Addiction affects everyone in the family
Millions of families across the country are affected by addiction and substance abuse. In fact, it’s estimated that one in three families is directly affected by alcoholism or drug addiction. Without proper treatment, substance abuse can cause serious problems in the family, ranging from financial difficulties to divorce to domestic violence. So, how do you begin to open that can of worms?
Perhaps what matters most is knowing what’s available to you. In fact, the best strategy for drug or alcohol intervention may be careful planning. And here, we offer you some needed guidance.
Planning family interventions for 35+ years
Louise Stanger, Ed.D. is a clinical social worker LCSW and Certified Intervention Professional CIP with over 35 years experience in substance abuse and mental health disorders, grief and loss. She has been a university educator (SDSU & USD) and researcher. She is active in the Network of Independent Interventionist and Association of Intervention Specialists and is also a Motivational Interviewing Trainer of Trainers. In other words, she’s the best of the best.
In this interview, Louise explains more to us about family intervention models, what treatment strategies they use, and how family members can prepare themselves before the intervention. She teaches us about the possible options, and helps us discern best practice in intervention from strategies you want to avoid. We hope this Q&A answers many of your questions, but we invite your thoughts and questions on this topic in the comments section below. Note that we’ll try to respond to all really questions with a personal and prompt reply.
Intervention strategies for families
ADDICTION BLOG: How many types of family intervention models are currently in practice?
LOUISE STANGER: There are several intervention models which can best be categorized as Surprise, Systemic, Action and Invitational.
The Surprise model was first developed by Dr. Vern Johnson, the grandfather of Intervention, and is described in his landmark book “I’ll Quit Tomorrow – A Practical Guide To Alcoholism Treatment”. Since then, this model has been expanded upon by Dr. Frank Picard, author of “Family Intervention”, Debra and Jeff Jay authors of “Love First”, Ken Seeley who was instrumental in starting the TV Show “Intervention”, John Southworth and Ed Storti, author of “Heart to Heart” among other books.
The Systematic Family Systems Model was introduced by Wayne Raiter Ph.D., while the Action Intervention Model technique is credited to Jean Campell LCSW, Dr. Jim Tracey, and Bill Maher, which uses strategies from psychodrama.
The Invitational Model of interventions surfaces from the Arise Model developed by Dr. Judith Landau and James Garret authors of “Invitational Intervention: A Step by Step guide for Clinicians Helping Families Engage Resistant Substance Abusers” and the BreakFree Model, “How To Help The One You Love” and other books which Brad Lamm has authored, and with whom I am co-facilitating his BreakFree Trainings this Fall, 2015.
ADDICTION BLOG: What are some of the main, evidence based family intervention models in use?
LOUISE STANGER: The strategies used in all models to some degree involve an understanding of:
- Family systems theory
- Human behavior and lifestyle development
- Mental health disorders
- Characteristics of substance abuse disorders
- Characteristics of process disorders
These models also require an understanding of 12-step facilitation, motivational interviewing, and solution-focused therapy from both the therapeutic and business research communities.
From my experience as a principal investigator for both NIH – NIAAA and U.S. Department of Education college-based interventions and family-based intervention studies, there has not been a major university or federal grant which test outs any one-intervention model. That being stated, the strategies mentioned above have been tested in a variety of clinical trials including and not limited to motivational interviewing, which has a robust history in hospital, college and prison and religious settings. In addition, there are evidence-based studies which examine cognitive behavioral and 12 Step facilitation, solution-focused therapy, psychodrama, mindfulness, and more in clinical settings.
ADDICTION BLOG: What type of model do you use and why? How does this preferred model differ from the others?
LOUISE STANGER: I believe that interventions are a process and not any one model, however I am invitational in my family systems approach.
In contrast to many intervention styles, with the Stanger Process, I am committed to helping intervention teams – which I call “accountability teams” consisting of:
- business acquaintances
- personal assistants
…and anyone who has an interest in and cares for the identified loved one to become healthier and stronger. We help each member of the team develop and practice self-care, setting clear boundaries. I believe each member of the intervention team will feel challenged to love your loved one and yourselves from a very deep place, and that no one will remain unchanged after our time together.
I have an 11-step process which – at best – yields a total team solution. My intervention approach is 11 steps divided into three-phases, all based on sound social work principles of starting where the client is – at the beginning and working from the foundation of unconditional positive regard. I work with families so they may understand their role in the intervention process, which is a systemic approach to healing the entire team. Together, treatment options are explored, and arrangements are made for your loved one to accept the treatment being offered.
I use a particular qualitative research methodology called Portraiture which was developed by the Harvard endowed scholar Sara Lawrence Lightfoot who is best known for her seminal works, “The Art and Science of Portraiture, Lives and Loss of Liberation”.
In addition, I utilize evidence-based approaches that includes qualitative research interview methodology called Portraiture, Cognitive Behavioral, Motivational Interviewing, Solution-Focused, 12-Step, and Mindfulness Modalities within an invitational Team-Systems framework.
I also offer a guarantee to the families that work with me. I guarantee that everyone participating in the intervention process will learn more about substance abuse, addiction, mental health disorders, and how these disorders affect people in general, as well as their specific family situation.
I guarantee that your family and loved ones will uncover the hidden stories around the addiction and their loved one, creating a more accurate picture of reality. Everyone will experience relief working toward a common goal, together.
ADDICTION BLOG: How prepared do family members need to be before an intervention?
LOUISE STANGER: Families must be prepared and need to know what to expect. Interventions are highly stylized conversations and as my colleague Ed Storti has said they are like “living eulogies”. I think no matter what the style, most interventionists will agree that this is the time for families to come together for the common good of helping their loved one whose behaviors while in the midst of a substance abuse/mental health disorder are often disruptive .
Hence, families require being taught about the nature of substance abuse and mental health disorders, the way in which an intervention is conducted and the part they may play in moving someone to change.
ADDICTION BLOG: How much time does it typically involve for the closest members of the family?
LOUISE STANGER: The person who assumes responsibility for payment spends the most time as he/she is connected to treatment centers that best match their loves ones presenting problems. They too are the ones who first suggest who might be part of the intervention team and reach out to others so that the interventionist may converse with them.
With respect to the type of work I do, we can, if appropriate, arrange for an intervention to take place in as quickly as two days with all the proper interviews or it can be spread out over a week or two weeks time. We first and foremost must let the client’s needs drive the engagement and constantly assess for safety and other concerns.
We recently had a young man who had overdosed in the ER and that Intervention took place in two days. On the other hand, I remember a wonderful 90-year-old father who desperately wanted his 64-year-old daughter to get help. Relatives were scattered across the United States. It was very important that he get through the holidays and so I worked with him through Thanksgiving. With all of the family present the day after Christmas, we invited her to change and to go to treatment.
Generally speaking, once an engagement is set, interviews can take place quickly and a date for a pre intervention and intervention meeting time are set. Decisions such as who will attend, can someone Skype, and location all have to be taken into account.
To help sustain lasting recovery, families, friends and loved ones should engage in their own recovery by taking advantage of family programs and free support groups such as ALANON, CODA, ACA or CRAFT meetings. Engage with your therapist or counselor or interventionist as there are many ebbs and flow that take place while your loved one is in outpatient, residential treatment, extended care or aftercare.
ADDICTION BLOG: What strategies in intervention lead to successful treatment engagement? In other words, what key principles should families focus on when starting the process?
LOUISE STANGER: Families need to be open to the process, feel heard and listened to by the interventionist they hire. They also need to allow the interventionist to talk to as many people as they want and to be open to novel ideas.
No one calls an interventionist unless they are exhausted from the nagging, pleading, lecturing, bargaining, etc. that they have tried and have failed. On my web site you will find a poem that I wrote “Imagine” which captures the despair that many families feel as they reach out with courage to an interventionist and ask for help.
Interventionists help the families discover how they can improve the quality of their life and those you love by making a difference in your own life. Interventions can be and are transformative!
ADDICTION BLOG: What kinds of realistic expectations can families have of the intervention process?
LOUISE STANGER: It’s important for anyone entertaining hiring an interventionist to check out his/her credentials and amount of time in the field. I’ve rounded up a list of questions to ask an interventionist to better understand their process:
- Is the interventionist independent or employed by a particular treatment center or centers?
- What is their academic and/or experience background?
- Do they work alone or have a team?
- What exact services do they provide?
- What services do they not provide?
- What are their professional affiliations?
- Do they specialize in any area (not all people can do everything)?
- What does their engagement offer?
- What is the length of time for their engagement?
- How accessible are they or their team to you?
As for my intervention process, engagements always include an Pre-Intervention Meeting and Intervention Meeting and all associated advance preparation time and activities, including:
- Complete Family Mapping
- Retrospective Bio-Psycho-Social Analysis
- All team and third party communication and liaison
- Case Strategy
- Team Formation
In addition, I offer individual phone interviews with prospective team members by myself or a team partner. Other services include
- Treatment center matching and referrals
- Safe escort service to the selected treatment center
- Follow-up and regular case management with treatment center while IP is in inpatient treatment
- Solution-focused family and friends’ recovery coaching
- Consultation and coordination of aftercare for all intervention team members
- Development and implementation of a family and friend change plan
ADDICTION BLOG: With the popularization of interventions via reality TV shows, families are more familiar with a confrontational model of intervention. Which practices in intervention should families AVOID, as depicted by reality TV?
LOUISE STANGER: Interventions are not like the scenarios played out on television screens. As a licensed professional, I have written in the Cengage textbook, Opposing Viewpoints, “Interventions are not made for TV”.
A confidential, respectful, invitational intervention is very different than what you see on TV. Confidentiality and discretion are paramount. I have trouble with seeing a loved one shoot up on TV and risk overdose while being filmed with a detox nurse in the background.
That being my position, the founders and interventionists who have appeared on the show have brought possibility and hope to families and free treatment for the treatment providers who participate on TV and provide a forum for advertising on a large scale for their services.
Interventions are NOT CONDUCTED when a person is:
- under the influence
- known to be violent
- extremely depressed
- in mania
- actively psychotic
- suffering from another serious mental health disorder.
If these conditions exist then the interventionists must be trained and aware of how to handle these potentially volatile situations, meaning they must understand mental health disorders, possible commitment laws, Duty to Warn Laws, and be mindful of safety and other concerns.
Additionally, extra precautions are taken when performing interventions with clients who have a history of violence. Other scenarios include when a patient is addicted to cocaine, methamphetamines, or other similar stimulants and is also in mania. Or when a young girl is suffering from both anorexia and depression. The utmost care must be taken that the entire process is safe, caring, and beneficial for everyone involved. It is imperative one understands family dynamics, mental health disorders and processes.
Interventions are not “grab-and-goes” where folks are tied to bedposts or ushered out under duress. Interventions are not sessions where shaming another person is the primary method of confrontation or where threats are used.
In my practice, families are carefully assessed to confirm that my Stanger’s Process of intervention is the right approach. If I am not the right person, I am happy to refer to a trusted colleague as the most important thing is for that loved one to get the help they need.
ADDICTION BLOG: Is the “Best Practice” in family intervention constantly evolving, or have we reached a good understanding of what works best?
LOUISE STANGER: Best practices are constantly evolving as we learn more and more about how our brain chemistry interfaces substance abuse and how process disorders and mental health disorders interface with our environment. There will always be room for continuous quality improvement.
With the advent and training of new evidence modalities we will continually improve our services. For example, the work of Dr. Brene Brown is doing much to help professionals learn how to deal more effectively with shame resilience while the research for people who experience traumatic brain injuries and post-traumatic stress disorder and their relationship to substance abuse disorders is helping interventionists as they guide loved ones and families towards accepting much needed help. Remember, the interventionist’s job is to help families be visionary architects and to imagine a better future full of health and wellness.
That being said, the process of intervention from pre-engagement to connection to treatment to case management and coaching after-care services are well delineated. Not everyone provides comprehensive services, so the family must carefully examine what is being offered and understand those limitations.
At this time, professional organizations and certification is still embryonic. My hope is there will come a time when the behavioral health care recognizes interventionists in the same way psychologists, social workers, marriage and family counselors, nurses and other similar professions are recognized.
ADDICTION BLOG: What kind of follow-up typically occurs with the family after an intervention?
LOUISE STANGER: That is dependent on the nature of the engagement. In my opinion, best practices suggest that case management services be offered as well as weekly scheduled phone calls with both treatment providers and loved ones.
My colleague and friend Dr. Joe Terhaar, who practices in Washington, recently sent me the following citation which supports the notion that the “intervention specialist must make sure the primary care program review the contingencies in a therapeutic manner, or schedule a follow up session before discharge for the family to present to them” (Before Discharge Intervention Method Ino & Hayadisa (2000).
ADDICTION BLOG: We understand you like to do interventions with another team member. Can you comment on that?
LOUISE STANGER: History has long proved the value of teamwork and partnership. In the treatment world, we all know that the best programs at their core are interdisciplinary and collaborative in their approach. Whether it is substance abuse and/or complex mental health treatment, no single professional can be all things to all clients. Even the most experienced physician would be remiss if he did not recommend the opinion of the support of a second physician.
There are many successful interventionists that team together, Lori Lenard and Sharon Guzman in Texas, Heather Hayes and Carey Davidson of Atlanta, Stephen Pfleider and Mark Onsager in San Francisco. These are a few of my colleagues that come to mind. I most often team with Jeffrey Merrick Esq. which makes us unique in the fact that we are one of the few attorney/clinical doctoral teams in the country.
No great film was ever made solely by a director, in the same way no successful treatment could be carried out with solely one physician/clinician. There are a handful of variables that add to the support of an effective treatment plan. Teaming provides a more robust service and gives families, friends and their loved ones a more comprehensive service.
ADDICTION BLOG: Is there anything else you would like to share with our readers?
LOUISE STANGER: It’s no surprise that I am passionate about the work I do and am more than happy to share with you my experiences, expertise, hope and curiosity. I love training others and welcome opportunities to do keynotes and trainings for families and staff development.
For the families who read this blog: I admire your courage and tenacity in reaching out to help your loved ones. You CAN AND WILL make a difference in your loved ones’ lives. Help and health is possible. Do not hesitate to reach out. If I am not the right person let me help you meet my colleagues who are talented, caring, ethical and professional as they help inspire others to change.
In case you are wondering why I haven’t written a book on my many experiences and adventures, I’m in the process of finishing my memoir, “All Fall Up: A Memoir of Resilience and Renewal” for families to read and will be out the later part of Spring, 2016.
Lastly, I want to thank Addiction Blog for inviting me to participate in this online forum and discussing this important topic. I invite you to feel free to reach out to me at http:www.allaboutinterventions.com or 619-507-1699.
Keep Inspiring Change,