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New approach to addiction interventions aims to be less painful — and more effective

People who have lived through traditional confrontation-style interventions are more likely to enter addiction treatment with a chip on their shoulder.

More than 90 percent of those who have been the subject of an intervention agree to seek treatment for their addiction.

Back when Marc Hertz started making his living as an intervention specialist, helping family members convince their reluctant loved ones to enter addiction treatment programs, he often felt conflicted. On the one hand, he truly believed that he was helping people take their first steps toward sobriety. There were too many days, though, when he wondered if he was doing more harm than good.

At the time, Hertz followed a style of intervention pioneered in the 1960s by Vernon Johnson of the Johnson Institute, which Hertz said is a “total ambush.”

“You are pulled out of bed or invited to come upstairs or go somewhere for brunch after church, and when you get there everyone you love is sitting in the living room and some stranger introduces himself.”

The stranger in the room is the intervention specialist, who has been meeting and planning in secret for days or even weeks with the targeted individual’s friends and family. The approach is intended to be confrontational, catching the addicted individual by surprise and giving those who initiated the event an opportunity to detail the negative effects of his or her substance abuse on their lives.

While this ambush approach can be painful for the subject, it often has the intended effect. More than 90 percent of those who have been the subject of an intervention agree to seek treatment for their addiction, Hertz said. After leading many painful interventions, however, Hertz found that moving one addicted person into treatment isn’t all that’s needed to successfully address addiction in most families.

“During interventions I started feeling haunted,” Hertz said, “secondarily by the ambush and the trauma involved in intervention, but primarily by the fact that there was no attention given to the larger family after the intervention was over. I would pull away to take the alcoholic to treatment and the family would be standing on the stoop crying their eyes out or in the kitchen telling each other how terrible they were. They got no help, no attention, no guidance, no repair work.”

Family members aren’t the only ones traumatized by the experience, Hertz added. For instance, people who’ve been the subject of an intervention may enter addiction treatment willingly, but too many aren’t emotionally ready to focus on their recovery for days or even weeks. “With negative leverage, 99 percent of the people who’ve been intervened-on might go to treatment, but they usually go there either angry or completely shut down,” Hertz said.

In Hertz’s experience, an alcoholic who is placed in a treatment center following a traditional intervention may be, “so angry or shut down or feeling so betrayed that center staff can’t even offer a solution for their alcoholism or addiction until they process those other emotions. And that can take three weeks out of a 28-day stay.”

Bob Poznanovich, vice president of business development at Hazelden Betty Ford Foundation, said that it’s true that people who’ve lived through traditional confrontation-style interventions are more likely to come into addiction treatment with a chip on their shoulder.

“People who go to treatment from a traditional intervention will be angrier initially,” he said. But some of those emotions just come with the territory. “The reality of treatment is that most people feel controlled when they get to treatment, but most also feel grateful that someone cared enough about them to try to save them. The anger usually passes pretty quickly. It’s illogical to be angry at people who love you and want you to get help.”

Non-confrontational approach

It may be true that many people eventually find their way to forgiveness in the wake of a traditional intervention, but Hertz came to believe that anger and trauma didn’t have to be an expected part of addiction treatment. So he began to develop a trauma-aware intervention style that relied on a non-confrontational approach emphasizing honesty over ambush.

Addiction, Hertz knew, doesn’t happen organically — family systems and histories often play a role. With this understanding, and with cooperation from families that were willing to try a novel approach with their loved ones, Hertz was able to get at the roots of addiction in a way that didn’t require confrontation (with the caveat that a client’s addictive behavior wasn’t an acute risk to the health and welfare of themselves or others).

Marc Hertz

MinnPost photo by Andy Steiner
Marc Hertz: “During interventions I started feeling haunted, secondarily by the ambush and the trauma involved in intervention, but primarily by the fact that there was no attention given to the larger family after the intervention was over.”

“I realized that I could take a more measured approach,” he said. “If I could get a family to first look at boundaries and unintentional enabling, many times I could get that alcoholic to go into treatment voluntarily.” In Hertz’s new approach, family members might meet for private workshops without the targeted individual’s knowledge. In a number of cases, when family members changed their own enabling behaviors, the targeted individual often sought addiction treatment voluntarily.

“Often we could end up with the alcoholic in treatment without their ever meeting me,” Hertz said.

Hands-off intervention

A good example of this new approach, Hertz said, was a family where the father and husband — a physician in private practice — had been an alcoholic for years. His wife, who worked as a receptionist in her husband’s clinic, covered up his addictive behavior.

“He’d go out into the car and pass out and she’d tell his patients, ‘We’re going to have to reschedule. Something came up,’” Hertz said. “He’d pass out in his car when he got home from work and she would get the adult kids to help him into his bed.”

Eventually the couple’s adult children brought their mother to see him. “I said: ‘We’re going to stop enabling this behavior.’ She said: ‘We’re going to lose our practice.’ The kids said: ‘Mom, you’re losing your practice now,’” Hertz recalled. After working with Hertz and her family to understand how her own behavior was making it easy for her husband to continue his addiction, the mother agreed to stop help the father cover up.

“When he passed out at the kitchen table after dinner, instead of helping him into bed she just left him there and let him wake up at two in the morning, ashamed,” Hertz said. “There was another event like that and three days after she called me and said, ‘He talked to the priest and they are on their way to Hazelden.’”

When his wife stopped helping him avoid the consequences of his addiction, the man realized its true impact on his life and the lives of others. He chose to enter treatment on his own, Hertz said, because his family members backed away and let him see the truth for himself.

Hertz hadn’t met this client in person, but a few weeks later he happened to be at Hazelden giving a talk when the two crossed paths. “This guy in a yellow sweater came up to me and told me his story,” Hertz recalled. “I asked, ‘What do you do?’ He said, ‘I’m a physician.’ It was him. He had no idea he’d been intervened on. He thought he’d made the decision to go into treatment all by himself — and in fact he did.”

Voice and Choice

A series of like experiences convinced Hertz of the power of practicing a more collaborative style of intervention. He got his start in Minnesota working for a California-based intervention company, and about six years ago he stepped away to found Family Recovery Resource Experts (FRre), a St. Paul-based organization that helps families reach sobriety through workshops, interventions and counseling. His staff includes a full-time licensed marriage and family therapist, a family services coordinator and two behavioral health consultants.

At FRre, Hertz and his colleagues offer a family systems-informed approach to intervention that he calls “voice and choice.” This methodology takes the attention off the intervention target and spreads it around to other family members, who must accept that their own behaviors play a role in their loved one’s addiction.

“Instead of focusing all of our attention on the alcoholic, we focus on all the relationships in the system,” Hertz said. “All of the elephants get marched into the room including alcohol. When that happens, people usually end up going to treatment without the ambush.”

Bob Poznanovich

Bob Poznanovich

Poznanovich likes the idea of a whole-family approach to recovery. Over the course of his career he has found that patients who come into treatment of their own free will, committed to their recovery with the support of their loved ones, have a higher odds of long-term success.

“With addiction, the entire family system gets sick,” Poznanovich said. “We make deals that we can’t keep and that only makes the situation worse. It makes the family worse because when they can’t keep their promises they start hiding and sneaking and controlling and lying.” When entire families are willing to deconstruct their behaviors and commit to making long-term change, positive results can happen.

Earlier this summer, staff at FRre conducted a two-day workshop with a family that was focused on helping a loved one get treatment for his alcoholism. The intervention target knew his drinking was what had prompted the workshop, and his family members — his wife, his parents, her parents, his sister  — were willing to examine how their own behaviors contributed to the problem.

At the workshop’s end, Hertz asked, “What is everybody willing to commit to going forward?”

“The mom and dad committed to doing couple’s counseling,” Hertz recalled. “His mom committed to going to a place in Tennessee to do a six-day workshop on codependency. Everybody in the family made commitments to doing things to move forward and fix the system.”

While the initially targeted individual committed to stop drinking, he hadn’t yet committed to enter treatment. “He probably will go into treatment in the future,” Hertz said.

When ambush is the only option

Even Hertz agrees that there are times when taking a more measured, trauma-aware approach to intervention doesn’t make sense. When a client is putting their own life or the lives of others in danger, for example, there is no time for subtlety.

“I just did a traditional intervention with a family,” Hertz said. “This guy was a meth addict and a alcoholic and a daily pot smoker. He was 5’11” and 120 lbs. We did not have an opportunity to slow it down and take a more collaborative approach. We did a traditional intervention on this guy. It was overwhelming to him. He sat with his head in his hands the whole time with snot coming out of his nose stifling tears.”

Though he says he “hates” the negative impact of these military-style operations, Hertz understands that there are times when it is the only option: “If it’s apparent that the trauma that’s going on in the house outweighs the trauma that we would cause in a traditional intervention, then we elevate to traditional intervention.”

A gear switch has even happened in the middle of an intervention he expected to be more trauma aware: “If we discover that someone is driving drunk with the kids, if we discover that there is a guy emotionally abusing his 16-year-old son, if we find out there is violence in the home, we may switch gears.”

That’s the nature of the business, Poznanovich said. In an ideal situation, a family is able to talk openly about the impact of their addicted loved one’s substance use, but often the addiction’s grip is far too firm for that approach.

“If the patent is willing to meet and have a conversation and be a part of the process, to come and talk with the family, it is fine, great even,” Paznanovich said. “But if a patient is too sick from a mental health perspective, or they are suicidal, they need a method that is more urgent.

“I once had family call me and say that they needed an immediate intervention because their brother was a surgeon and he was scheduled to operate on someone [the next] morning and he was high. They needed someone who could come there within an hour and intervene before he could hurt his patient. Classic intervention was the only option in that case.”

In other situations, waiting for a measured, indirect approach to take root in a family system can cause more harm than good, Paznanovich added: “Letting people struggle and letting them figure it out on their own and not offering help is more cruel than surprising them. Letting an alcoholic hit bottom is cruel. Saying that someone has to get worse before they get better doesn’t make sense. Today can be the day that you can recover. If someone has the courage to say, ‘This is what I’ve seen. This is what I’ll do to support you. This is how I won’t enable you anymore.’ If you can do that, a person can have the strength it takes to recover.”

That said, Poznanovich believes that an approach like the one practiced at FR can help the recovery process happen without re-traumatization.  “At Hazelden we know of interventionists like Marc that have done good work with their patients and their families. Their patients do well in treatment. They aren’t traumatized when they come in if the family is well educated.”

That’s the kind of response that Hertz likes to hear. He wants to deliver his people to treatment centers who are at peace and on board with the recovery process and committed to focusing on their long-term sobriety. Unexamined emotional baggage just weighs them down.

“The feedback we get from providers is, ‘This is an intervention? They came in with both feet in the boat,’” he said. “They’re not angry. They want to solve their problem. That’s our goal.”