Vernon Johnson saw how successful EAPs were, and felt something needed to be done for families. If employers could motivate the alcoholic, then perhaps families could. He also recognized that frequently, the alcoholic would use employment as the excuse for claiming not to be an alcoholic: “I still have my job haven’t I?”

During the next two decades, the Johnson Model underwent changes, partly due to the new research on the success of motivational counseling (Miller and Rollnick, 1991); the lack of evidence that confrontation works; the recognition of the extent of the suffering of family members; and the knowledge that alcoholics are more apt to remain sober if their families have also changed.

From the 1990s to present day, two additional models have gained in popularity, the Invitational or Systemic Model and the Arise Model, in addition to several variations bearing the names of their proponents. It is important to keep in mind, however, that except in research studies, individual interventionists tend to mix and match and interject their own characteristic styles into their interventions, as is true of the various psychotherapy models.

At this time, there is no one universally accepted model of SFI. This is not surprising. Just think about the myriad of counseling and psychotherapy models available to clinicians. Below are descriptions of the most popular intervention models, followed by a discussion of the future challenges for the intervention field as a whole.

The Johnson model

Dr. Vernon Johnson, an Episcopal priest who was known as the “father” of intervention, founded the Johnson Institute in 1965. Its mission was to educate the public about alcoholism. The concept of intervening in the workplace, however, dates back to 1944, when both DuPont and Eastman Kodak established multi-plant alcoholism programs. Despite the fact that by 1959 approximately 50 companies had formal alcoholism programs in place (Scanlon, 1991), in addition to the early success of Treatment Centers such as Hazelden, the prevailing view was that the alcoholic was beyond hope.

Another popular opinion at that time was that nothing could be done for the alcoholic until he or she “hits bottom.” Equally pervasive was the belief that a chemically dependent person had to want help and even ask for help in order to respond favorably to remedial care. Denial was conceptualized as a psychological defense mechanism so strong that it was considered the most significant roadblock to the dependent person who was accepting help. Further, it was seen as something that had to be “broken through” in an aggressive way (Weinstein, 1999).

Vernon Johnson, in the mid 1960s, undertook a study of 200 recovered alcoholics, in an attempt to determine why they had waited so long to accept help. All responded that they “saw the light” one day, and that it was this spontaneous insight that motivated them to get help. Johnson redesigned the questionnaire, asking more specific questions about what was going on in their lives when this spontaneous insight occurred. What he found was that the recovered alcoholics had suffered a buildup of crises in various areas of their lives, such as family, health, work, etc. From this, Johnson posited that it was this buildup of crises that led to the “moment of truth,” and that perhaps these crises could be used creatively to break through defenses and motivate the person earlier in the disease process (private conversation with author, June, 1991).

Johnson’s definition of intervention is “presenting reality to a person out of touch with it in a receivable way” (Johnson, 1980). His approach involved presenting facts in a way that the alcoholic can hear and understand them, in an objective, unequivocal, non-judgmental and caring way. Although Johnson viewed the intervention process as a confrontation, he considered it to be different in important respects from the type of confrontation that most people were familiar with — one that had little or no positive effect.

In other words, Johnson believed the alcohol and/or drug dependent person had to be confronted, but not in a combative manner. According to Johnson, alcoholics, due to nature and progression of the disease, are unable (not unwilling) to see the reality of how their drinking and drugging are affecting themselves and others around them. Thus, reality must be presented to them, but in a way they can accept, and in a way that will diminish defenses, not strengthen them. Further, Johnson believed that the chemically dependent person has a highly developed defense system and becomes “seriously deluded,” but he also understood that those defenses arose around the alcoholics’ feeling of shame, guilt, anxiety and self-hatred (Johnson, 1980).

In developing his intervention model, Johnson recognized that the real power was in those closest to the alcoholic, be it the family, friends, clergy, colleagues, etc. Therefore, educating and preparing this “team” became crucial. Family intervention, as developed by Johnson, is comprised of the following seven components:

1) A team of meaningful people should be formed and educated as to the disease of addiction, and the importance of their roles.
2) The team should list very specific facts about the effects of the drinking, avoiding opinions, generalizations and hearsay.
3) The tone should not be judgmental, and should show concern and caring.
4) The evidence should be tied to the drinking, wherever possible.
5) The evidence of the behavior that is presented to the addicted person should be in significant detail.
6) The goal of the intervention is to have the alcoholic see and accept reality so he or she can accept help.
7) Available choices (decided ahead of time) are offered, allowing the alcoholic to be part of the decision making (Johnson, 1980). The preferred treatment modality is inpatient, 28 days or longer.

In this model, all the preparation and rehearsals are conducted without the knowledge of the addicted person, but it is recommended that this should be revealed as part of the intervention. In other words, the alcoholic should be told in the beginning that his family has been meeting, out of concern, and is now ready to share their concerns with him or her.

Invitational models

The Systemic Family Intervention Model was originally developed by Ed Speare (deceased) and Wayne Raiter. This model focuses on the whole family rather than the individual addicted person. The philosophical underpinnings come from systems theory, which posits that if the system changes the way it perceives and responds, then every individual within that system will change.

The goal is to assist each family member in beginning to understand their roles within an addicted system, and to commit to a plan of recovery, thereby greatly increasing the likelihood that the addicted family member will accept the appropriate help.

This is achieved by the interventionist facilitating a two-day workshop for the entire family, including the addicted person. This two-day workshop includes material on the neurobiology of addiction, the process of addiction, the intergenerational nature of addiction, the effects of addiction on the family, enabling, etc. The educational nature of the workshop, as well as the non-judgmental stance of the interventionist, allows for safe and honest discussions, so the entire family can begin to heal (Raiter,2006).

There are five or six steps in this model:

1) A concerned person calls an interventionist about a family member with an alcohol/drug dependency.
2) Two or three family members either meet with the interventionist in person or via conference call for an assessment. Plans are made for the workshop, including who, where and when. Someone is chosen and couched on how to invite the addicted person. Even if he or she chooses not to attend, the family still goes ahead with the workshop.
3) Family members are asked to attend several Alcoholics Anonymous (AA) and Alanon meetings and to complete some assigned reading prior to the workshop.
4) The two-day workshop is conducted.
5) The interventionist discusses different options for treatment for each family member, such as addictions, co-dependency and trauma resolution treatment, which is usually inpatient.
6) Follow-up is often conducted, either in person or via telephone, for up to one year.

The ARISE model

ARISE is a three-stage graduated continuum of intervention, which begins with the least demanding option, increasing the effort only if the addicted person is not engaged at a lesser level. It was developed by Judith Landau and James Garrett, and originally based on Landau’s model of working with people who are struggling with addiction — Transitional Family Therapy. This new method was formalized in the early 1990s, and with the help of a grant from the National Institutes on Drug Abuse (NIDA), the protocol was tested extensively (Landau & Garrett 1996).

The three stages are: 1) telephone coaching; 2) mobilizing the network to engage the chemically dependent person (CDP); and 3) the ARISE intervention (which is a modified Johnson-style intervention).

ARISE is based on the assumptions that families are capable of doing much of the therapy work on their own, due to resilience and family strength, and a trust in the inherent ability of families to heal. The ARISE model also operates under the assumption that many situations do not require that consequences be called into play, and that outpatient treatment is the preferred modality because of its connection with the real world, in which the addicted person must function (Landau & Stanton, 1986).

Stage One: Telephone Coaching. A concerned person calls out of concern for a family member or friend who has a substance dependence problem for which he or she has not sought help and/or refuses to do so. This structured coaching consists of a 10 to 15 minute phone call, during which the coach accomplishes the following:

1) Identifies the “crisis” that precipitated the call
2) Determines the reason for the call
3) Obtains an overview of the dependent person’s abuse his-tory and current level of use
4) Takes a brief treatment history, including self-harm risk, history of violence or mental illness
5) Constructs a preliminary geno-gram or intergenerational map
6) Determines what has been said to the CDP and what attempts have been made to stop him or her from using
7) Emphasizes the intervention continuum — the importance of family and friends in the recovery process — and explains how initial motivation may have little to do with the eventual outcome
8) Obtains permission to speak to the others in the network of meaningful  family and friends
9) Instructs the caller to ask the addicted person to come to the first appointment, which is an evaluation session
10) Schedules evaluation interview
11) Instructs the network group to come to the appointment whether or not the CDP comes, and warns the caller not to engage in any argument with the CDP once he or she is invited, regardless of the decision.
12) Supports the caller by offering to be available to address any problems that may arise.

Stage Two: Mobilizing the network to engage the CDP. The initial part of the session is conducted as an evaluation. Participants are asked to explain why they are present and what they see as the problem to be addressed. If the CDP is present, the session evolves into a motivational session to get a commitment from him or her to begin treatment and to meet with the network group in one week to report progress. The network continues to meet with the CDP once or twice a month for a total of two to five sessions.

If the CDP is not present, the evaluation is completed similar to above, with the group deciding on the next best step to engage the CDP in treatment. Whether the CDP engages in treatment or not, the network continues meeting. The network mobilizes its strength to motivate the CDP to attend sessions and enter treatment.

If, after a period of time, the CDP is not in treatment, the group members decide whether or not to undertake a more formal intervention.

Stage Three:  A modified Johnson style intervention. It includes formal training and rehearsals, and includes consequences if the CDP does not choose to enter treatment.

Challenges and the future of interventions

The future of the field of family interventions faces many of the same challenges as the field of alcoholism and drug addiction, as a whole. Among them are competition, accessibility, competence and real and/or perceived conflicts of interest.

Interventionists have joined the ranks of other professionals, advertising in magazines, exhibiting at conferences, and competing among themselves. In this era of product recognition and “branding,” several individuals and corporate entities have coined names for their styles of intervention. In addition to Systemic Family Intervention (SFI) (Raiter); the Johnson Model (Vernon Johnson); and ARISE (Landau & Garrett), there are now carefrontations (Andrew Wainright); Gentle, Respectful Interventions (Bill Maher); and several others. The challenge will be to continue to promote one’s preferred method in a professional manner, without stating half truths, exaggerations and distortions of the other styles of intervention.

Accessibility

At the present time, interventions are generally not accessible to the vast majority of families, for a variety of reasons, the most obvious being the cost. The average cost of an intervention is about $4,000; and the range can be from $2,000 to as high as $10,000. Part of the reason for this is the entrepreneurial nature of the field, which is both its strength and its weakness. There is a growing interest on the part of non-profit agencies and councils in conducting interventions, which should bring interventions to more families, especially those whose members live in the same community.

Competence

As with the substance abuse field as a whole, many early interventionists were recovering alcoholics and addicts with little or no formal training. As the field matures and grows, interventionists will have to answer a number of questions relating to competence. Many social workers, psychologists and even physicians are now facilitating family interventions. Is an advanced degree necessary? Is there a knowledge base and skill set specific to the intervention field, and if so, of what does it consist? In addition to knowledge and skill related to alcohol and drug dependence, should it include family systems theory, family therapy, psychiatric disorders, gender issues, cultural differences, gambling and eating disorders, etc, etc, etc? To gain and maintain credibility and respect, it is this author’s opinion that these, and other questions must be dealt with by the intervention field itself.

Conflict of interest

There has been much discussion of late regarding what constitutes a conflict of interest, and is, therefore, unethical; and how that differs from a perceived conflict of interest. The line between the two can be quite thin. Take for example a person who is a full-time employee, as a marketing representative, of treatment Center A. As part of the job description, he or she conducts interventions at no or minimal fee. This individual also may get a raise and/or bonus for keeping the beds full. What if this person does intervention on his or her own, and charges independently? Is there an ethical obligation to inform his or her families of the relationship with Treatment Center A? Another related issue is the widespread practice of treatment centers referring families to interventionists with the condition that the chemically dependent person be referred back to that center for addictions treatment.

Summary and conclusions

In the four decades since Vern Johnson developed his model of family intervention, new models, modifications and differing styles have evolved. One fact has remained the same; because of family interventions, chemically dependent persons and their families have received life-saving help without waiting for the addicted person to “hit bottom” or have a “moment of clarity” on his or her own.

“Dear Vern,

Congratulations on the 20th anniversary of the Johnson Institute. Over that twenty year period you have certainly been a pioneer in the changes that have occurred in the treatment and awareness of alcohol and drug dependency.

As one of the people who has benefited from your intervention process, offer you a hearty thanks — from all the members of the Ford family. The past 7 1/2 years of my life have led me on an incredible path” (letter to Vernon Johnson from former first Lady Betty Ford, January 1986).

Bette Ann Weinstein, PhD is nationally known for her work in the assessment and
motivation of chemically dependent persons and their families, and has been conducting family and executive interventions since 1978. A professor at Catholic University School of Social Work for 17 years, she still serves on the faculty of the Rutgers Summer School of Alcohol & Drug Studies (1979-present).

References

Colandro, Christiana. Intervention by Invitation Long Island Council Offers Systemic Family Intervention. www.licadd.org/systemic.htm
Johnson, Vernon (1986). Intervention, Hazelden Foundation, Center City, MN
Johnson, Vernon (1980). I’ll Quit Tomorrow, Revised Edition, Harper San Francisco
Landau, Judith & Garrett, James (1996). Invitational Intervention, BookSurge, LLC
Landau, J – Stanton, J. (1986) Competence impermanence and transitional Mapping. in L.C. Wynne, S.H. McDanie & T. weber (Eds.) Systems Consultation. NY: Guilford Press
McElrath, Damien (1987). Hazelden A Spiritual Odyssey, Hazelden Foundation, Center  City, MN
McElraith, Damien (1987). A Spiritual Odyssey .Hazelden Press
Miller, William & Rollnick, Stephen (1991). Motivational Interviewing The Guilford Press.
Scanlon, Walter (1991). Alcoholism and Drug Abuse in the Workplace. Praeger 
Weinstein, Bette Ann (1999). Re-examining the Clinical Response to Denial in Alcoholics Employee Assistance Quarterly. Haworth Press

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joeAnne   |79.112.117.xxx |2008-10-06 14:32:12 Unfortunately, a lot of families have problems like this. There are a lot of cases when these problems start because the lack of money. I've heard there is an Employee Program which might help a lot. Reply 0   0

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