In the 1900s, there were high mortality rates from what was then called alcoholism. In the 1930s, psychiatry defined uncontrolled drinking as an emotional/psychological problem. Then in 1956, the American Medical Association for the first time recognissed alcoholism as a permanent and fatal disease with defined symptoms. In the 1960s, Dr Vernon Johnson studied 200 recovered alcoholics with an attempt to figure out why they chose to quit.
He found that most of these alcoholics quit when there were multiple disruptions or a variety of negative consequences in one or more of their major life areas, such as work, family and so forth, rather than a defining moment such as a car accident or visit to the emergency room. As a result, he developed and birthed the Johnson model of intervention and is known for his landmark book that still sells today, I’ll Quit Tomorrow, which began distribution in 1973.
The Johnson model had seven components…
1. An intervention specialist heads up the team to help the addict. The team is made up of family members, friends and co-workers.
2. In a planning session held with the interventionist and team, they plan out how to lovingly share exactly what they would like to say to the alcoholic.
3. All information focuses on concern and care, not blame or anger. Families can highlight to the addict that they love them but they hate their disease.
4. All information presented should be tied to the alcoholism, not other problems or concerns that might be occurring.
5. Statements should be backed up by evidence, statistics, relating stories (in a factual manner) – and that evidence should be specific.
6. The team has to agree that the goal of the intervention was to lead the alcoholic into a residential setting of treatment. The goal is not presented as a punishment, but as an offer of assistance.
7. The team can offer this help with their presentations to the alcoholic in an office at a meeting that everybody was openly invited to attend.
From Johnson’s day to this, there has been an ongoing evolution of the intervention process. A variety of models and perspectives continue to assist in getting thousands of individuals help for substance-use disorders over the last six decades. This is not new, even if it feels like it.
>> Jeff and Debra Jay are the co-authors of Love First, a Family Guide to Intervention. Together, they developed what they call the Love First Intervention Process, which is probably the most well known continued take-off from the Johnson Model.
>> Ed Storti, the author of Heart to Heart, created the Storti model of motivational intervention.
>> Wayne Rader and Ed Speer developed the Family Systemic Invitational model of intervention, which was seen as the first invitational model. This approach involves changing of the relationships that surround the addicted person, which leaves them no longer supported by old enabling behaviours, thereby forcing change in the addict’s action or behaviour. It differs from the Johnson model, because it is invitational and educational. The invitation is to all loved ones (including the one that suffers from a substance use disorder) to attend a family workshop. It is educational because the interactive family workshop is held so that all participants can learn about the disease, their family system, their family of origin and the impact that the historical family system has on them and their current relationships with everyone else in the family.
>> Another well known model is the Arise model, known as a relational intervention and a sequence of engagement, and developed by Dr Judith Landau. This model integrates traditional family therapy, Johnson Intervention techniques, and DiClemente and Prochaska’s research dealing with motivational stages of change. This model is also known as a collaborative process; from the initial invitation, the process conveys respect and establishes the ground rules for openness. In addition, it acknowledges that mistrust will be a major issue if things are created in secret, and assures the individual suffering from a substance-use disorder that they can trust family and friends.
The overarching 5 ethical principles of each of these models are:
to do no harm, make things better, respect others, be fair
and be compassionate.
It is important to note that intervention is not a coercive process. It is not shame-based. It is not an ambush or uncaring attack. It is a planned interaction between an individual and a group whose sole purpose it is to modify the individual’s dependence on a harmful substance or practice. It is a process of invitation, education and preparing family and friends who make the commitment to initiate change in their, or a loved one’s, life.
The goal is to return to healthy productive living for the individual suffering, and for each of the individual family members.
The truth is that intervention is a process founded on love and honesty. I have always defined family intervention, regardless of the model being used, as a process in which you present an individual suffering from substance-use disorder and their significant others with objective information in a caring way with the goal of motivating each of them to accept appropriate help and/or treatment. It is always wise to remember that someone who suffers from substance-use disorders and their loved ones are blind to their disease (as it is a disease of denial). They need to be motivated in a way that will allow each of them to seek immediate help.
Historically, the arenas in which one can practice intervention work have been: private practice or a larger organisation. In a private practice setting, delivering intervention as a single service, a variety of services could also be offered, such as educational consultation, being an author, developing marketing strategies, and offering other clinical services such as individual and outpatient services. Interventions can also be in the context of a larger organisation that deliver an array of addiction services such as detox, residential, and/or outpatient.
As the evolution of addiction treatment services have evolved, we have found that these techniques can be used to help all individuals with substance-use disorders, family members that suffer from codependency, people with eating disorders, gambling addictions, mental-health issues, and other process/behavioural addictions and compulsive behaviours.
The role of the interventionist remains consistent through all of the models: providing information about the nature and dynamics of substance use disorder, being the one to describe the principles and specific techniques about the intervention model being utilised, selecting and equipping the family members with information about each of these roles within the intervention process, listing the various alternatives in a continuum of care for all of those involved in the process, and coaching and modelling throughout the process.
I hope that this overview has provided you a snapshot of the roots and origins of intervention, as well as the evolution. My favourite saying has everything to do with interventions: you can lead a horse to water, but you can’t make him drink – however, you can make him thirsty.