acknowledge the seriousness of her situation than if she has been fired due to alcohol-related behavior. Therefore, for some patients, the timing of the intervention may be critical.

Further, addiction means that the person experiences incredibly strong biological cravings for alcohol or drugs. Withdrawal, a painful process during which the body is denied the alcohol or drugs it craves, is often a terrifying prospect. Although most treatment programs will handle withdrawal gently using a medically supervised process called medical detoxification, fear of withdrawal symptoms (or fear of cessation of the feeling association with drinking or taking drugs) can be strong enough to cause a person to acknowledge the need for treatment, yet refuse to go.

Even the most well-known and successful interventionist may not connect with the patient

If you have ever been to psychological therapy, you may know that it is not always easy to find a therapist that fits. Characteristics such as gender, treatment style, personality and social status may attract us to or repel us from a particular therapist.

The relationship between patient and interventionist can be similar to the relationship between patient and therapist. Although the interaction between interventionist and patient is often brief (as opposed to therapy which is long-term), the patient will probably not agree to treatment if she does not feel comfortable enough with the interventionist to trust him. Although a disconnection between patient and interventionist may not have anything to do with the competency or talents of the interventionist, it will have the same effect as using an incompetent or inexperienced interventionist, i.e., a failed intervention.

One major difference between choosing a therapist and choosing an interventionist is that the subject of an intervention is not permitted to make the choice herself. Instead, a family member or friend has taken the choice away from her prior to the start of the intervention. This feeling of being forced to allow a stranger access to an intensely personal situation may overwhelm the intervention regardless of the interventionist. However, selecting an interventionist that the patient can connect with or, more importantly, has already been through what the patient is going through can go along way to encouraging trust between patient and interventionist.

The process of selecting an interventionist should be handled with extreme care. Some of the best interventionists will be former alcoholics or drug addicts who have already walked in the patient’s shoes and can address the addiction-related fears and concerns that family and friends may not even be aware of, never mind be able to address. Since selecting the wrong interventionist can torpedo an otherwise favorable intervention, do not be afraid to explore the personal background and success record of any prospective interventionist.

Family Dynamics Shift

Over time, as family members of the addict go about their daily lives, their roles begin to shift. This happens subtly and without conscious thought, in most instances, as a means to simply get by. What may be obvious addictive behavior to an outsider becomes a tolerated every day event within the family. One or more family members cover up, make excuses, rationalize, justify, deny or ignore the real issue: Addiction is a disease and it doesn’t go away by itself. In the process, the addict’s family members become co-dependent. They, in fact, enable the addict to continue his or her self-destructive path.

Here’s how some of the roles shift. Of course, there’s the addict, who becomes, in effect, the center of the family universe. Sooner or later, everything seems to revolve around the addict and his or her needs. There’s the need to tend to the consequences that occur as a result of the addiction and the necessity to tiptoe around the addict’s wildly unpredictable, unrealistic, and/or violent behavior. The addict is the tyrant, the dictator, destroying the fabric of normal family life – all as a result of the addiction.

Addiction counselors identify several roles in the co-dependent family members. In smaller families, one or two individuals assume the various roles as circumstances demand, while in larger families the roles are more clearly defined. In all cases, the roles are unhealthy and only serve to perpetuate the behavior of the addict.

• The Joker – Making light of the situation is the province of the joker. This person tries to use humor, at times light, other times biting and cruel, to inject levity into the situation. Often, the joker experiences profound embarrassment, shame, and anger about the family situation. Who wants to deal with the depressive state that surrounds addiction? Something has to deflate the lead cloud in the home. The joker serves this part well, but this behavior does nothing to alter the circumstances and only further complicates any hope of recovery – for the addict or the family.

• The Savior – Sometimes called the hero, the savior does everything in his or her power to cast the family in the best possible light. We’re a normal family. We don’t have a problem, everything’s just fine. The savior, who is also often a perfectionist, talks about things and goes on about life as if the addiction simply doesn’t exist. Underneath, the savior feels intense guilt, shame, and fear that others outside the family will find out.

• The Sad-Eyed Child – This family member remains silent most of the time. Usually, it’s a child, although it can be an adult family member as well. The characteristics of the sad-eyed child are that he or she will never speak about the addiction, never refer to it in an overt way. Often ignored, shunted to the side as a result of the necessity to cater to the needs of the addict, the sad-eyed child suffers greatly and stays out of the way of the addict. With none of his or her own needs met, the sad-eyed child can’t grow. Inside, however, intense feelings of loneliness, neglect, guilt, and anger are festering.

• The Enabler – Often a female family member, the enabler, also called the caretaker, is the chief co-dependent, the person that makes the roles of the other family members possible. The enabler puts on the positive face to everyone outside the family and never brings up the issue of getting treatment. Instead, all the bad behavior and consequences that ensue from the addict are glossed over, denied, or excused by the enabler. Furthermore, the enabler’s driving ambition is to keep the family from talking about the addiction, to operate in a vacuum where addiction, treatment or recovery doesn’t exist. Everything’s fine. We’re okay just as we are – one happy family. The enabler, however, has mounting fear, helplessness, and a sense of inadequacy.

Things Go From Bad to Worse

In the whirling turmoil of family addiction, just getting by becomes more and more difficult. Depending on the extent of the addiction, how long it has gone on, what substances are involved, and whether or not there are underlying medical or psychological conditions present, the family situation can deteriorate slowly or much more rapidly.

There may be profound consequences that occur as a result of the progression of the addiction that need to be dealt with. These may be financial, social, or legal problems. The addict may be the breadwinner in the family and, when he or she loses their job, loss of the family home and other financial losses may threaten disaster. If the addict has had a motor vehicle accident while under the influence of alcohol or drugs, there may be liability claims, injuries or death as a result. There certainly will be mounting legal expenses, fines, increased insurance costs, and possibly jail time.

The risk of family violence increases as addiction progresses. So do drowning, fights that may turn deadly, and crimes committed to finance the addict’s habit which may end in murder.

Medical problems start to crop up for the addict, including stomach ulcers, hepatitis, HIV/AIDS, cirrhosis of the liver, kidney failure, heart disease, stroke, neuritis, brain damage, dementia, and ultimately even death. Overdose death is an increasing risk, particularly for heroin and methamphetamine addicts, but also from acute alcohol intoxication. Some drugs such as MDMA or ecstasy, also referred to as party drugs, cause problems with fluid balance – too much water or dehydration. Hyperthermia or overheating often results. This is a very dangerous condition that can cause permanent brain damage or death.

But it isn’t just the addict that suffers as the addiction progresses. Everyone in the family is impacted. The roles so carefully maintained just to get by no longer insulate family members from the consequences of the addict’s behavior. Stresses mount up. Frequent outbursts of anger, tears, recrimination and blame start to occur as the family dynamic continues to unravel.

At some point, something has to give. It’s at this point where one of the family members may bring up the topic of treatment.

Turning It All Around

When the recognition of the problem begins to dawn on family members – or at least with one of them – this is the critical turning point. Without recognition, there can be no hope of recovery. Someone has to bring up the subject, directly or indirectly. One method that is helpful, particularly in families where nothing else has worked, is intervention.

In an intervention, which is conducted by an intervention professional, family members and friends confront the addict and encourage him or her to admit they have a problem and to commit to going to treatment to overcome it. The conclusion of the successful intervention is that the addict is escorted by the interventionist directly into treatment. Of course, not all interventions are successful, since the addict has to be willing to undergo treatment for the best potential outcome. But many are, hence their popularity as a mechanism to get the addict into a program where the disease can be treated.

It is important to note that denial of the problem by the addict is the chief hurdle the intervention seeks to overcome. The addict usually says that he or she will go to AA or some other 12-step group meetings. Promises of quitting or cutting down are also common. But these are just words, and words have no teeth against addiction.

The reason so many interventions are successful lies in the power of the group support, encouragement and love displayed by family members and close friends. It isn’t an issue of ganging up on the addict. Rather, it’s the supportive environment where all concerned talk about what the addict’s behavior has done, how it hurts each person, how they feel about the situation, and how they want the addict to get help.

There’s actually nothing more powerful than such group support, especially when it ends in the addict agreeing to enter treatment – and actually going. It needs to happen immediately, not tomorrow or next week. All the arrangements are made ahead of time, all the paperwork and financial agreements concluded, so that when the addict says, “Okay, I’ll go,” he or she leaves the home (or wherever the intervention is held) and goes right into treatment.

Some families may not have insurance that covers treatment. While this could complicate getting the addict into treatment, there are alternatives. The most successful treatment for some chronic, long-term addictions is a residential treatment program. These entail a minimum of 30 to 60 days, and can last longer, depending on the individual’s needs. Many residential treatment facilities have pay-as-you-go or sliding-scale payment plans, in addition to insurance that may pay for some part of the treatment. Others offer special financing, or provide scholarships or grants to help cover the treatment. The key is not to let finances deter families from seeking treatment for their addicted loved one. There is always a way to get help. It may take a bit of research and asking a lot of questions, but it can be done.

Treatment for the Family

Addiction is a family disease. So it’s more than just the addict that needs to get treatment. No, this doesn’t mean that the other family members go into a facility for one or two months. What it does mean is that the family members are actively involved in various aspects of their loved one’s treatment program. The treatment staff will invite the family members in for different aspects of the plan. This often involves regularly scheduled individual and/or group counseling, educational meetings and recreational or social interaction with the addict and others at the facility.

Some facilities have intensive couple’s seminars of varying lengths – weekends, 4 to 7 days, or longer – consisting of educational and clinical activities to promote forgiveness, understanding, and acceptance. At the same time, such seminars or workshops focus on working through the years of accumulated shame, anger, resentment, bitterness, and fear. Coping strategies and development of healthy behaviors are taught.

Aftercare is another critical part of recovery, both for the addict and the family members. Continuing individual and group counseling is essential, as is attendance and participation at 12-step support group meetings. For the addict, these may include Alcoholics Anonymous, Cocaine Anonymous, Narcotics Anonymous, Crystal Meth Anonymous, Gamblers Anonymous, Overeaters Anonymous, Debtors Anonymous, Marijuana Anonymous, Sexaholics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual Compulsives Anonymous, and Workaholics Anonymous.

Support groups for family members include Al-Anon/Alateen, Adult Children of Alcoholics, Co-Anon Family Groups, Co-Dependents Anonymous World Fellowship, COSA, Gam-Anon, Nar-Anon Family Groups, and S-Anon International Family Groups.

A family wellness program helps educate family members about the disease of addiction, encourages them to examine their roles within the family, and provides strategies for identifying and addressing addictive behavior. Understanding what behavior is helpful and what is harmful to a substance abuser is also a key part of family treatment. Each family member needs to learn tools and strategies to use in order to remain healthy while their loved one is in treatment and then in recovery. Even if the loved one rejects treatment, or suffers a relapse, family treatment is vitally important.

How long does such family treatment and counseling take? It varies for each family and individual. The focus shouldn’t be on how long it takes but how effective it is in helping family members. Healing is a process, and it takes as much time as each person needs.

In the final analysis, it is only when the elephant in the room is recognized that family members can take the appropriate steps to help themselves – and the addict – find their way into recovery. Although it seems hard to believe for those who are deeply immersed in the effects of family addiction, recovery is not only possible, it may mean the beginning of a highly productive and successful life. It begins, as always, with the first step: the desire to make a change.

Question: What is case management in the intervention process and why do some families benefit from full case management?

Earl: Case management is a pretty broad term that covers a lot of terpurposes of intervention, there are two types of case management. One type is done post-intervention, post-treatment. We’ll sometimes be called upon to help by the family because they’re comfortable with us, they trust our judgment, and they know we’re not going to tell them we do things that we don’t. They see us as the first line of defense for the family in the ongoing process. They take our counsel when we did the intervention. Once the treatment center was identified, they needed to focus on their counselor – that’s your number one person now; we want you to focus on that person because they’re the ones who have your family member in their care. They’re the ones with the day to day information, most up to date information, engaging your family member in moving through this phase of the treatment process.

However, during that treatment, a lot of times family members come to us and say, listen, you found us the right treatment center, you found the right counselor, things are going well, we’d like to keep you involved in this process, so we’d like to contract with you to determine along with the treatment team what services will be utilized post treatment – are they going to go onto extended care, are they going to go onto day treatment or outpatient, if so where, from there will they go into sober living. What is this continuum of care starting to map out and look like; what facilities, individuals, and allied professionals will we be engaging in this process. They want the person they trust to oversee this. They retain us to facilitate that for them. That’s one type of case management.

Another way we get engaged as case managers is, a family will call us up and say, there’s a lot going on – some horrific scenario, such as our son has been trafficking in cocaine; he’s been arrested, he’s in jail; we’re facing multiple felony counts. He’s also got Hepatitis C and it looks as if there’s another mental health issue that’s starting to rear up and present itself. We have no idea how to deal with all this. We want to retain you to help case manage from the get go.

In a case like that we would be team leader. We would coordinate with the attorney for the legal issues; we would put the medical team together to address the hepatitis; we would enlist the aid of a psychiatrist and the mental health community to address the presenting depression; we would bring in an addictionologist to address the cocaine issue. And all of this would have to be coordinated because there are conflicting priorities. When seeking the counsel of the attorney, the attorney is looking at the case from the perspective of do as little time as possible, beat the case, because that’s his job he’s going to look at this that way. The liver doc is going to feel that what takes the lead is the need to address liver function; that’s his job, his focus, even though what he might be suggesting as the doctor is in direct conflict with what the attorney wants to do, which might be in conflict with what the addictionologist is saying, which might be in direct conflict with what the psychiatrist who is addressing the depression is suggesting. So somebody has to coordinate all of this – someone who is able to step back far enough to look at all elements of the case, effectively prioritize; it’s kind of like creating a tree of services – what’s number 1, what falls in places as number 2a or 2b, however it breaks down. As case manager I take the time to coordinate all this, and the family that’s paying for everything can control it financially: how you get paid is you listen to him. Everybody falls into line under the case manager.

Question: What are some of the other benefits of having a case manager?

Earl: A good example would be a case where we need independent clinical supervision or the case requires some other expertise. If we don’t have enough clinical expertise to make a certain decision, we’ve got our own provider network; we’ve got all the professionals a person would ever need that we’ve worked with for years – people that we trust, that we have long-term working relationship with that we can call upon to make a decision that is not in any way conflicted – they’re going to make a decision based on the information on hand. We can get, whether it be psychiatric supervision, general medicine supervision, legal consultation, whatever it may be, we can get that and bring it to bear on the case. Those are actually exciting cases because it’s like being a football coach, and if you all the elements working together right you can have a profound impact on somebody’s life. You can take a disaster like the one I described and come out the other end with an individual who’s in really good shape, who has a good foundation underneath them, and has a great deal of hope in their life to create something positive for themselves.