Author:Adam Mindel

Adam Mindel Interventionist with patient

Jan 17 2020

Interventions and Recovery: a Process | part 3

Adam Mindel, Addiction, Recovery Blog, Rehabilitation Process

As I look back over the last several months of working with individuals and families towards recovery, I promise I am terribly understating when I describe interventions as a process versus an event. All interventions are a process, I promise you, and I promise you so is recovery. Firsthand, I reflect on my nearly 17-year journey of recovery and recognize the years I spent in my addiction leading up to my current sobriety as all part of the process that produced the recovery that I have today.

Research shows that individuals must often go through a process of preparation before they are ready for permanent sobriety. The Transtheoretical Mode of Change by Prochaska & DiClemente is a model which describes sobriety as a movement from Denial to Contemplation to Preparation and ultimately Action and Maintenance.

Two Predominant Methods to Move Individuals from Denial to Motivated States of Change

If the above is true, then realistically how do I utilize interventions to move individuals from states of denial to more motivated states of change? I suggest there are two predominant ways:

1. Utilizing leverage to engage individuals in treatment, with ultimately, treatment itself as the vehicle which provides the process of resolving ambiguity and resistance to change
2. Meeting individuals “where they are at”, by finding levels of care that can begin to engage individuals in a process of change.

Two important qualities required for an intervention

First, let’s cover the basics in all models of interventions, most interventionist asses for two important qualities required for an intervention

A. Influence – The capacity to have an effect on the character, development, or behavior of someone.

B. Leverage – The power to create consequences, or require behavioral change by an individual that is addicted.

I additionally assess for Attachment, which -is a deep and enduring emotional bond that connects one person to another across time and space (Ainsworth, 1973; Bowlby, 1969). Put simply, I like to know how much individuals care for and are connected to the friends and family that love them. Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. At the same time, addiction and neurochemical changes will often resemble anti-social behavior.

Realistically individuals with high levels of sociopathy do not generally enter treatment without being compelled by the fear of consequences. Click To Tweet

Individuals often enter treatment due to tensions in interpersonal relationships.

With over 15 years of experience working with families and individual in treatment, I can unequivocally inform you that individuals with deep attachments to friends and family have better outcomes from interventions and addiction treatment.

Having experience and understanding the quality of influence and leverage is vital to producing positive outcomes and creating the correct type of intervention. Quite frankly it is always easiest to intervene on loving individuals that care for their friends and family, and due to interdependent relationships, there are real consequences if the loved one does not enter treatment. For example, I recently intervened on a college student that had very close relationships with his parents and extended family. From the beginning, the initial assessment it was clear that this dutiful son would be entering treatment. In addition, he was dependent upon his parents to return to college. The intervention became high-level consultation, psychoeducation, and changing family dynamics while creating an accountable path back to university with the parent’s support post-treatment.

Unfortunately, not all interventions are high in relational influence or attachment, and not all interventions have real leverage. Click To Tweet

I describe “real leverage” as actual consequence that an individual would experience if they choose to not enter addiction treatment. These consequences may include the removal of financial support, parental or marital consequences.

“Adaptive models of interventions find ways to engage with individuals realistically in different stages of change” – Adam Mindel

Adaptive models of interventions find ways to engage with individuals realistically in different stages of change, different levels of care, and often must create processes that allow individuals to fail or provide them the dignity to try things “their way”, before accepting recommended courses of action.

For example, I recently Intervened on a successful businessman that was abusing both opiates and amphetamines. Though he loved his family, no individual in his family had any type of leverage, he was well able to finance/self-enable his own addiction. In addition, as a result of chronic amphetamine abuse, the client was dysregulated and unable to acquiesce to residential treatment, and insisted upon beginning outpatient treatment. An agreement was made between the client and his friends and family that included scheduled follow-up meetings to track his progress in outpatient. Ultimately, due to repeated relapses while attending outpatient treatment, the client became more intrinsically accepting of entering residential treatment of his own accord versus external coercion.

After the Intervention

Once in treatment a further process was created moving client through different levels of care which included residential treatment, sober living coupled with day treatment, intensive outpatient treatment, and ongoing continuing care which included week individual therapy for 6 months, psychiatric care, continued urine analysis monitoring, and of course the client’s agreement to attend self-help group throughout the recovery process. The client to this day continues in his own process of recovery and growth…the process continues.

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What is Psychotherapy

Adam Mindel

Adam Mindel, Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment

What is Psychotherapy?

Psychotherapy, also known as Talk Therapy, is the treatment of disorders using psychological techniques rather than medical intervention. The general intention of psychotherapy is the promotion of communication to aid in recovery from a variety of ailments. PT is used to improve conditions of emotional stress, anxiety, and substance abuse. By communicating with trained psychotherapy professionals, the patient can work towards a solution to their problems, usually by learning how to modify their thinking and behavior. The wide variety of approaches used in PT means it can prove successful for those of any age, gender, and personality type.

Types of Psychotherapy

Cognitive Behavioral Therapy, often referred to as just CBT, falls under the category of a psychotherapy. The psychotherapist’s aim with CBT is to aid the patient in altering their own behavior and thought. Commonly used for anxiety and depression, Cognitive Behavioral Therapy is a type of talk therapy where the therapist focuses on specific solutions to the patient’s problems. The Purpose of CBT is to get the patient thinking and acting more appropriately for their situation.

Psychodynamic/Relational

Psychodynamic Therapy is sometimes known as Relational Therapy and involves in-depth psychoanalysis conducted by a specifically trained psychotherapist. This unique technique in psychotherapy attempts to help both the therapist and the patient understand where their problems are coming from. Be it from emotional distress or deeply rooted fears or behaviors, the goal of the therapist is to develop the establish and enrich the patient’s self-awareness. Psychodynamic Therapy hopes to connect previous experiences to current behaviors.

Somatic Experiencing

Somatic Experiencing is a psychotherapy approach concerned directly with body awareness. Its principal intent is to heal trauma that is often the result from what has become known as post-traumatic stress disorder (PTSD). The focus of the treatment is on the patient’s somatic sensations; their perceived body sensations. The theory behind SE is that negative symptoms of trauma, like shame, anxiety, and embarrassment occur because we do not fully process the trauma. During treatment, the therapist will introduce minute amounts of stressful trauma and make observations on the patient’s response. From this, the Somatic Experiencing therapist can begin developing with the patient, strategies to regulate their stress responses.SE is one of the more recently developed psychotherapy treatments and has been successful for a variety of stress disorders.

EMDR

It’s a long one! EMDR stands for Eye Movement Desensitization and Reprocessing Therapy. What could that possibly entail? This psychotherapy approach has been very well researched and has consistently shown to produce positive results with respect to trauma recovery. During the treatment, the therapist will dig into the patient’s history to determine the root-cause of the trauma. The patient will then be trained in a few stress reduction techniques to be used during the therapy sessions. Visualization of the trauma, identification of self-negativity, and emotional responses and body sensations are all key aspects of the treatment. The actual EMDR techniques are a bit difficult to envision but include eye movements, taps, and tones. The inclusion of these stimuli is what has shown in research to bring success to the therapy.

TRM

The goal of this psychotherapy approach is for the patient to be able to manage their nervous system by controlling the sensations they experience with respect to their traumas. Our bodies have automatic responses to perceived threats; think fight, flight, and freeze. Trauma Resiliency Model uses several approaches to help the patient understand their natural responses to trauma and stress. Titration, tracking, and pendulation are some of the technique you’ll come across if you choose to undergo this psychotherapy. The uniqueness of TRM is that the body’s innate responses provide the foundation to work from. In other words, the patient already has everything needed to be successful in this approach to psychotherapy.

Motivational Interviewing

Motivational Interviewing is a fairly straightforward psychotherapy approach that works on facilitating and engaging intrinsic motivation within the client by focusing counseling session more on specific goals rather than self-expression from the patient. In MI the aim of the therapist is to influence the patient directly in hopes of accomplishing specific goals geared towards improving the patient’s state of mind and behavior. The presence of ambivalence is commonly very high in those suffering from addictions and trauma. The focused and direct approach of motivational interviewing sessions is designed to help the patient omit conflicting and contradictory feelings and thoughts which impede progress and eventual success in psychotherapy.

Group Therapy

This is one of the more well-known types of psychotherapy. Most often involving 6-12 patients and a single therapist, group therapy is a very open strategy that can integrate other psychotherapy techniques like cognitive behavioral therapy and motivational interviewing, in a group format. In this approach, the group itself is the key strategy. Group therapy leverages the group setting as an instrument for change by relying on the dynamics of interpersonal relationships. In groups, patients can lean on each other for support while learning from one another’s strengths and skillsets. For this reason, group therapy is one of the more command preferred psychotherapy approaches.

Interpersonal

Interpersonal psychotherapy is as the name implies, personal. Differing from group therapy as a one on one approach, IPT is highly structured and follows a strict timeframe usually of 12-16 weeks. Originally developed to treat depression, this psychotherapy approach is now utilized to treat many more types of issues, including substance abuse. There are 2 principal techniques in IPT, attachment theory, and interpersonal theory. The ultimate goal of interpersonal psychotherapy is to develop the patient’s communication abilities and therefore improve their ability to enter and maintain relationships with others.

What to Expect

There is no general expectation one could have for psychotherapy. The variety of approaches means the patient won’t know what to expect until they speak with a professional. Also varying is the length of treatment. Again, until the patient meets with a psychotherapy provider it is hard to say exactly how frequently and for how long they will receive treatment. When deciding to contact a PT provider it is key to keep in mind that these types of treatments for addiction have a long-standing record of success. Discuss your goals and define key indicators of successful psychotherapy with your provider.

Who Can Benefit

So, who can benefit from psychotherapy? In a nutshell, everyone. While psychotherapy comes in many different approaches and strategies there is more or less something for everyone. The benefits of PT to those suffering from addiction are well documented and widely utilized. However, it should be noted that a patient undergoing psychotherapy for addition can frequently make improvements in other aspects of life including mood, anxiety, and personality disorders.

How to Find a Provider

Google, of course! When searching for a provider in your area consider all the traits you would for most services. A local, well-established psychotherapy provider will have a better understanding of the local community and the common issues with substance abuse and addiction in that area. Ensure your providers is certified with reviews and has long-standing experience with your specific needs.

How to Stage an Intervention

Adam Mindel

Adam Mindel, Addiction, Recovery Blog, Rehabilitation Process, The Field of Treatment

What is an Intervention

An intervention is often the very first step taken by loved ones in helping someone with addiction. Whether it be an alcohol intervention, or a drug abuse intervention, there is an organized, planned approach for success. The purpose of the intervention is to confront the addict in hopes of promoting acceptance of the addiction and to show comforting support for the rehabilitation process to come.

How to Stage an Intervention

Gather a team

This is the foundation of an intervention, the team. Family interventions are most common however friends and colleagues of the addict can also be present. The ideal size for an intervention team is typically between 3-5 people the addict has a close relationship with. 3-5 team members are large enough to show the addict that there is an obvious addiction, but small enough to not overwhelm them and allow for easy communication amongst the group.

Intervention professional

Selecting the right interventionist is key to a successful intervention. Make sure the professional you choose is certified, and they should hold some sort of counseling degree or license. Experience counts too! The number of interventions they’ve conducted and their approach to interventions is also highly important. Have they had much experience with family interventions?

Planning an intervention

Interventions can be highly stressful for everyone involved and are crucial to beginning the drug rehabilitation process. It is, of course, most important to identify exactly what the issue is and the reasons why an intervention is needed. Given the dramatic and emotional nature of interventions, thought must be given in selecting your intervention team. Decide who the addict is closest to and with whom they have comfort and trust.

Rehearse

Not too many of us have interventions as commonplace in our lives. For this reason, rehearsing and practicing the intervention with your team, and your chosen interventional professional is a must. Go over the initial approach, discuss and prepare exactly how the intervention should go. Perhaps most importantly, prepare yourself and your intervention team for the likely refusal or resistance from the addict to participate.

Define consequences

Accepting that one has an addiction is a very difficult thing. There is a very good chance the addict will deny the issue, or refuse to participate in the intervention and planned follow up care. Situations like these are why the intervention team should have planned some consequences to the addict if they refuse help. The consequences, of course, are dependent on the situation but oftentimes a proposed consequence may be taking away a vehicle, denial of visitation rights to children, or loss of employment. Your interventionist will be able to discuss these with you.

Choose a location

Remember that when choosing your intervention team, you must consider how comfortable and trusting the addict will be with the team members. The same consideration should be taken when deciding on where to conduct the intervention. Family interventions are personal and can be very emotionally charged. For that reason, public venues should be avoided. Consider where the addict is likely to be comfortable. Make sure the venue is a commonly visited place by the addict but not somewhere that may have a negative association. Perhaps some dramatic events related to the addiction have occurred at the addict’s home; choose a more neutral location for the intervention.

Be prepared for anything

Anything can happen during an intervention. This is one major reason why a professional interventionist should be present. Consider the viewpoint from the addict. Will they be defensive, offended, confused? There is an added element of unpredictability when dealing with those suffering from drug or alcohol addictions. Give some thought to the addict’s personality, the type of addiction they suffer from, and recent behaviors. Consider the possible reactions during the intervention and use that when considering your team members. A professional interventionist will be well versed in a variety of possible scenarios.

What Happens After an Intervention?

Detox

Time is of the essence post-intervention. It is imperative that the intervention team be ready for the addict’s acceptance for help and have a follow-up plan in place. The team should have a treatment facility chosen and registered. There needs to be an immediate transfer of the addict to their treatment facility following acceptance of the intervention and agreement to therapy. Have necessary items ready to go for the addict so no distraction can occur with packing. Have what they need ready, and ensure them everything is planned.

Extended care

Also known as Aftercare, extended care is the step following Detox. Here the addict may enter an inpatient care facility or an outpatient care center that allows the patient to return to some normal life activities. More information on Extended Care can be found at this link:

Sober living

A version of Extended Care where the addict can live in a designated housing community amongst other recovering addicts. This type of aftercare allows for a sense of normal life while still maintaining recovery strategies like group therapy, counseling, and structured behavior. This type of care may or may not suit all recovering addicts but should definitely be considered as a type of aftercare.

What if your Drug Intervention Fails?

What to do

Convincing an addict to seek treatment isn’t usually easy. Staging a successful intervention is tough and even if you do everything right there is a chance the addict may resist treatment. Don’t be discouraged if the first intervention attempt fails; plan, and try again. However, your post-intervention behavior is crucial to future success. Whatever ultimatums you made during the initial intervention should be maintained. This means you may have to move out of the house, cut off money supplies, or even make the addict leave the home. However difficult, you must stand firm on promises made during your intervention. Again, the most important thing you must do after a failed intervention is – try again.

What not to do

The things you shouldn’t do following a failed intervention fall in line with what you should do. Firstly, do not give up. It could very well take several tries before your attempt at intervention is successful. Secondly, do not make compromises. Remember the promises you made during the intervention; to leave, to file for divorce, to take away child visitation rights; this may be difficult but it is an absolute must for future success.

Why might your intervention fail?

Interventions are tough. They are tough to plan, tough to initiate, tough to go through, and tough to accomplish. Many will fail and if your intervention fails it is important to consider why. Perhaps the planning fell short. Maybe the flow of conversation wasn’t there or maybe the addict wasn’t comfortable with the group or location. Perhaps the intervention went in too many directions. Were there solid ultimatums given? Were those ultimatums committed to? Another reason interventions fail is because no clear solution to the addiction was presented. If too much focus is placed on the problem and not the solution, the intervention may stall. Focus on the solution!