Intervention: Halting the Progress of Chemical Dependency

 

elements of addictionChemical dependency is a disease. You have probably heard this said before, but may still have a hard time understanding that a person who abuses alcohol or other drugs is a victim of an illness. He or she does not abuse or misuse drugs deliberately. When you understand that this dependency is a sickness, hopefully some of the frustration and resentment you feel will subside.

Just as you do not blame someone for catching the flu, you cannot blame a chemically dependent person for being chemically dependent. If this seems hard to accept, you are not alone. There are still some doctors who do not accept it. However, it was in 1956 that the American Medical Association recognized alcoholism as a disease. Before that time, most doctors and psychiatrists believed it was the result of some psychological disorder.

According to Vernon E. Johnson, D.D., of the Johnson Institute, "Nobody is too young to develop a harmful and eventually fatal dependency on alcohol or drugs. And nobody is too old to recover."


What We Know About The Disease

1. The disease can be described.
Chemical dependency can be diagnosed. A list of distinct symptoms is available. One of the main symptoms is the compulsion to drink (smoke marijuana, mainline heroin, etc.). The compulsion is inappropriate, unpredictable, excessive, and constant. The dependent person may deny the compulsion, saying that he decides whether or not to drink. He doesn't have to drink. But, as you have probably noticed, he always eventually decides to drink.

2. The disease is primary.
Chemical dependency is the cause of emotional and physical problems, or aggravates those that already exist. Alcohol is involved in 25 to 50% of admissions to hospitals. Problems such as gastritis, cirrhosis of the liver, impotence, mental deterioration, and alcohol-related heart disease will continue to worsen as long as the person keeps drinking. Of course, social and family problems will also continue to worsen.

3. The disease is progressive.
Chemical dependency runs a predictable course. However, it is also progressive. It will always get worse, never better, if left untreated. It effects the person physically, mentally, emotionally, and spiritually.

4. The disease is chronic.
Chemical dependence lasts forever. This is a disease that never truly goes away. It can be arrested, and dependent people can go on to live healthy, happy lives-- as long as they do not return to drinking or using drugs. The chemically dependent person must abstain from all mood-altering drugs. One slip could return the person to the active stages of the disease. There is a saying among members of Alcoholics Anonymous (A.A.) that "the best day drinking is not as good as the hardest day sober."

5. The disease is fatal.
If a chemically dependent person continues to drink or use drugs, he will eventually die prematurely. If not stopped, the disease of chemical dependency is 100% fatal. The cause of the premature death may be physical (heart disease, liver failure), accidental (car crashes, work accidents), or emotional (depression-related suicide).

6. The disease is treatable.
Although the disease is primary, progressive, chronic, and fatal, it is also treatable. The proof is in the millions of people who are recovering. According to the Johnson Institute, seven or eight out of every ten who go into treatment emerge successful. Chemically dependent people are always recovering, never recovered. Because the disease is incurable, recovery is a lifelong process.

How to Tell if Someone is Chemically Dependent
All kinds of people become chemically dependent. While some suggest the disease is hereditary, others claim it is related to a specific personality type. However, there are millions of alcoholics who do not fit into any particular profile.

Chemical dependency is not the result of a lack of willpower or a weak character. It is not a mental illness, nor is it the result of an unhappy marriage or peer pressure. If someone you care about is alcoholic or drug dependent, it is not your fault or theirs.

The chemically dependent person is almost always the last to admit she has a problem. It may be up to you to observe the signs and make a conclusion. The following test, written by Dr. Johnson, will help you find out if your suspicions are correct. Answer each question "yes" or "no."

1. Is the person drinking (or using any drug) more now than in the past?

2. Are you afraid to be around the person when he is using alcohol or drugs?

3. Has the person ever forgotten or denied things that happened when he was drinking or using drugs?

4. Do you worry about the person's drinking or drug use?

5. Does the person refuse to discuss his drinking or drug use?

6. Has the person broken promises to control or stop the drinking or drug use?

7. Has the person ever lied to you about his drinking or drug use?

8. Have you ever been embarrassed by it?

9. Have you ever made excuses for him?

10. Are holidays and parties unpleasant because of the person's drinking or drug use?

11. Have you ever helped the person "cover up" by calling his employer, or telling others that the person is "sick?"

12. Does the person deny that he has a drinking problem because he only drinks beer? Or deny that he has a drug problem because use is "limited" to marijuana?

13. Does the person's behavior change noticeably when he is drinking or using?

14. Does the person avoid social functions where alcohol or drugs will not be available or permitted?

15. Has the person ever driven a car while intoxicated or under the influence of drugs?

16. Has the person ever received a DWI or DUI?

17. Has anyone else ever talked to you about the person's drinking or using behavior?

18. Have you ever found alcohol or drugs that the person has hidden?

19. Is the person having financial difficulties related to his drinking or drug use?

20. Does the person look forward to times when he can drink or use drugs?

If you answered "yes" to any two of the above questions, there is a good chance the person has a drinking or drug problem. If you answered "yes" to five or more, you can safely assume the person has a definite problem. The following definition of chemical dependency may be helpful to you:

If the use of alcohol or other drugs is causing any continuing disruption in an individual's personal, social, spiritual or economic life, and the individual does not stop using, he or she is chemically dependent.

The chemically dependent person will continue using the drug no matter what. He is essentially saying, "My family, friends, and job are not as important to me as drinking or using drugs." This refusal to stop clearly signals a harmful dependency.

The Delusional System of Chemical Dependency
The chemically dependent person will find ways to rationalize their problem or project it onto others. Projection allows them to place the blame elsewhere. In the later stages of the disease, blackouts, repression, and euphoric recall actually destroy the person's ability to remember what happened during a drinking or using episode. They have now developed a faulty memory, or delusional system.

Blackouts
Have you ever gone somewhere, seen people, made phone calls, driven and parked your car, and later couldn't remember any of it? The chemically dependent person will understand that these blackout episodes are a result of her drinking or using, but instead of getting help will learn ways to cover it up. According to Dr. Johnson, "the willingness to tolerate repeated blackouts as a normal part of life rarely if ever occurs in the absence of chemical dependency."

A blackout is a chemically induced period of amnesia. Alcoholics have driven cars, flown airplanes, performed surgery and argued court cases while experiencing blackouts. Victims cannot account for large periods of time. One alcoholic described it this way: "I thought I was going crazy. So every time this happened to me, I'd force myself to forget it." Another recalled, "I used to think that everyone drew a blank once in a while, when he had drunk too much."

Repression
Repression is psychologically induced, unlike blackouts, which are chemically induced. Repression is the ability to "forget" shameful or unwanted memories. It pushes the dependent person deeper into the disease. For example, he may instinctively close off bad memories of the previous evening. He lets his mind go off in a new, more pleasant direction. In this way, the husband who has made a terrible scene at a party last night can greet his furious wife the next morning with a truly innocent, "Is something bothering you?"

Euphoric Recall
Euphoric recall makes it possible for chemically dependent people to think that when they are "under the influence" they are capable of doing everything they can do when they are sober. This explains the classic example of the person who is clearly intoxicated but is completely confident of his ability to drive home safely. The next morning, she will remember how she felt, but not how she behaved. She won't remember that while she was insisting she could drive, she was also staggering and slurring her words.


How You Become Part of the Delusional System A person who is in a relationship with a victim of chemical dependency will feel forced into several different roles. See if any of the following seem familiar to you.


The Protector
During the initial stages of the disease you become the defender, or protector. You make apologies to family and friends for the victim. You make excuses to his boss for his absences and tardiness. Your self-image is dropping as you receive more and more accusations from him. Although he is dumping his self-hatred off on you, it leads you to wonder whether you are the cause of his problem. You think things like "If I change somehow, this will all go away."

The Controller
As her drinking or drug abuse continues, you feel increasingly responsible for her behavior. You begin drinking or doing drugs with her hoping to help her to cut back. You try to buy the alcohol or drug for her, hoping to limit the supply. You pour liquor down the sink or hide extra quantities. You think that you are the cause of her problem. You believe you won't be able to feel good about yourself until she does something about her drinking or using. It seems the more you try to control her intake the more she consumes.

The Blamer
You start trying to project your own feelings of failure onto other people-- usually the chemically dependent person. You find yourself saying things like, "If you wouldn't drink so much, I wouldn't be such a nag," and "If you don't stop drinking, this relationship is over." You are having uncontrollable mood swings and feel bewildered and scared.

The Loner
You notice family and friends feel uncomfortable with you because you are always on the defensive. You don't know who you can talk to or what to do and are beginning to feel as if you are alone in the world.

The Co-Dependent
You are out of touch with reality, just like the chemically dependent person you care about. You are becoming even more controlling and blaming. You are trying to hide the truth from him and yourself. You are now also suffering from the disease which is progressive, chronic, and even fatal.

The Intervener
This is the one positive role available to you. If you take on this role you will reverse the direction you are headed in and make a start toward recovery. You will help the chemically dependent person come back to reality.

The more you are able to learn about the disease, the more successful you will be. You must realize that you are not responsible for what is happening to the chemically dependent person. Then you will be free to choose the useful and effective response to the problem--intervention.


Preparing for the Intervention

The longer you wait, the longer the person you love will suffer. It is very rare for the chemically dependent person to admit he has a problem and decide to get treatment on his own. This usually only happens when a person "hits bottom" so hard that there is no other option. Sometimes so many crises happen at once that a person will practically run for treatment. But, people who reach this point are some of the sickest. Obviously, early intervention is best.


Gathering the Intervention Team

Make a list of all the people who are important to the victim of chemically dependency and have a strong influence on her. If the person is married and you are not the spouse, then the spouse should be invited. It is also very helpful to have the victim's employer or supervisor join the team. You should also try to involve her parents, siblings, and children. It is best if the children are at least eight-years-old. Consider inviting a close friend, neighbor, co-worker, or member of the clergy. According to the Johnson Institute, groups of three to five are best.

The team members must understand chemical dependency. They must be willing to "risk" their relationship with the victim. If a potential team member feels that addiction is a sign of weakness or a simple lack of willpower he will not be a good addition to the team.

You will have to expect some hesitancy from team members. Some may be afraid of how the person will react. Your simple argument is: If they do nothing, the chemically dependent person will die prematurely.


Gathering the Information

Every team member must make a list of incidents related to the person's drinking or drug use that prove there is reason for concern. The lists should be written in second person, because they will be read aloud to the person during the intervention. Each item on the list should specifically describe a certain incident. For example:

  • When I came home last week the kids were outside by themselves. You were passed out on the couch with beer bottles on the floor. The kids were hungry and scared.
  • You forgot where your car was twice last month after you had been out drinking.
  • When you picked me up from school two weeks ago you drove really fast and I was scared. I couldn't understand what you were saying because you weren't making any sense.


You will also need to find out about treatment options. Check the White Pages of your phone book for the following:

  • Alcoholics Anonymous
  • Division on Alcoholism, Public Health Department
  • (Your city or county) Committee on Alcoholism


In the Yellow Pages, look under "Alcoholism Information and Treatment Centers," "Family Service Organizations," and "Mental Health Clinics." Once you have found several possibilities, research some more. Ask for brochures and program descriptions. Find out if they provide aftercare, and what percentage of their patients are still recovering. You will need to have at least one acceptable treatment option. You cannot do the intervention until you do.

Rehearsing the Intervention
You should have at least one "rehearsal" prior to doing the intervention. Rehearsals will help the team members learn that other people have been affected by the chemically dependent person in similar ways. It will increase support and understanding among the members. It will also lessen the chances that someone will say something unclear or something they do not want to say.

Step One: Choose a chairperson.
You should all agree on one person to be in charge of the rehearsals and the intervention itself. The victim's boss is usually the best choice. A spouse or child is not usually a good choice. The pain they have suffered is likely to make them too emotional to handle this role well. The chairperson is responsible for keeping the intervention organized and effective.

Step Two: Go over all the lists the team members have prepared.
Reviewing the lists is very important. It gives everyone a chance to figure out exactly what they want to say. It also breaks the "rule of silence." It may be hard for the team members to accept that it is OK to talk about the person's drinking and behavior. They may be hesitant to speak out because of "loyalty" to the person. They need to learn that their silence only supports their friend's sickness. Determine the order in which the lists will be read in advance so that there are no awkward pauses in the intervention.

Step Three: Prepare to respond to the chemically dependent person.
Chances are good the victim will not just sit quietly and listen. Your responses must be realistic and firm. For instance, is the spouse prepared to take the kids and move out if the person refuses to get help? If not, then this should not be said. No one should give an ultimatum unless they are committed to follow through with it. If the victim tries to leave, someone should be prepared to say, "Please sit down and listen to the rest of what we have to say." If the victim starts crying and promises never to drink again, the team members should be ready to say that he needs help or treatment in order to be able to keep that promise.

Should You Get the Help of a Professional?
It is probably not necessary, but certainly not a bad idea to get the assistance of a Certified Addictions Counselor. Interview the counselor to find out if she recognizes chemical dependency as a disease and supports the intervention process. You should also find out if he has experience with interventions.

The counselor will also be an ideal person to take on the chairperson role. Two or three intervention rehearsals with the counselor are helpful, but according to the Johnson Institute, "there is seldom a need to undergo several months of counseling or preparation prior to the intervention." The counselor should agree with you about the urgency of stopping the progression of the disease as soon as possible.

There are situations in which you should not attempt to do an intervention. You must get professional help if any of the following circumstances apply:

  • The chemically dependent person is mentally ill.
  • His behavior has been violent or abusive.
  • He has been depressed for a period of time.


In addition, while it is generally easy to recognize signs of drinking, you may not be able to notice the presence of other drugs. Some drugs can produce psychotic states in the user. If you are not positive that the victim is chemically free at the time of the intervention, wait and seek professional help before trying again.


Doing the Intervention

The intervention should be conducted according to what Dr. Johnson has called the Five Principles of Intervention:

1. Important people in the life of the victim are involved.

2. These people must write down specific information about incidents involving the person's drinking or drug use which give legitimacy to their concerns.

3. They tell the victim how they feel about what has been happening in their lives in a nonjudgmental way.

4. The victim is offered specific choices (attend Alcoholics Anonymous, enter a treatment center, or be admitted to a hospital).

5. When the victim agrees to accept help, it is made available immediately.

If the victim refuses to accept help and promises to quit on his own, then your team will have to present the question of "What-If." Ask, "What if you start drinking again? What if you take one more drink?" The victim should agree that if this happens, he will accept help. And then, make him keep that promise.

According to Dr. Johnson, if you follow this plan, the chances of success are eight in ten. He says, "In my personal experience, I have expected it to work every time -- and it has."

If the person goes to an in-patient treatment program, he should still be committed to attending weekly A.A. meetings when he gets out. Spouses will go to Al-Anon, and teenagers to Ala-teen.

What if the Intervention Doesn't Work?
If the victim walks out of the intervention, continues drinking or using, and never gets treatment, has the intervention been a failure? Dr Johnson has stated, "No, it has not. Properly done, intervention works every time. Properly done, there are no failures." Here is why:

  • The team members who do the intervening are changed forever. They know they are not alone. They know there are others who understand and can provide help and support to each other.
  • The family of the victim is no longer the paralyzed, fearful, guilt-ridden group they were before. They understand chemical dependency and see that the victim's sickness is not their fault. They are able to get help for themselves.
  • The victim is changed, even if he will not accept help at this time. The intervention experience is one he will not be able to forget.


Attempting an intervention cannot make things worse. At least it gives the victim a chance at recovery that did not exist before, and starts his family and friends in a new and positive direction.

Family members must get help for themselves. They need to learn that they are each responsible for their own behavior, feelings, and recovery. Many people who are raised in homes with chemically dependent family members have not been able to fully experience a range of feelings. Dr. Johnson says, "Recovering the rich and rewarding feeling of life that is part and parcel of the healthy family system may take time to accomplish. But whatever time it takes, it is worth the effort." If the chemically dependent person continues to resist your efforts to help, don't allow this to inhibit your own recovery. Seeing you and the rest of the family healthy and happy will make his drinking or drug use even more uncomfortable. He will feel left out because the life of the family will no longer revolve around him and his problem. This, and your continued efforts to help him, may eventually break down his resistance and result in a willingness to accept the treatment he needs.

We and readers would like to hear about your success with intervening with substance abuse and chemical dependence. What did you find that worked for you?

References
Johnson, Vernon E., D.D. (1986). Intervention. Minneapolis, Minnesota: Johnson Institute Books.



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Comments

bonobos marcos
12/23/2014 12:38pm
I agree with the idea that just like you can't blame someone with the flu, you can't blame someone with a chemical dependency. At least, to a degree, Someone also does have a choice to first try or to return to a substance. I am glad that there are programs to help these people return to normal.
01/13/2017 11:44am
This is a good point. Perhaps what is key here is at the point when someone becomes chemically dependent. People can choose to use substances, but at the point they become dependent, they begin to lose control–or the ability to choose. Understanding this point may not necessarily change what someone needs to do to recover, but it does help those affected (family and friends watching someone struggle with addiction) shape perspective so they can be more supportive and, perhaps, less judgmental and hurt.
01/11/2017 8:51am
I really appreciate how you mention that chemical dependency is not the result of a lack of willpower or a weak character. My sister has struggled with chemical dependency since high school when she fell into the wrong crowd of people. She really is a great person when she's not using, but she could be so much better, so I think it's time to intervene and get her some help.

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