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Adam Mindel Interventionist with patient
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Interventions and Recovery: a 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 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 level of care, and often must create processes that allow individual 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 in 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.

 

 

 

Schedule a 30-min consultation with Adam

 

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We Believe in meeting individuals where they are and the power of  Long-Term Care

 

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Interventions: A Series | Part 2 of 3

Understanding Change and Raising The Bottom

 

 

Must Substance Abusers lose nearly all before getting help?

 

Interventions must address the particular circumstances of each client who might enter treatment and no, not every user has to “hit bottom” for intervention and subsequent treatment to be effective. Occasionally an individual might “hit bottom,” however defined and seek treatment. Most users though arrive at treatment due to the mounting stressors that accumulate through the course of their substance abuse. Whether it’s familial pressure, legal difficulties, job loss, or hospitalization, some form of coercion is usually present. Furthermore, studies have shown that coerced clients often have better outcomes than those entering treatment voluntarily.

 

“Individuals differ in severity of use and readiness to change as well as their therapeutic needs, waiting for individuals ambivalence to be resolved is not the answer.” Click To Tweet

 Adam Mindel, Interventionist and Program Director of Recover Integrity.

 

Despite dated paradigms, conventional wisdom, and tacit implications that popular culture continually reinforces, the options Intervention present to the user for treatment can resolve a user’s ambivalence to change at every stage of substance use. With the destruction and lethality of substance abuse reaching pandemic proportions, outdated thinking on Intervention and subsequent modalities of treatment can be as harmful as waiting on the sidelines as users struggle to hopefully become ready to effectively address their substance use.

 

Effective intervention accepts the inconsistencies users present in their readiness to address their substance use. Simultaneous and contradictory attitudes are integral in formulating the insights and subsequent decisions on a path to recovery. Human beings can be quite complex.

 

Families and loved ones have to embrace ambivalence as a normal part of the process of change. Most clients enter treatment with conflicted feelings surrounding their substance use.

 

It’s important to understand that at a minimum, the role of treatment is to resolve ambivalence and consolidate a client’s often fleeting sense of motivation Click To Tweet

Adam Mindel

 

Intervention is very much a process of being able to meet the client where they are at. When appropriate and possible, Mindel has shifted his style of Intervention. “I like to work with families collaboratively so that they can better understand recovery as a process versus an event.” In collaborative models, open discussions are facilitated about addiction and the prospect of recovery. Users and their families develop a mutual understanding of each other. Families come to more realistic terms of recognizing the path to recovery as a process and users begin to recognize the absolute need to respect healthy boundaries. This is a model in which the whole system learns simultaneously.

 

As the process continues, work arrives at learning what level of services the user is willing to engage in. “We have to be patient enough to allow individuals to engage in their own starting point of care,” says Mindel. “Often in my own practice, a client might prefer to begin in Outpatient Treatment. If they have difficulty succeeding at this level, they may become more amenable to Residential Treatment.” This model of intervention is a consistent and transparent discussion of commitments, setbacks, and ultimately progress.

 

To assess whether a collaborative model of intervention might be appropriate for you or your loved one. Please contact Adam Mindel

 

Schedule a 30-min consultation with Adam

 

Schedule Free ConsultationSchedule Free Consultation

 

Find out if we can help you raise the bottom 

 

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Interventionist Adam Mindel
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Interventions: A Series | Part 1 of 3

Interventions:  A Three-Part Series

by Adam Mindel and Ben Goodman

 

Intervention on account of its ubiquity is a term ingrained in the consciousness of modern culture

 

and has been for quite some time. Part of this has to do with the success of the reality TV show bearing the title, but more importantly, it reflects the prevalence of substance abuse permeating modern life.

 

Common familiarity with intervention has been honed to the point of parody. Recall the Sopranos, where Christopher’s intervention for heroin abuse ends with a stomping by Ralphie and Paulie and a trip to the emergency room.

 

The scenario contrasts starkly from the ideal’s intervention aims for which are a reckoning within the substance abuser and the emergence of a path towards recovery for all concerned, user, family, loved ones. Intervention is the medium through which light breaks on the horizon and life can resume.

 

“Intervention is the medium through which light breaks on the horizon and life can resume.” Click To Tweet

 

A long-held notion within traditional recovery circles has been the idea that a user had to “hit bottom” before becoming vulnerable enough to accept or seek help.

 

Such a bottom was typically preceded by a downward spiral, decades-long, and a wake of despair. The proliferation of Alcoholics Anonymous as a viable means of treating addiction resulted in a foreseeable alternative as the book 12 Steps and 12 Traditions stated, “It was obviously necessary to raise the bottom the rest of us had to hit to the point where it would hit them.”

When Vernon Johnson was developing the initial model of intervention in the late Sixties and early Seventies, preventing the addict’s death was his chief concern. Seeking out the best approach in doing this, Johnson studied 200 recovering alcoholics attempting to answer the question, “What made them want to quit drinking?”

What he found was that the decision to quit was more a result of the impact of alcoholic illness reflected by tensions within the family and other close relationships than a bottoming out per se. 

 

“What he found was that the decision to quit was more a result of the impact of alcoholic illness reflected by tensions within the family and other close relationships than a bottoming out per se.” Click To Tweet

 

Interventions have evolved over the years from Johnson Method to Invitational, Systemic, Engagement, and simply Collaborative models that work side by side with individuals and their families to harness family tensions and mobilize the power of love and attachment to create the essential willingness required for individuals to enter treatment. (next month’s blog will discuss different styles of intervention in depth)

The ensuing years, as it turns out, have seen intervention become the most promising means of raising the bottom for individuals suffering from the disease of addiction.  Adam Mindel, Program Director of Recover Integrity and Interventionist, is impassioned about raising the bottom. Adam states that with more than 72,000 overdose deaths including opiates and all drugs of abuse in 2017 we have no choice to but to “raise the bottom”. The old saying that each and every addict has to bottom out first is no longer relevant when there is such lethality.

According to The American Society of Addiction Medicine, Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

 

if addiction is brain disease as described above by the chronic pathological seeking of substances, does it make sense for us as families and society to expect our addicted loved ones magically to wake up one day and separate… Click To Tweet

 

 

Therefore, if addiction is brain disease as described above by the chronic pathological seeking of substances, does it make sense for us as families and society to expect our addicted loved ones magically to wake up one day and separate themselves from the disease of addiction. Furthermore, if addiction is characterized by neurochemical, personality, cognitive and mood disturbances, we must recognize that many individuals have lost the ability to separate themselves from chronic use.

Adam describes a series of cases involving intervention with clients drinking themselves to the point which each of them required hospitalization, who were pathologically defended in accepting treatment due to changes in their personality as a result of neurochemical changes in the brain caused by alcoholism. Each of these client’s neurochemistry was so affected that they lost a degree of insight to the severity of their alcoholism and were operating on a day to day basis in “limbic survival like responses” which were servicing their alcoholism in either seeking alcohol or protecting continued use.

With the stakes this high, the question becomes not whether to intervene, but how and when to intervene on an addicted person.

 

For further information please contact Adam Mindel directly at amindel@recoverintegrity.com, or 310-694-3552, or keep reading Interventions, Part 2, Understanding Change and Raising the Bottom

 

Schedule a 30-min consultation with Adam

 

Schedule Free ConsultationSchedule Free Consultation

 

Find out if we can help you raise the bottom 

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