Drug Abuse “Intervention:” Why it Works

In Jonah’s Berger’s excellent new book, The Catalyst: How to Change Anyone’s Mind, he discusses effective ways to get people to look at things in new ways. Even die hard ideologues can sometimes be reached using many of his methods. He also talks about why persuasive arguments and presenting new information in an effort by one person to get another person to reconsider entrenched positions usually does not work. 

In the chapter called “corroborating evidence,” he uses a successful “intervention” with a drug abuser to illustrate how, in influencing others, having multiple people give information is often much more powerful than just one person’s speaking , especially when the multiple sources are all operating at or near the same time. 

In the Intervention technique in substance abuse treatment, the actual intervention is having an outside therapist come in and coach the family members to write out a speech about how much they care about the user and how his or her behavior is hurting everyone. They are instructed to avoid telling him what to do. Nonetheless, the therapist has a rehab facility lined up in hopes that the object of the intervention will agree to do something about his “problem.”

They each say how sad they are because of the problem and how much they miss him and want the drug abuser “back.” They also give the addict the message, “If you want to be an addict, we can’t stop you. But if you want to get high, you aren’t going to do it here.” 

With families, Berger points out, several members have often -  over time and individually – “asked, begged, yelled, screamed, and threatened. All to no avail.” But then he goes on to say things that consist of the usual wisdom about these sorts of things, such as “They (addicts) don’t believe they have a problem.” They are “in denial.” They may not remember wrapping a car around a lamp post” because they “blacked out.” If an addict doesn’t think he has a reason to quit, “is one person really going to change their mind?”

That sounds reasonable, but is it really? Doesn’t the addict find out what happened to the car after he comes to? Isn’t losing a good job and resorting to crime to finance an addiction considered by the drug abuser to be problems? As I often say, he would have to have the IQ of a kumquat – or maybe a rutabaga, I’m not really sure – to not “know” he had a problem. So what’s really going on here?

Berger attributes the relatively high success rates of organized family “interventions” to the number of people giving a similar message. He's partly correct. But he also seems subliminally aware that there is something else going on here. He states, “In order to get addicts to change, their entire ecosystem has to be altered. Without realizing it, friends and family members may be unintentionally enabling the problems. So for change to stick, the whole system has to change…”

Was the particular family the author described enabling the abuser, “Phil”? Why as a matter of fact, quite so. In the author’s description, the family didn’t seem to think of him as an addict for extended periods, especially at first, because he had a job and didn’t steal to support his habit. He did start to steal a bit later. They sent him to rehab 19 different times even though each of them was unsuccessful. They repeatedly let him move back home. They resorted to having him sign a contract promising to turn over a new leaf, but all that did was to “train him to be a better liar.”

Hearing this, it might seem fairly clear why Phil may have thought his family was actually invested in him continuing to be an addict, because they made it so damn easy! Unlike most of us, they know that family members are not that stupid even if they seem to be “in denial.” Of course, I have to put the usual caution here: since I haven’t personally evaluated this family I can’t say what follows with certainty, although IMO what I am about to describe is extremely likely.

Another hint that the above formulation may be on the mark is a statement by the book author that "family was everything to Phil." The author thinks that Phil realizing he was tearing the others to shreds was the motive for quitting. But again, how could Phil possibly think that this hadn't been the case all along? Because he thought the family needed him to be an addict!

In dysfunctional families with shared conflicts over certain behavior, say for example puritanical attitudes towards work and intoxication, several members are usually involved in either enabling or refusing to notice the problems of the addict. The addict is actually taking the cue to deny that he has a problem from the family. When one member occasionally seems to object about addict-like behavior, another family member may give the addict the opposite message. In such a situation, this can become a game without end even more easily than when just two people are stuck in this game. So no wonder the addict ignores the asking, begging, yelling, screaming, and threatening from any one family member.

However, when the whole family comes together to give the same message – that they all will no longer deny that the addiction has become a problem — and all clearly state that all of their enabling behavior in toto is going to cease, their wanting him to stop becomes far more believable. So it isn’t just multiple sources of info as Berger assumes, but the fact that they are all indirectly acknowledging their own contributions to the addict’s continuing addiction.

Of course, the addict may still be skeptical. If Phil leaves yet another rehab program without success, and his parents still let him return home, nothing will stick. In this case, that fortunately did not happen.

The Impact of Intervention in Addiction Through an Amy Winehouse Scope

Today's post in a guest post courtesy of Allison Gamble, a writer for psychologydegree.net. 

“They tried to make me go to rehab, I said, "No, no, no"

Yes, I've been black but when I come back you'll know, know, know

I ain't got the time and if my daddy thinks I'm fine

He's tried to make me go to rehab, I won't go, go, go”

           ~ "Rehab" Amy Winehouse

The late singer Amy Winehouse released “Rehab” in 2007, a now haunting song that revealed her struggles with drug and alcohol abuse, her reluctance to seek help, and the role her family and friends played in her life. Some attempted to push her towards treatment, while others seemed to enable Winehouse's destructive behavior and ignored warning signs that may have caused her sudden death. While Winehouse’s plight has gained media attention, her celebrity is one of the only factors that separated her situation from the problems that many individuals who abuse drugs and alcohol deal with every day.

Like many other families who have loved ones with a substance abuse problem, Amy’s family is placing fault on others for her sad demise. It doesn’t take a degree in psychology to smell the denial in the air. Interviews with her parents show they lay blame for her death on detox methods instead of also looking at both their behavior and having not intervened in time to possibly help Amy.  Of course, losing a child is awful enough, but they are likely also feeling tremendous guilt that they had not taken more steps to try to protect her from a fate no one wanted to believe would come to fruition.

In American and the UK alike, due to the absence or failure of family members and friends intervening, many addicts like Amy are left to cycle through pricey rehab clinics and wind up taking endless supplies of anti-psychotics, anti-depressants, anti-anxiety meds and more. Gaining the approval of doctors, rehab clinics and pharmaceutical companies, families are held harmless as they look at addiction as a disease. With this medical model, the one loser winds up being the addict.

While little has been revealed about Winehouse’s upbringing, it is known that her parents separated when she was 9 years old. Father, Mitch Winehouse, claimed in a 2008 interview, titled “How my affair made Amy suffer,” with British newspaper The Daily Mail, that a longstanding affair with a colleague was an open secret in their home. Winehouse’s paramour was even known by Amy and her siblings as “Daddy’s work wife.” Mitch Wineshouse claims he never realized that their family’s dysfunction had impacted Amy so negatively until years later when he heard her song “What it is About Men” that the line “all the shit my mother went through” referred to his deception.

Amy’s mother Janis claims her Amy had always been a rebel but that her defiant streak intensified when Amy became a teenager. In an unusual move by Janis, Amy was allowed to leave home to live with a friend at the age of 15. "It would have been fine but she moved out for her own convenience. She wanted to live with a friend. Perhaps she wanted her mum to fight to make her stay. But I felt she had grown up by then,” her mother said in a January 2008 interview, eerily titled “Amy Winehouse’s mum says she’ll be dead in a year,” with the Sunday Mirror. This is not to say that Janis is solely responsible - there are surely hundreds of children who move out early without overdosing at 27. But could a firmer hand have helped steady the wheel? We’ll never know.

Janis went on to say that she while she doesn’t feel responsible for Amy’s decline into drugs, she reveals being lackadaisical when Amy started running into trouble. "Amy was never an easy child and she was always open to any new bad influence. Her life became a bit muddled when she left home. She started smoking marijuana and got her first tattoo - a Betty Boop on her back. I just said, 'Oh well.’”

Amy’s family always seemed to have a disturbing dynamic. Janis was unhappy; Amy was rebellious, but always trying to please her out-of-the-picture father Mitch. "I don't do happy. [Amy] doesn't, it seems, do emotion either. But it's just her way of coping,” Janis explained.

As a Amy became an adult, her family unit added another dysfunctional member: ex-husband Blake Fielder-Civil. A self-admitted addict, Blake claims to have introduced Amy to narcotics usage. “I’m not trying to defend his behavior and I know him for what he is: he’s an addict and he has done some terrible things. He feels enormous grief and responsibility for some of the things that have happened, as well he should,” Fielder-Civil’s mother, Georgette, told the Daily Mail in “Don’t blame my son for Amy’s death: Blake Fielder-Civil's mother's plea as she insists the couple were still in love.”

Although some families shift the blame for a substance abuse problem on medical issues, they are often the ones who have, perhaps unwittingly, facilitated the problem to a significant degree. In 1991, The Journal of the Academy of Child and Adolescent Psychiatry reported that researcher James R. McKay and colleagues had studied adolescent substance abusers and confirmed what we know anecdotally: that greater perceived degrees of dysfunction were linked to increased levels of substance abuse prior to hospitalization.

With modern medicine focusing on the disease model of addiction, pharmaceutical companies have been instrumental in keeping substance abusers like Amy addicted by flooding the market with painkillers and psychoactive meds, while also profiting from drugs to counter addiction.

In July 2011, financial website This is Money reported that one such company, Reckitt Benckiser Pharmaceuticals, was delighted to announce that its newest delivery system for the heroin addiction drug, Suboxone, would now be a big moneymaker. “As is well known, our Suboxone tablets can become subject to generic competition in the U.S. at any time, and moving more of our business into the film remains a key priority. At the end of June 2011, the Suboxone film had captured a 41 per cent volume share of the U.S. market,” he said.

Talk show host and former journalist Piers Morgan knew Winehouse and told Entertainment Tonight in “Piers Morgan hits out at Amy Winehouse’s record company after singer’s death,” that while the troubled singer ultimately succumbed due to her own addictive behavior, others in her life failed to take responsibility. Echoing a common question, Morgan wanted to know where everyone was when she needed help. He stated, “I do blame people. Where were all the people making money out of her when it mattered? Really, where were they? You know, it's just not good enough that they're all going to make millions out of it now she’s dead.”

Blake Fielder-Civil’s mother seems to agree. “We all played our part in what happened to her. I have had to look deep into my heart and wonder if I could have helped, done things differently,” she said.

While we may never know what caused Amy's death, ultimately she was responsible for her actions. However, family members, “friends,” doctors, rehab centers and pharmaceutical companies must also accept responsibility for the role they played in her destruction. We need to move towards a more cohesive model that merges psychology and psychiatry to prevent more parents from losing their daughters.