If you can't help an alcoholic until he or she wants help, then what will it take to get them to that point?
That question - what will it take - changes the way we think about addiction and the way we approach the problem. We don't have to wait for personal tragedy to strike, such as divorce, job loss, financial ruin, child neglect, jail, cirrhosis, insanity, or death. Hitting bottom has a steep price tag. And the alcoholic isn't the only one who pays.

Modern intervention techniques were first developed by Vernon Johnson and the staff of St. Mary's Hospital during the 1960s, and they've been greatly refined and expanded over the years. Structured family interventions are a powerful catalyst for change, raising the alcoholic's bottom to the present moment without the danger and trauma that defines addiction.

Some argue that treatment doesn't work unless the alcoholic spontaneously chooses to get help. If they're "forced in," the reasoning goes, they won't be motivated for change. But a 25-year study by Hazelden compared patients mandated into treatment by the courts with those patients who admitted themselves "on their own." The success rate in treatment was the same for both groups. William Bennett, author and former White House Drug Czar, wrote in the Washington Post: "One clear fact about drug treatment is that success in treatment is often a function of time in treatment. And time in treatment is often a function of coercion - being forced into treatment by a loved one, an employer, or, as is often the case, the legal system."

Families worrying about the harshness of forcing loved ones into treatment, often overlook the option of effectively asking them to enter treatment by implementing a loving, family intervention. When the role of love takes center stage during an intervention, most families never have to resort to using tough love. Love breaks through denial first.

Structure is the key
We often tell families that there are three keys to a successful intervention: plan, plan, plan. The intervention team is comprised of the most important people in the alcoholic's life, including family members, friends, and colleagues. The team may also include a physician or employer. Planning meetings are used to prepare answers to all the alcoholic's objections, to line up the many details of treatment, and to unify the group. Most importantly, letters are prepared with a specific format and content, which will provide a script for the intervention. By writing everything down in advance, the team can be confident that they will remain in control of the situation, delivering a powerful message to the individual with a substance abuse problem.

There are many details that go into planning and carrying out a successful intervention. The counselor may find it useful to share the guidelines listed on the Intervention Checklist (see sidebar below) with the alcoholic's family.

Letters provide the script
When an intervention begins, the alcoholic is often surprised to find that he isn't being blamed and condemned. Instead, the power of love is used to break through denial, followed by facts. The loving part of the letter is often the longest and most detailed section. The alcoholic, feeling anything but lovable, is overwhelmed by a group of his most cherished friends and family telling him in very specific terms, and from the heart, how important he is to each of them. The following is an excerpt of a letter written by a friend of the alcoholic:

Dear Greg,
We've been best friends since the ninth grade. That's twenty-one years now. You were always the guy ready to try anything. You've never let anything get in your way. I may not have told you this before, but you have always been an inspiration to me. I've pushed myself harder to accomplish more in my life because of the example you've set.
You were the best man at my wedding, and you're my son's godfather. This makes you more than my best friend - you're a member of my family. The kids call you "Uncle Greg," and they love you very much. ...
The letter continues its tone of love and family connectedness as the old friend writes about the disease of chemical dependency and how alcohol has turned against Greg:
Lately, however, the kids are asking me what's wrong with you. The last several times you've been over you've been drunk, and the kids have been frightened because you get too loud and aggressive. The kids have always adored you, but the alcohol changes you. We've explained to them that you have an illness. Christopher asked us why nobody was helping you. At that moment I realized I was avoiding you more and more when I should be helping you instead. I promised Chris I would do whatever I could to help.
Preserving the alcoholic's dignity is the number-one goal of the intervention. After citing more facts that illustrate the problem, the friend pledges his support, without any shred of judgment or blame:
That is why I am here today. I've always considered myself a good friend to you, but I've known for some time that alcohol is a problem in your life and I chose to look the other way. That's not what friends do. Today I am willing to do the tough think and ask you to accept treatment for your alcohol problem.

He ends his letter by reiterating his love and concern, and his willingness to stand by the family as they go through the treatment process together.

Bottom line backup
In our professional experience, 85 percent of those with an addiction accept help the day of the intervention, while 15 percent do not. Families and friends prepare for those who refuse help by answering two questions for themselves on paper: "How have I enabled the disease in the past, and how do I choose to only support recovery in the future?" and "If my loved one chooses to stay in his/her disease, what do I need to do to begin taking care of myself?"

The following is an example of a friend's response to his best friend's refusal to accept help. It illustrates how the loving tone should continue even with the bottom line:

You're my best friend and you can always call me if you change your mind and decide to get help. I'll pick you up and drive you to treatment anytime, but I'm not going to lend you any more money. Also, I'm going to ask that you don't stop by the house until you get help. If you choose alcohol over treatment, you can't be around the kids. They've already been affected by your drinking problem, and their welfare is my first priority. It doesn't mean we don't love you. It means we are deciding how to take care of ourselves. Won't you take care of yourself and get help today?

Bottom lines should be written on a separate piece of paper and are not part of the intervention letter. When the individual with an addiction agrees to treatment, we do not read the bottom lines. We use bottom lines only when treatment is refused and no amount of discussion will change the alcoholic's stance.

Once bottom lines are read, many addicts change their minds and accept help. They understand that the price of staying in their disease is too high, and treatment is a better option. Some alcoholics, however, test the family's resolve. They don't believe that the people who have enabled them for so long will stand firm with their decisions to only support recovery.

As time goes by, and family and friends stick to their bottom lines, the alcoholic's life becomes increasingly unmanageable and agreeing to treatment becomes more probable.

Intervention letters as therapeutic tools
Intervention letters can be powerful therapeutic tools during the treatment process. Treatment staff and interventionists should encourage family members to send or deliver the intervention letters to the alcoholic's primary counselor. The letters can help patients work through anger and denial. Counselors can ask their patients to read the intervention letters during an individual counseling session. Patients can then be given an assignment to read two or three intervention letters during group therapy and ask for feedback. Another assignment is to ask the patient to share his/her intervention letters with a peer and listen to the peer's feedback.

The loving approach of the intervention letters typically illicit responses from peers, such as, "Your family must love you very much to do what they did for you. I wish my family had done that for me." Peers hear the outpouring of love in the letters and point out how fortunate the patient is to have family and friends who still care. Some peers may tell how they alienated the people in their lives and have no one left who cares. Other peers share the many losses they experienced before getting treatment. They wonder what pains and troubles an intervention may have spared them. Feedback from the group helps move alcoholics out of anger and into acceptance. Many alcoholics read and reread the intervention letters. One patient wrote to her family during her third week of residential treatment: "The more I've read your letters, the more they mean to me. I'm grateful that you cared enough to help me when I couldn't help myself."

Intervention letters help break through denial. When a group of people all write down the symptoms of addiction they have personally witnessed in the patient, it is more difficult for the patient to rationalize, minimize, and deny the addiction. Delusional thinking and euphoric recall blocks the alcoholic's ability to clearly see how addiction is affecting him and the people around him. The intervention letters help the patient see his addiction through other people's eyes. Counselors and peers can point out discrepancies between the patient's account of his drug problem and his family's account reported in the letters.

Putting bottom lines to work in treatment
When an alcoholic agrees to get help at the time of the intervention, the family doesn't use the bottom lines - they go unread. But if the alcoholic decides to abort treatment against staff advice, clinicians can team up with the family and put the bottom lines to work. The counselor can ask the members of the intervention team to come to the treatment center and do a conflict resolution with the staff. Family members can read their bottom lines to the patient with the clinical staff present. If family members cannot be present, they can participate over the phone. Of course, this is only possible if the patient has signed release of information forms for family members. If not, the interventionist can instruct family members to send the bottom lines with the intervention letters, instructing the primary counselor to use the bottom lines only if the patient decides to leave treatment early. When most patients understand that leaving treatment triggers consequences at home, they are more likely to reconsider their decision.

A powerful and under-utilized tool
Intervention is like CPR for alcoholism. It can break through the natural defenses and denial of the alcoholic person in a loving way, and enable them to accept the help that is readily available. Too many people cling to the myth that an alcoholic must actively want to get sober before the first steps can be taken.

It's a good thing Bill Wilson didn't believe that. Dr. Bob adamantly refused to meet with the stockbroker, showing absolutely no willingness to deal with his alcoholism. But Dr. Bob's wife and their friend Henrietta insisted on the meeting, and that famous intervention led to the birth of Alcoholics Anonymous.

One person has commented on this article.

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Julie, Unregistered

Reading this article has inspired me to quite enabling a dear friend of mine and do the tough thing and write him a letter letting him know his drinking/drug use is a problem and I am willing to enable the problem! Thank you.......it helped me find the words I needed to write him!....Julie

 Posted 2008-02-20 08:32:23

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