Elements of intervention

With this in mind let's consider the hallmark features of the acute and complex intervention client. Intervention clients, by the very nature of the fact that they are typically at imminent risk of hurting themselves or others, are earmarked as clinically complex. Simply put, they would not be intervention clients if they were at any earlier stage of their illness. They have slipped through many cracks and have artfully evaded all outreach efforts from the people who care about them. Without a well-orchestrated professional rescue plan their outcomes are often grim and the people who are in their sphere of influence remain at risk.

Untreated, these individuals, many of whom come from families with addiction histories, cannot help but influence the next generation (their children) by grooming them to become the next wave of addicts or adult children of addicts. Each such designation carries with it medical, psychological, behavioral and spiritual burdens. Furthermore, the entire family system becomes toxic, and without treatment or good counsel they cannot help passing along to the next generation the collateral damage of untreated co-dependence, enmeshment, poor boundaries and unhealthy communication practices.

A great majority of intervention clients are dually diagnosed. They have addiction issues compounded by features of or actual diagnosed mental illness. Their early developmental histories often include elements of neglect, trauma, grief and loss. The scope of their derailment can be evidenced by significant drama in nearly every area of their lives. Most untreated addicts come with legal complications, damaged interpersonal relationships, financial wreckage, employment trouble, and family unhappiness and chaos. In spite of the real, indisputable evidence before them they will vehemently and self-righteously defend their disease and deny its power over them. They often cannot empathetically connect to the ripple effect their behavior has on their families, friends and society. Even the threat of irreversible medical problems, incarceration, divorce, death and banishment from work and family might not be enough to engage an addict in a solution-oriented recovery plan.

Intervention, on any level, moves dysfunctional people and their families from illness to wellness. It is a change-oriented process that serves to free the trapped individuals and their families held hostage by this dark force. It is a strategy that empowers families to save their own and it reconnects them with the fact that they too are worthy of being saved and are entitled to live healthy, happy lives. The message of love, hope and help to the addict is delivered in one voice via a powerful, loving, well-orchestrated family meeting. Once the intervention process is initiated, nothing remains the same. It is a game changer for the entire family system.

While trained interventionists ultimately adopt their own styles and practice divergent methodologies, most would agree that comprehensive intervention strategies include elements of:

• An initial phone triage assessment followed by a more comprehensive dialogue that serves to educate and inform families about the process of intervention and the nature of the disease;

• Collection of collateral assessment information;

• Suggestions for appropriate treatment referrals for both the addict and the family;

• Establishment of date, times, travel plans;

• Pre-intervention/rehearsal training;

• The intervention;

• The transport;

• Case management through completion of treatment; and

• Ongoing case management and monitoring through the first year of recovery and in many cases beyond.

In order to best serve intervention clients and their families, every element of this process must be executed or we run the risk of underserving this population, which could lead to recidivism, ongoing family trauma and tragic outcomes.

Professional status

There are approximately 200 Board Registered Interventionists that are members of the Association of Intervention Specialists (AIS). In order to receive the BRI distinction an individual must minimally possess specified training, certifications in addiction and/or advanced education. There is a mentoring/supervision period and biannual meetings that are designed to bring this group together and provide them with educational programming and social/professional supports. The individuals who are members are a committed group who want to serve this population with absolute professionalism. They have voluntarily jumped through the necessary hoops to be part of the effort to elevate quality.

Yet there are hundreds more who are practicing intervention with no training, ethical accountability or supervisory support, which has created a “wild, wild west” culture within the field of intervention. Additionally, the lure of money entices droves of individuals influenced by reality TV shows, among other things, to throw their hat into the ring. Many believe their sobriety and good intentions alone qualify them to deal with the most problematic and reactive group of people within the addiction field. This puts vulnerable families at great risk, and that is simply unacceptable.

For years we have railed about the recidivism of the disease and poor outcome statistics. It is time we looked to ourselves as individuals and institutions and honestly asked, “What is our part in this equation? Are we truly the best we can be?”

Certainly, in terms of the intervention world we need to continue all efforts to raise the bar for interventionists currently in the field as well as individuals wishing to enter the field. Organizations such as AIS and the International Interventionists Credentialing Board (IICB) have made great strides to create structure, accountability, camaraderie and support for interventionists. AIS is the only credible membership-driven organization currently available to intervention specialists; it has worked hard to create a professional standard and a code of ethics for interventionists.

One suggested way of addressing the “wild, wild west” of untrained and unsupervised interventionists would be to refer only to a BRI. Further, based on the clinical complexities of a case that would include significant mental health disorders, eating disorders and other process addictions compounded by chemical addictions, a referent might want to consider using an interventionist who has a clinical license or is a master's- or PhD-level clinician also trained in intervention.

The reality is until interventionists are required to become nationally and internationally certified or licensed, not just Board Registered, we will have no way of standardizing and holding the intervention field to the highest practice standards. Until then, we rely on the good-faith efforts of those paraprofessionals wanting to be counted as credible intervention specialists.

The field evolves

The intervention field is in a growth spurt in terms of defining itself. In order to stabilize the current culture of intervention and ensure its responsible growth going forward, there is much to be done in terms of training and education, organizational development and political and professional outreach. This industry must raise the level of sophistication of our credentialing and mentoring processes, must model itself after other credentialed and licensed specialties, and must continue to lobby in Washington for essential healthcare reform. Ultimately, the solution will lie in diverse, accessible clinical and method-based curricula, both traditional and online, that produce licensed intervention specialists.

The obvious net benefit to an individual who chooses to pursue any educational endeavor is increased competency, relevance and viability. The field of intervention is one of the fastest-growing subspecialties within the addiction and counseling fields. If we are to serve this most complex population we had better be competent. We must not only maintain current skill sets within our own areas of interest but also endeavor to expand our awareness to include other relevant clinical areas. By investing our time in our own education we ensure our professional relevance in this dynamic field. In these turbulent times, continuing education can only additionally serve to increase one's viability in the workplace.

Each of us, in our own way, runs the risk of becoming complacent in our lives and our work. Without knowing it, we can drift into the procedure of our work and slowly lose our connection to the joy, creativity and passion of our craft. To buy into the belief that we know enough or have done enough is substandard thinking. It is our responsibility to make sure we stay enthusiastic and engaged, not only with our clients but with our peers and most importantly ourselves. We must adopt the mindset that nothing less than exceeding our own expectations will do.

A concerted effort to fuel ourselves with new ideas is paramount to our professional and personal development. After all, passion creates dialogue. Dialogue creates ideas. Ideas create change. Change affects outcomes and restores hope. Hope can inspire and heal future generations.

The decision to commit to growth through education and training will undoubtedly invigorate not only us as professionals but the industry as a whole. The upside of holding ourselves to these higher standards is that the trickle-down effect to the people we serve is positively immeasurable. The flip side of that coin is that if we do not commit to improving ourselves and we choose complacency and the status quo over being proactive, we become antiquated, ineffective and possibly dangerous to the people who trust in us to guide them through the worst times of their lives. Upgrading ourselves educationally should be treated as reverently as our commitment to our individual spiritual care and development.

With this in mind, I would like to suggest that one way to begin this evolution might be by learning about intervention or actually adopting an intervention skill set. It is a crisis methodology that not only saves lives but also is guaranteed to increase your personal and professional firepower for 2010 and beyond.