Michael Provines, MD Chief Operating Officer 1-800-673-1847
INTERVENTION MOTIVATING SUBSTANCE ABUSERS TO ENTER TREATMENT 1-800-673-1847
TREATMENT PROVIDERS <ul><li>We are not law enforcement, we provide treatment to the patient and family system </li></ul><u...
Disease Model of Addiction <ul><li>A disease causes an interruption, cessation, or disorder of bodily function, systems, o...
Alcoholics Anonymous <ul><li>Alcoholics Anonymous is a fellowship of men and women who share their experience, strength an...
Primary Illness <ul><li>Addiction is a primary illness </li></ul><ul><li>Must be treated before other “problems” can be ma...
Chronic and Progressive <ul><li>Addiction is a chronic and progressive disease.  </li></ul><ul><ul><li>Can be arrested but...
Fatal <ul><li>Fatal from direct or indirect actions of the substance </li></ul><ul><ul><li>Production of organ system dise...
12-Steps (AA, NA, CA, MA) <ul><li>State that chronic addiction ends in, “jails, institutions, and death.” </li></ul><ul><l...
Treatable <ul><li>Successful treatment is available </li></ul><ul><ul><li>Medical interventions </li></ul></ul><ul><ul><li...
Denial <ul><li>Denial is a state of being that places the person out of touch with reality </li></ul><ul><li>The most diff...
Enabling <ul><li>AA </li></ul><ul><ul><li>doing something for someone that they should or could be doing for themselves </...
Enabling <ul><li>Often misunderstood </li></ul><ul><ul><li>Not as simple as buying drugs or alcohol for a patient, or supp...
Enabling <ul><li>Examples </li></ul><ul><ul><li>Making excuses for the addict </li></ul></ul><ul><ul><li>Paying bills </li...
Consequences <ul><li>The severity of consequences for addict and for family will determine the willingness to intervene </...
Intervention <ul><li>A formal or informal process to aid in motivating a person to seek treatment </li></ul><ul><li>Many d...
Intervention Models <ul><li>Major categories are direct and indirect </li></ul><ul><ul><li>Direct is a direct confrontatio...
Johnson Model <ul><li>Originated in 1960s with Dr. Vernon Johnson </li></ul><ul><li>Taught at the Johnson Institute </li><...
Confrontational vs. Motivational Approaches <ul><li>Confrontational approaches may work more quickly </li></ul><ul><li>Con...
Forcible Intervention  <ul><li>Civil liberty issues arise with forcible interventions </li></ul><ul><li>Interventions that...
Underlying Themes of Modern Interventions <ul><li>Utilize motivation rather than confrontation </li></ul><ul><li>Are invit...
Modern models <ul><ul><li>Motivational Interviewing </li></ul></ul><ul><ul><li>Systemic </li></ul></ul><ul><ul><li>A.R.I.S...
Motivational Interviewing <ul><li>Open-ended questions </li></ul><ul><li>Utilizes mirroring </li></ul><ul><li>Reflective l...
Systemic Approaches <ul><li>Can help the family return to a state of health, even if the addict continues to use </li></ul...
A.R.I.S.E. (  A Relational Intervention Sequence of Engagement ) <ul><li>Divided into phases </li></ul><ul><ul><li>Phase A...
CRAFT <ul><li>Designed for others who need assistance in getting help for their loved one </li></ul><ul><li>Utilizes posit...
CRAFT <ul><li>Uses positive communication styles to encourage the family and addict </li></ul><ul><ul><li>Brief sessions t...
Treatment of the Family <ul><li>Help is available for the family, even if the addict is unable to gain motivation for chan...
Choosing a technique <ul><li>A “one size fits all” approach does not work </li></ul><ul><li>You must match the technique w...
Interventions are initiated by <ul><li>Family </li></ul><ul><li>Friends </li></ul><ul><li>Employers </li></ul><ul><li>EAPs...
Recovery Connection <ul><li>If you are looking for assistance, please call our 24 hour helpline, free of charge </li></ul>...
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Intervention Motivating Substance Abusers To Enter Treatment

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Intervention Motivating Substance Abusers To Enter Treatment

  1. 1. Michael Provines, MD Chief Operating Officer 1-800-673-1847
  2. 2. INTERVENTION MOTIVATING SUBSTANCE ABUSERS TO ENTER TREATMENT 1-800-673-1847
  3. 3. TREATMENT PROVIDERS <ul><li>We are not law enforcement, we provide treatment to the patient and family system </li></ul><ul><li>We do not judge our patients for having the disease </li></ul><ul><li>We base our decisions on the facts of the case we are treating </li></ul><ul><li>We are not involved in the morality (concern with the distinction </li></ul><ul><li>between good and evil or right and wrong) of addiction </li></ul><ul><li>The “disease model” of addiction describes addiction as a lifelong DISEASE involving biologic and environmental sources of origin. </li></ul><ul><li>Justice Department involvement is a symptom of the disease and may not be avoidable </li></ul>1-800-673-1847
  4. 4. Disease Model of Addiction <ul><li>A disease causes an interruption, cessation, or disorder of bodily function, systems, or organs </li></ul><ul><li>And is characterized by: </li></ul><ul><ul><li>A recognized etiologic agent (or agents) </li></ul></ul><ul><ul><li>An identifiable group of signs and symptoms </li></ul></ul><ul><ul><li>Consistent anatomical alterations of known body systems </li></ul></ul><ul><li>Treatable with medications and cognitive, behavioral interventions. </li></ul>1-800-673-1847
  5. 5. Alcoholics Anonymous <ul><li>Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. </li></ul><ul><li>Described as an “allergy” to alcohol. </li></ul><ul><li>First edition of “big book” published in 1939. </li></ul>1-800-673-1847
  6. 6. Primary Illness <ul><li>Addiction is a primary illness </li></ul><ul><li>Must be treated before other “problems” can be managed (legal, social, financial). </li></ul><ul><li>Oftentimes treated concurrently with other mental health and medical issues </li></ul><ul><li>Chronic mental health and medical issues are unlikely to improve unless addiction is treated simultaneously </li></ul>1-800-673-1847
  7. 7. Chronic and Progressive <ul><li>Addiction is a chronic and progressive disease. </li></ul><ul><ul><li>Can be arrested but not eliminated </li></ul></ul><ul><ul><li>Tends to worsen over time </li></ul></ul><ul><ul><ul><li>Increase use of the substance </li></ul></ul></ul><ul><ul><ul><li>Worsening of consequences (symptoms) </li></ul></ul></ul>1-800-673-1847
  8. 8. Fatal <ul><li>Fatal from direct or indirect actions of the substance </li></ul><ul><ul><li>Production of organ system disease </li></ul></ul><ul><ul><ul><li>i.e. alcoholic hepatitis leading to chirrosis, cocaine induce cardiomyopathy </li></ul></ul></ul><ul><ul><li>Behaviors </li></ul></ul><ul><ul><ul><li>Accidents </li></ul></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul><ul><ul><ul><li>Neglect of body (eating, sleeping, hygiene, sexual health) </li></ul></ul></ul><ul><ul><ul><li>Suicide </li></ul></ul></ul><ul><ul><ul><li>Violence </li></ul></ul></ul><ul><ul><ul><li>Overdosage </li></ul></ul></ul>1-800-673-1847
  9. 9. 12-Steps (AA, NA, CA, MA) <ul><li>State that chronic addiction ends in, “jails, institutions, and death.” </li></ul><ul><li>Self-help groups that offer support and encouragement to its fellows </li></ul><ul><li>Offer practical, real-life advice on coping skills </li></ul><ul><li>Spiritually based, not religious </li></ul><ul><li>Do not treatment medical ailments, psychological or psychiatric problems, and do not offer clinical advice </li></ul>1-800-673-1847
  10. 10. Treatable <ul><li>Successful treatment is available </li></ul><ul><ul><li>Medical interventions </li></ul></ul><ul><ul><li>Cognitive and behavioral interventions </li></ul></ul><ul><ul><li>Social interventions </li></ul></ul><ul><ul><li>Support groups </li></ul></ul><ul><li>But the disease is characterized by…… </li></ul>1-800-673-1847
  11. 11. Denial <ul><li>Denial is a state of being that places the person out of touch with reality </li></ul><ul><li>The most difficult aspect of treatment for addiction </li></ul><ul><li>The support network and the patient can be in denial </li></ul><ul><li>Caused by multiple factors </li></ul><ul><ul><li>Distortions of memory (blackouts and euphoric recall) </li></ul></ul><ul><ul><li>Psychological defense mechanisms (projection, repression, etc.) </li></ul></ul><ul><ul><li>Social factors (enabling, environment of origin, normalizing the lifestyle) </li></ul></ul><ul><ul><li>And…….. </li></ul></ul>1-800-673-1847
  12. 12. Enabling <ul><li>AA </li></ul><ul><ul><li>doing something for someone that they should or could be doing for themselves </li></ul></ul><ul><li>CODA </li></ul><ul><ul><li>putting someone elses needs above your own </li></ul></ul><ul><li>Clinical </li></ul><ul><ul><li>doing something for someone that prevents them from experiencing consequences </li></ul></ul>1-800-673-1847
  13. 13. Enabling <ul><li>Often misunderstood </li></ul><ul><ul><li>Not as simple as buying drugs or alcohol for a patient, or supporting the addict financially </li></ul></ul><ul><ul><li>Can be as simple as accepting the behavior without addressing it </li></ul></ul><ul><ul><li>The reduction of enabling DOES NOT mean that the goal is to give additional consequences to the addict, the consequences will come naturally </li></ul></ul><ul><ul><ul><li>Reduction of enabling leads to the cessation of the prevention of consequences </li></ul></ul></ul><ul><ul><ul><li>Is not meant to induce “tattle-telling” in family members </li></ul></ul></ul><ul><ul><li>AA and AL-ANON slogan “live and let live” </li></ul></ul>1-800-673-1847
  14. 14. Enabling <ul><li>Examples </li></ul><ul><ul><li>Making excuses for the addict </li></ul></ul><ul><ul><li>Paying bills </li></ul></ul><ul><ul><li>Bailing them out of jail </li></ul></ul><ul><ul><li>Making rationalizations </li></ul></ul><ul><ul><li>Ignoring problems cause by use (financial, employment, legal) </li></ul></ul><ul><ul><li>Cleaning up messes </li></ul></ul><ul><ul><li>Not discussing the problem of chemical use </li></ul></ul><ul><ul><li>Not getting help for “yourself” </li></ul></ul>1-800-673-1847
  15. 15. Consequences <ul><li>The severity of consequences for addict and for family will determine the willingness to intervene </li></ul><ul><li>Consequences can be completely internal (emotional collapse, depression, anxiety, sleeplessness, guilt, fear, etc.) </li></ul><ul><li>External consequences (financial, legal, employment, medical) are more likely to lead to intervention, but not necessarily. </li></ul><ul><ul><li>Dependent on the stage of the disease </li></ul></ul>1-800-673-1847
  16. 16. Intervention <ul><li>A formal or informal process to aid in motivating a person to seek treatment </li></ul><ul><li>Many different styles of intervention </li></ul><ul><li>Older styles relied more upon threatening the addict with consequences </li></ul><ul><li>Newer styles rely on treating the family system and prevention of enabling behaviors </li></ul>1-800-673-1847
  17. 17. Intervention Models <ul><li>Major categories are direct and indirect </li></ul><ul><ul><li>Direct is a direct confrontation with the addict </li></ul></ul><ul><ul><ul><li>First direct model was the Johnson Model, originating in the 1960s </li></ul></ul></ul><ul><ul><li>Indirect is working with a co-dependent person in the addict’s support network </li></ul></ul><ul><ul><ul><li>Allows co-dependent person to be more effective in working with the addict (AL-ANON) </li></ul></ul></ul>1-800-673-1847
  18. 18. Johnson Model <ul><li>Originated in 1960s with Dr. Vernon Johnson </li></ul><ul><li>Taught at the Johnson Institute </li></ul><ul><li>Very effective in treatment entry rates </li></ul><ul><li>Method </li></ul><ul><ul><li>Family meets with a counselor (or interventionist) </li></ul></ul><ul><ul><li>Family prepares letters to addict </li></ul></ul><ul><ul><li>Intervention rehearsal meeting takes place </li></ul></ul><ul><ul><li>List of consequences if addict does not enter treatment is developed </li></ul></ul><ul><ul><li>Intervention takes place and is usually a rapid process </li></ul></ul><ul><ul><li>Addict agrees to treatment or accepts consequences </li></ul></ul>
  19. 19. Confrontational vs. Motivational Approaches <ul><li>Confrontational approaches may work more quickly </li></ul><ul><li>Confrontational approaches tend to address the addict, rather than the entire family unit </li></ul><ul><li>Confrontational approaches may lead to higher treatment drop-out </li></ul><ul><li>Confrontational approaches are more stressful for the family unit and addict </li></ul>1-800-673-1847
  20. 20. Forcible Intervention <ul><li>Civil liberty issues arise with forcible interventions </li></ul><ul><li>Interventions that use physical force to capture or even confine the addict </li></ul><ul><li>Addict has not been allowed to attend court nor have they been served with legal action </li></ul><ul><li>Deprives the person of liberty without due process </li></ul>1-800-673-1847
  21. 21. Underlying Themes of Modern Interventions <ul><li>Utilize motivation rather than confrontation </li></ul><ul><li>Are invitational in nature, rather than by surprise </li></ul><ul><li>Decreases the focus on the addicted individual </li></ul><ul><li>Focuses on need of entire family system to grow towards increased health </li></ul><ul><li>Focus on dignity and respect for the addict and the family </li></ul><ul><li>May be effective in helping the addict decrease use without their direct participation </li></ul>1-800-673-1847
  22. 22. Modern models <ul><ul><li>Motivational Interviewing </li></ul></ul><ul><ul><li>Systemic </li></ul></ul><ul><ul><li>A.R.I.S.E. (A Relational Intervention Sequence of Engagement) </li></ul></ul><ul><ul><li>CRAFT (Community Reinforcement and Family Training) </li></ul></ul>1-800-673-1847
  23. 23. Motivational Interviewing <ul><li>Open-ended questions </li></ul><ul><li>Utilizes mirroring </li></ul><ul><li>Reflective listening </li></ul><ul><li>Affirmations </li></ul><ul><li>Summaries </li></ul><ul><li>Reframing </li></ul><ul><li>Takes the burden of motivation away from the family </li></ul><ul><li>Patient eventually accepts the consequences of their actions </li></ul>1-800-673-1847
  24. 24. Systemic Approaches <ul><li>Can help the family return to a state of health, even if the addict continues to use </li></ul><ul><li>Rewards sober activities </li></ul><ul><li>Discourages activities that include drugs or alcohol </li></ul><ul><li>Eventually reasons not to use outweigh the reasons to use, the addict seeks treatment </li></ul><ul><li>Avoids nagging, pleading, and threatening </li></ul><ul><li>Addict gradually develops insight into the consequences of their actions </li></ul>1-800-673-1847
  25. 25. A.R.I.S.E. ( A Relational Intervention Sequence of Engagement ) <ul><li>Divided into phases </li></ul><ul><ul><li>Phase A </li></ul></ul><ul><ul><ul><li>Level 1—first call and first meeting of intervention team </li></ul></ul></ul><ul><ul><ul><li>Level 2—Continue intervention meetings </li></ul></ul></ul><ul><ul><ul><li>Level 3—Formal ARISE intervention takes place and consequences are given if patient has not entered treatment </li></ul></ul></ul><ul><ul><li>Phase B </li></ul></ul><ul><ul><ul><li>Individual and family healing, individual and family get treatment </li></ul></ul></ul><ul><ul><li>Phase C </li></ul></ul><ul><ul><ul><li>Relapse prevention and long-term recovery </li></ul></ul></ul>1-800-673-1847
  26. 26. CRAFT <ul><li>Designed for others who need assistance in getting help for their loved one </li></ul><ul><li>Utilizes positive communication </li></ul><ul><li>Rewards sober activities </li></ul><ul><li>Discourages using activities </li></ul><ul><li>Could lead to a lower rate of relapse b/c entire family unit is motivated </li></ul><ul><li>Goals: </li></ul><ul><ul><li>Increase happiness of family members </li></ul></ul><ul><ul><li>Decrease addict’s use </li></ul></ul><ul><ul><li>Motivate addict to seek treatment </li></ul></ul>1-800-673-1847
  27. 27. CRAFT <ul><li>Uses positive communication styles to encourage the family and addict </li></ul><ul><ul><li>Brief sessions to describe problem </li></ul></ul><ul><ul><li>Positive and hopeful </li></ul></ul><ul><ul><li>Use I statements and stick to fact </li></ul></ul><ul><ul><li>Indicate hopes for future outcome </li></ul></ul>1-800-673-1847
  28. 28. Treatment of the Family <ul><li>Help is available for the family, even if the addict is unable to gain motivation for change </li></ul><ul><li>Self help groups such as AL-ANON and CODA are helpful tools and offer support at no cost </li></ul><ul><li>Individual and family therapy </li></ul><ul><li>Help from an interventionist </li></ul><ul><li>Help from a treatment facility to guide family through process </li></ul>1-800-673-1847
  29. 29. Choosing a technique <ul><li>A “one size fits all” approach does not work </li></ul><ul><li>You must match the technique with the family and patient’s needs </li></ul><ul><li>The urgency of the situation may dictate your approach </li></ul><ul><li>If one approach is unsuccessful, try another </li></ul><ul><li>Reminder that working with the family or employer who initiated the intervention is of utmost importance </li></ul>1-800-673-1847
  30. 30. Interventions are initiated by <ul><li>Family </li></ul><ul><li>Friends </li></ul><ul><li>Employers </li></ul><ul><li>EAPs </li></ul><ul><li>Professional licensing agencies </li></ul><ul><li>Law enforcement and legal means </li></ul><ul><li>Child protective services </li></ul><ul><li>Physicians </li></ul><ul><li>Therapists or counselors </li></ul>1-800-673-1847
  31. 31. Recovery Connection <ul><li>If you are looking for assistance, please call our 24 hour helpline, free of charge </li></ul><ul><li>800-673-1847, Recovery Connection </li></ul><ul><li>Guidance is available in looking at options </li></ul><ul><li>Staff here receive 30,000 calls per month and are experts at interventions </li></ul>1-800-673-1847

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