Patients who are severely dependent and unwilling or unable to see the severity of their addiction need a crisis intervention. Crisis intervention is a confrontation by a group of concerned family and friends.  This confrontation must be loving,  gentle,  and supportive;  and it is best to use a trained interventionist to help you develop the intervention strategy. 

If you want to do the intervention yourself, first read the book Love First by Jeff and Debra Jay (Hazelden, 800-328-9000). This is an excellent text that carefully discusses the intervention techniques. Basically, an intervention has to be carefully organized, rehearsed, and choreographed. Each member of the group should be a loving, caring significant other and not an alcohol abuser. Each person writes a letter stating exactly how the patient’s alcoholism has negatively affected his or her life (see Figure 1.1). In this letter, group members share their love and concern for the patient and ask that the patient enter treatment. The patient is told it is not he or she who is the problem but the illness. It is a lethal problem and it needs treatment.

Each person reads his or her letter of concern and love for the patient and asks the patient to go into treatment that day.

Figure 1.1   Example of an intervention letter.

Bob, you are my closest friend, and I can’t tell you how much your
friendship has meant to me. We have grown up together. Our kids love to
play ball together, and you and I enjoy being the vocal coaches on the
sideline. There is no one in my life who has had a more positive effect on
my life and successful business than you. Thank you for all of the years
you have stood by me. When I made mistakes, you were always there to
comfort me and give me good advice like a brother. Now comes the hard
part of this letter, and I might not handle this very well, so bear with me.
Lately, I have been concerned with your drinking. I see you driving the
car with the children after you have had too much to drink. In fact, after
the Halloween party on Saturday, you were so drunk you could hardly
walk, yet you insisted on driving your wife and your children home. We all
tried to stop you, but you wouldn’t listen to anyone. Bob, alcoholism is a
disease, just like the alcoholism that killed your father. It’s genetic and
life threatening. I am here to ask you to get the treatment that you need to
get well. It hurts me too much to see you suffer. You and I know you can’t
drink in a healthy way anymore. These problems have happened too
much. My own kids don’t want to go to your house anymore, and I avoid
you myself. This hurts me too much for it to go on. Please help yourself
and your family and get the help you need. The counselor has set up
treatment for you today at—Treatment Center, and we would
all be incredibly proud of you if you would go for help. I love you very
much, brother. Please do this for all of the people who love you.
Love, Fred

The treatment setting has been arranged, and the patient’s bags are packed. The intervention should be held at a neutral location when the patient is sober, not in the patient’s home or office where the patient may feel more comfortable. It is difficult for the wall of denial to hold up under all of this love, and most of the time the patient agrees to go into treatment. If the patient refuses, the truth has still come out, which often leads to treatment at a later time. Each participant is encouraged to exhibit the following behaviors:

•  Show positive regard for the patient and negative regard for the drinking.
•  Give specific situations where the drinking negatively affected them.
•  Validate that alcoholism is a disease and not the patient’s fault.

Save the best letter for last. This is someone very tender and special to the patient.  It might be the patient’s child,  a friend,  or family member.

It’s someone whose letter breaks your heart. It is very difficult for denial to work in this tremendous atmosphere of love and truth. Most patients agree and go to treatment.  Remember that no intervention is a failure.

Even if the patient refuses to get treatment, the truth came out, and that’s always a victory.

Interventions and treatment are going to take time. If you are a primary care physician,  emergency room doctor,  cardiologist,  or surgeon,  you might not have the time to struggle with this problem. All addiction treatment is a long journey toward the truth,  and this journey is slow and painful. Patients have to face the demons they have hidden from for years.

They need to walk into the dark forest of fear, and they need a trustworthy guide. They need someone with time, energy, patience, and love, a person who has been on this journey many times and who has come out alive. At some point,  you need to decide if you are going to take on this problem yourself or refer to an addiction professional. Remember that alcoholism is a chronic relapsing brain disease. It is only at the five-year sobriety point that the relapse rate drops to around zero (Vaillant,  1996).  So if you take this battle on, it’s going to be a long one. If you look at addiction programs around the country, you will see that about half of the patients who leave treatment stay sober for the next year. This does not mean that they quit; this means that the person helping the patient quit. The recovery community was not tenacious enough to make sure the patient was working his or her program. Ninety percent of patients who work the program stay clean and sober. So if you want to take on this job, remember that you are in a five-year fight for the patient’s life. You must do everything in your power to make sure that they work the program.  Because of protracted withdrawal, dual diagnoses, organic brain syndrome, and many other factors, about half of all alcoholics are not able to work their program. They do not have the spiritual, mental, or physical ability to work the program. These patients may need years in a structured facility.

Sometimes you will want to refer an alcoholic to an addiction professional.  There are excellent alcohol and drug counselors and physicians who are used to the battle and have specialized training to deal with the special problems of addiction. A treatment facility locator can be found here.  Other times,  you will want to try to help the patient yourself, but, remember, you are in for a five-year battle.

Never forget that you are the healer, and you will do everything in your power to keep your patient sober.

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Robert R. Perkinson,  PHD
Helping Your Clients Find the Road to Recovery

Alcoholism - Treatment.  I.  Title.
RC565.P375 - 2004
616.86’10651- dc22