When Vernon Johnson wrote I’ll Quit Tomorrow in 1973, and Intervention: How to Help Someone Who Doesn’t Want Help in 1986, his radical ideas were met with resistance from many groups. One such group included advocates of the peer-topeer recovery method, which was based on the belief that only after hitting bottom could one decide to escape their substance misuse (and possible death). The Johnson Model works around the idea that one needs to “raise the bottom” by getting those who are misusing substances to agree to go to treatment, or to be treated before they hit rock bottom on their own. Hitting one’s lowest point in terms of their substance abuse or misuse is often dangerous, and can be life-threatening. By “raising the bottom”, countless lives can be saved, and precious time can be gained and consequently, put towards recovery.
This idea of “raising the bottom,” was truly improved upon by Dr. Judith Landau with her introduction of the family systems more invitational model of intervention. Her “ARISE” method is described as “a collaborative, non-confrontational approach to guiding addicts into recovery. Broadly speaking, the researched and known models of intervention are distinguished by their traits, goals, timeframes, and how invitational the approach is.
The Johnson Model is built upon 7 components:
1. Team Effort – This “team” is a support system brought together by an interventionist that can include family, close friends, loved ones, colleagues, as well as anyone else important in the addict’s life.
2. Planning – The “team” decides on when and where the intervention will be held, and what is going to be addressed and said in their letters.
3. Care-Centered – This is vital to the success of the intervention. There should never be yelling, blaming or threatening of the addict. Everything should be coming from a place of care and concern.
4. Focus – During the process, it is important to stay on topic. The only thing being addressed should be the addiction. This is not a time for unpacking harbored grudges from 10 years ago.
5. Evidence – There should be presentable evidence in the letters, details of past events that prove the impact of the addict’s substance abuse.
6. Goal-Oriented – The team should work together as a team to achieve the goal of getting the addict to accept treatment. This should never be discussed as though it is a punishment or “last straw”. It should be explained as a way to save or vastly improve the addict’s life.
7. Treatment – Ideally, at the conclusion of the intervention, the loved one in need of treatment will accept to seek out help. For this to happen, the team should put together a list of treatment options.
In some versions of the Johnson Model, which is perhaps more widely known thanks to its popular portrayals on television and in movies- letter reading and “bottom lines” are included. It is important to note that many practitioners of the Johnson Model have evolved in their practices, and now include many of the ideas that are found in all models of intervention. In fact, many top interventionists report having had multiple trainings in competing models, and borrowing from them when creating their own practices. The “ambush” or “surprise” approach, versus the “invitational” approach is one of the biggest differentiators in intervention.
The idea of an “invitational” method showing success may surprise and seem counterintuitive to families and corporations that have been adamant (and unsuccessful) in their attempts to cajole, threaten, and manipulate people into recovery. However, upon first meeting, well-trained practitioners average an 83% success rate when following ethical models. This percentage can be expected to increase to over 90% with entry to higher level care. Needless to say, the top leaders in this field are very successful in their methods.
The “Systemic” model, originated by Ed Speare and Wayne Raiter, is often used in three day corporate retreat models. According to some research, the CRAFT model, which is often used in therapists’ office practices, takes an average of 6 months to achieve goals and behavioral changes.
John Southworth once jokingly described interventionists to me as “sometimes presenting as a mixture of an exorcism and a bouncer.” The challenges today in many ways remain the same:
• How can we convince families, governments, and corporations to remove the stigmas?
• How can we get them to save lives by quickly and openly addressing behavioral health and substance misuse with compassion?
• How can we move away from shame about mental health, trauma, family, and systemic secrets?
• How can we move towards simultaneously helping each other improve the lives around us, and society as a whole?
The misunderstanding of substance misuse is often accompanied by deep hurt and confusion. Family and loved ones will ask, “How could they lie to me?”, “How could they throw everything away?”. The broad range and different challenges of substance misuse aren’t unlike those of gambling, food, and sexual disorders, in that they are all (in their own way), baffling, infuriating, and in the end bring us to despair. We cannot underestimate the power of the “second hand trauma” of being in relationships of any kind with someone struggling. Jeff and Debra Jay’s best seller “Love First” outlined the importance in recognizing that as an alcoholic descends to their “bottom”, they take their loved ones with them.
Many of the best interventionists will attest that healing the support system is as important or perhaps more important as changing the behaviors of the struggling person. This can often be confusing at first to the families that hire them. However, self- care encourages everyone affected to begin their own recovery, and all major research points to the long-term improvement of outcomes when the family or support system forms a unified front to change, heal, and learn compassionate and consistent boundaries.
Today, more and more legal challenges and consequences are common. Practitioners are experiencing truly complex family systems as the norm, with high divorce rates, and over 50% of families involving step-parents and siblings. Years ago, when I was creating my genogram for the family I was helping, I was informed that the 19-year-old in many ways felt closest to his first step-mother who had raised him from when he was 3 until he was 12. He was currently living in the basement of the home where his father and his father’s third wife were living. These realities bring in aspects of learning and determining who has the real “love leverage” when you are building the support system team for this person. Genograms, family history and timelines are of incredible value when working with family systems, especially when connecting to resilience and hoping to inspire change.
References Provided Upon Request
Brian O’Shea is a noted interventionist and sober coach. He cofounded Caring Interventions, LLC in 2010. He is well respected and trusted among the recovery and addiction treatment community, having facilitated successful interventions and managed cases in 20 states. He serves as Brand Ambassador for ZenCharts, an intelligent electronic health record system (EHR) built by clinicians for clinicians. As Brand Ambassador, O’Shea works to engage with fellow clinicians in the industry to help enhance and optimize the ZenChart technology to continually meet the needs of users.