Here’s a weekly question we pose to our resident advocacy professional, Joe Schrank. Joe’s been a social worker for 25 years, so he’s seen a lot of shit. Today Joe tackles interventions, which, he argues, hurt more than help. (He thought this even before the TV show “Intervention” became a runaway rubbernecking hit. ) Joe’s helpful responses to some questions begin right below this bold paragraph. Do interventions even work? Interventions can work. The question is how is “work” defined. If the goal is to read a letter, cry, and be whisked to rehab to then become a counselor at said rehab, that’s a low batting average. When I conduct an intervention the key is the system around the person of concern. What is their motivation, intention, and expectations? I think of an intervention as bringing the situation into honesty. If the person says “Yeah, I have a drinking issue and my intent is to drink myself to death,” the family has their answer. I have had some weird things happen at an intervention. One family asked me if I wanted a glass of wine. One mother started crying and said she “needed her Xanax.” People have swung at me, walked out, threatened to sue. I actually have a really high batting average of getting people to go to treatment but what then? I’m not sure if it’s a great thing to put into the culture. It’s kind of steeped in control which is a bad plan. Handled well, an intervention can be an effective way to help someone. Did the show make them more popular? The show made the word “intervention” part of pop culture. I hear it all the time. Just yesterday I heard a girl at SoulCycle proclaim she loves their clothes and can’t stop buying them “I need an intervention”. Way to trivialize addiction? “Your purchasing of SoulCycle leggings is hurting me”. I’m not a fan of most of the interventionists on that show either. They always cry. If anyone cries at an intervention, it shouldn’t be the interventionist. A&E once hired me to develop other addiction related programming. I was hesitant but ultimately they said “If you don’t someone will, don’t you want a voice in the projects?” I hated it. The production company was in LA and they would come out to NY and complain about the weather. Their crap was all over my loft and the show that was produced was stupid. There may be some added value for people to know they can take action but if you think about it, it’s a weird show. They follow severe cases, find the tawdry details, make them inject in a gas station on camera, then boundary- shame the parents and make them cry with Little League photos in the background. What’s a good alternative? I think a good alternative is honesty. America loves drugs, we have to stop hating drug users. We need to accept that drug use isn’t inherently crime or pathology. I’m much more in favor of a process rather than an ambush event if that’s possible. It’s not always. I’m also in favor of boundaries such as, “OK, you use drugs, we won’t finance it” I’m not big on banishing people from the kingdom, locking them out, not taking their calls, etc. Tough love is fine, but it’s often devoid of love and more punitive. I had a case recently where a women wanted to facilitate an intervention with her now-retired parents who spent their days getting pretty inebriated. The woman was self-righteous and angry: “They have all the time and money to travel and they just sit watching Fox News getting drunk!” Ultimately the parents responded with, “Yeah, we could travel, we’d rather get drunk and watch the news.” That’s not crime, but it may be hard to accept. The woman’s Al-Anon group told her to cut them off and not allow access to the grandchildren. I thought a better solution would be, “You need to be sober to be around the children.” Cutting people off because they don’t comply with demands is actually bad clinical advice. With all systems, I’d like to see more diversity of success. Improvement matters, holding people hostage if they don’t agree to total abstinence and AA is wrong. So is there an example of an intervention that’s handled well? What does that look like? A well-handled intervention can be lifesaving. The outcome may be that the family system gains insight and acceptance into the drug use of the individual. They may reach a point of acceptance that they have a member of their family who is a drug use, they may be able to set limits and boundaries that will protect them from the ripple effect of egregious drug use. Families may also learn a lot. I recently told a family that “liking to drink and fuck dudes” isn’t pathology, it’s slut shaming. An intervention shouldn’t be used to force the will of someone into another. Otherwise where does it end? “Our son is gay, we want to intervene or he will suffer eternal damnation.” There are ethical implications with the judgement of knowing better than the identified patient. Ultimately, all drug policy is successful to the degree that people will be honest about it; that is true of family systems as well. The individual may, in fact, go to treatment but that’s not the whole story. How about one that goes horribly wrong? Ever been involved with one of those? Some devolve into total shit-fights. Understandably, people get very activated at the ambush. I’ve had people take a swing at me, try to hit on me, or even offer me a drink, drugs, or clean urine. One guy accused me of having an affair with his wife, who I hadn’t met until the intervention. One patient was highly, highly intoxicated and vomited on me. I once had to take a very out-of-it doctor to Betty Ford, who was sure he was brought there to train other doctors. He was super pissed when I explained to him we were there for his alcohol abuse issues. I once had a NY commodities trader so impaired that three of his regular “girlfriends”(read: escorts) organized his intervention. They explained if he died, they lose a clean, safe, well paying customer. Bottom line is my interventions never look like the “read a letter and cry” variety. Maybe it’s me? Maybe I’m doing something wrong? Maybe the situations I get into blur the line between crisis management and traditional focused intervention? Or maybe I’m just not afraid of addiction and its insanity.
Remember: The stated goal of most rehab facilities is “total abstinence forever” and the success rate of that is low. I mean it's really, really, really, low. Of course, when it doesn’t work, the individual is to blame, often times dismissed as “not ready" or "unwilling" etc. That's part of of it, but not to the degree to which the current paradigm fails. The science of addiction and possible medical interventions has all progressed, but most rehabs still prefer to be A.A. indoctrination vessels. And if that doesn't work? The solution is usually more rehab, of course.
Sometimes what hurts the most is actually asking for help. Just let it happen, captain.
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