This most frequently asked question derives from the fear of change. Subconsciously, the family is concerned with what will happen to them if the substance user says yes. Forgoing intervention, believing they will just say no codependently, makes it all about the substance user. It also suggests the fear that if he or she says yes, the codependents have much to change themselves. The family has been hearing “no” from the substance user up to the time they make the call to us. Families know how to do “no”; it has become their new normal. “Yes” means a complete change for both the family and the substance user and requires setting aside the illusion of control. We professionals remind one another: “If you want to understand the problem at its core as to why families are afraid to intervene and change, just watch what happens to them when the loved one says yes.” This kind of change is difficult, especially at first, as most change is. As with the substance user in recovery, the situation gets better with time.
This second most commonly asked question is also a screen for the family’s fears, related to the underlying issue of codependency. It is a fair question that one would ask regarding most medical concerns. The difference is the family’s response to the answer. If someone asked an Oncologist, for example, about the success rate for a specific treatment, the answer would rarely lead to a decision not to fight the cancer. A lower success rate might even trigger a stronger will to fight. In regards to addiction and intervention, any answer less than 100% provides a subconscious reason to cling to the normal, to the status quo. Our experience suggests there are many families who would be scared off if the success rate was in fact 100%. This question has so much underlying meaning that we have dedicated an entire section to it.
Bottom is not something a substance user hits; it is something that is felt. Intervention is about helping family members focus on their needs. When a family waits for their loved one to ask for help or to feel dire consequences, there are often two things going on that likely make this approach ineffective. First, the family is still placing the substance user’s needs before their own. The family doesn’t have to wait for the substance user to hit bottom; they can take action when the family reaches their bottom. Putting the loved one first is fueled by codependency and results in making his or her needs the priority. Second, most families are enabling and providing comfort that would thwart any chance for the substance user to hit bottom or ask for help. On the one hand, the family makes it about the substance user’s feelings; on the other hand, they provide support so the loved one doesn’t want to or have to change. This arrangement provides nothing short of prolonged insanity and destruction to the family. In all this, the substance user is comforted even as the family suffers.
If you thought your loved one was using heroin but found out it was methamphetamines or alcohol, would it change the need to intervene? The substance user’s behavior is much more the issue than the alcohol or drug of choice. The concern is not what they use, how much or how often; it is what they do as a result of the use. When substance users enter treatment programs, they are not taught how to fight off substance use with willpower. Instead, they are given the opportunity to explore the reasons behind the need for self-medication. Putting off taking action until the family knows what substances are being used is a diversion from the underlying reasons that explain why a family waits. Unbeknownst to the family asking the question, there is often an underlying, codependent, fear-driven roadblock to the query. With the help of a professional interventionist and ongoing family recovery, family members can change their behaviors and thoughts to improve the outcome for themselves and the substance user.
There are three approaches to the treatment of dual disorders. The sequential treatment approach calls for one problem to be addressed and under control followed by the other control. Parallel treatment is when both substance use and mental health issues are treated simultaneously. The drawback to parallel treatment stems from different professionals from different organizations providing the treatment. The approach used most often today is integrated treatment. With integrated treatment, there is no primary and secondary disorder; all disorders are treated simultaneously by the same professional group at the same location. This is often the case at dual diagnosis treatment centers.
With integrated treatment, professionals prefer to get the substance use disorder under control prior to making a clinical judgement on the severity or actual diagnosis of the mental health issue. Drug and alcohol use can bring out underlying mental health issues and can also cause behaviors to look like mental health concerns. An integrated treatment provider can help, whether it is the substance use causing the mental health symptoms or if the substance user is self-medicating a pre-existing mental health issue.
You most certainly can and you probably already have tried to do just that in various ways many times. Having that talk almost always results in more promises and false hope. Intervention is not about the speech that convinces the substance user to enter treatment. It is about the family changing and healing from the harm done to them by the substance user’s behaviors. Merely talking, giving ultimatums, and deadlines rarely provide positive outcomes. Choosing to try to talk him or her into treatment does more for the pride and ego of the one trying than it helps with the overall problem. Because this question often comes up, it is discussed in our How to Do an Intervention Section Here.
It is quite possible that one of those outcomes will be the result of an intervention, at least temporarily. Most substance users beat families into submission by instilling fear in them. It is one of the reasons families hesitate to do an intervention. The substance user needs the family far more than the family needs the pain and suffering from the addictive behaviors. Whenever we protect someone else’s feelings, we are ultimately protecting our own. Following an intervention, whether help is accepted or not, at some point the intervention team, the treatment team, and the family are going to be verbally attacked. Substance users avoid accountability and blame their strife on everything other than themselves. People who are hurting tend to hurt other people, and it allows for justification and a victim mentality. These are all defense mechanisms that substance users employ until they learn new, healthy coping skills. The intervention team works with the family to help them understand the substance user’s volatility and how not to react to the loved one’s emotional roller coaster.
Anyone who has ever had a job knows what happens when sickness occurs or medical leave is needed. The employer almost always says to just take care of yourself. If not, then you probably should not be working for that person anyway. The employer also knows everyone is replaceable, although most families and the substance user do not think so. Substance users like to use their job as a barometer and justification. For those who are able to hold onto a job, as long as they are pulling a solid A grade from 9-5, the F grade they pull from 5-9 balances out to a C grade average. In other words, the job is minimizing the symptoms of substance use. It allows the family and the substance user to believe they are not as bad as others. Both family and substance users wear the job as a justification that they aren’t like those real addicts and alcoholics. Most families believe that if not for the job, he or she would spiral out of control as the job is the only thing keeping things together. If the substance user had any other medical condition, would the family be concerned about the job? It would likely not even be a question or consideration. Worrying about the loved one’s employment is a codependent diversion and stall tactic. Jobs do not provide solutions for substance users; they only create diversions and excuses for both them and the family. And for those who cling to the belief their employers don’t know something is off, they always do. Anytime the substance user needs to leave for treatment and brings it to the employer’s attention, the request is never met with shock or surprise. And what does it say about the substance user or the family who say nothing. Is the substance user truly employable given the liability he or she represents to the employer and other employees? Even if substance users remain abstinent while on the job, are they really of clear mind and body? If you owned a business with everything you know about the substance user, would you allow that person to continue working at your business?
Families often use logistical and timing concerns to delay the intervention. At times, they wait for that one person who they feel has to be there and who will make or break the intervention. Holidays and other events are common reasons family find to defer or prolong the inevitable, too. Certain situations arise where the substance user can be more vulnerable, such as being in the hospital or jail, conditions that can make the consequences feel temporarily more severe. That quickly wears off and provides a short window of opportunity to seize the moment. Families often suggest waiting until he or she is sober or clean before the intervention happens. When that occurs, often families say there has been no use of drugs or alcohol and, thus, the substance abuser has been in a holding pattern. As a result, the family is waiting to see what happens next. Like most of the questions people ask, there are often underlying fears that inhibit families from moving forward as quickly as possible. Whenever people are faced with serious medical issues, they almost always schedule an appointment with a medical professional as soon as there is availability. Rarely are excuses made to forgo those appointments, and other appointments and needs become secondary to the new priority. With all that being said, there is no “perfect timing” for when to do an intervention. The intervention is going to happen when family members overcome their fears and trust the professionals over themselves and the substance user.
A professional intervention should include preparing families for how things should unfold. It is not uncommon for a substance user to test the family’s boundaries at the intervention. Further testing does not stop because the loved one has accepted help and is now in treatment. Family boundaries and enforcement of consequences almost always keep substance users in treatment. In the event they try to test those boundaries, the intervention team can and will help the family through the event. Should the substance user leave treatment, there is a reason you will be asked for help getting home. Such individuals are unable to accomplish making it on their own; they need help to assist them in their addiction as was likely the case prior to the intervention. Substance users often go through a whirlwind of emotions, and there may be times when the temptation to fight or flight turns to flight. Most of the time, the treatment team at the center in collaboration with the interventionist and family guidance are able to come together to convince the substance user to continue treatment.
After the intervention, it is recommended for the family to engage in its own recovery. It is likely that at some point, the family will become hypercritical of the intervention team and the treatment team. This almost always happens when the substance user calls home from the treatment center and stirs up emotions. This can include a vivid description of the environment at the center, what it is like, and the terrible thing the family has done to their loved one. Some common manipulations are: there are drugs in the facility; they have not seen a counselor or a therapist; the food is horrible, or they are not being fed; and they are bored and not given anything to do. Families often react in fear, which turns to anger, and they react first to us and then to the treatment center. We often have to remind families that just because their loved one has been in treatment for a few days, weeks, or months doesn’t mean everything being reported is accurate. It requires two people to be dishonest—the one speaking and the one listening. After the intervention, many families cannot help themselves from taking the bait and getting another dose of chaos that has been their normal. The biggest challenge to the intervention is the urge to react that families just can’t seem to get beyond; they just have to take that call from their loved one and allow the drama and chaos to resurface.
As volatile as the substance user will be in the early phases of the intervention, the family will be, too. As the feelings and emotions of the family adjust to the new normal of the substance user being gone, the family may at times act in a way similar to what the substance user had accustomed them to. Hopefully, the family will come to realize that the problems they thought were solely the result of the substance user’s behavior run much deeper than that. The addiction shifted the whole family in an unhealthy direction. Now, after the intervention, the family is going to have to construct a healthy way of living. After the intervention, our services provide a module system of Family Recovery Coaching. Our experience suggests that families who engage in Family Recovery Coaching and take advantage of the resources offered do much better than those who choose not to do so. Families have learned to live a certain way for a long time. It is not easy to bounce back to the way things used to be because the substance user is in treatment. The family is strongly encouraged to look at the intervention as a process and not an event. We look forward to being a bridge for your family to start the journey toward healing after the intervention.