What if someone you care deeply about is headed in a rapid downward spiral and seems not to realize that there is a serious problem? You might be afraid that the addiction will lead to incarceration or death, as it often does, and you want to do something. This is a different situation from that of a family member who is emotionally invested in controlling the addict, like Mary in the vignettes. This feeling arises out of your knowledge of the severe danger your loved one is in and out of a sense of caring and concern. You see your loved one running full speed ahead toward a cliff, and you want to try to prevent disaster.

The first thing you should do is to make a commitment to go to 12-step meetings for the family members of addicts and alcoholics (Al-Anon, Narc-Anon and others). Pick out a convenient meeting, and go, today if possible. There is probably a listing in your phone book for AA; they will have the information you need. Two other strategies - intervention and court-ordered treatment - are both tricky from an emotional and relational standpoint. You not only need the support and encouragement you will get from these meetings, but you will also have to look at how your loved one’s addiction has affected your coping skills and your overall mental health.

The term “intervention” indicates a procedure used by addiction professionals; it is designed to bring the addict rapidly to a point where treatment is accepted. It is somewhat controversial and if not properly conceived and carried out can be quite dangerous. In short, don’t try this on your own.

Intervention is generally intiated by a family member, an employer, or a colleague. It involves taking extensive history from the people who know the addict best and who are most concerned about his or her situation.

A list is made of the specific negative consequences that have occurred as a result of the addiction. A plan for getting the addict into a comprehensive treatment program is also devised and set out in advance. The addict is summoned to the intervention, usually not suspecting that family members and others are going to be present. The professional who is orchestrating the intervention will then lead the group through a presentation of the various negative consequences of the addiction, the intention being to break down denial and resistance to treatment. The addict is then presented with a choice between the previously laid-out treatment plan and some type of negative consequence, such as being fired or losing an important relationship.

Intervention is very dangerous emotionally for the addict as well as for the family. It should be carried out only by addiction professionals who are licensed and experienced in this specific technique. It should be done in a supportive manner, and, before the intervention, the confronters (family members, friends, coworkers) should be given ample opportunity to work out their anger at the addict’s behavior. The purpose of the session is not to give the participants an opportunity to ventilate anger but to use a form of emotional manipulation to help the addict “hit bottom” before it’s too late.

Court-mandated treatment is available in some states through a commitment procedure. Since it means temporarily suspending the addict’s civil rights, it involves due process and is carried out through the court. Although the laws in each state vary, they are all based on the premise that the addict is not able to make rational choices about the addiction.

A family member or some other interested party can make an application to the court for a hearing and will be required to testify as to the reason for the request. The addict is given a chance to refute any testimony given and is represented by an attorney. If the court decides that it is in the best interest of the addict to go to a treatment center, an order is written by the judge, and the addict has to go. The treatment facility must also be involved in this decision and must be willing to accept the addict as a patient. Many state-run and some private facilities will accept involuntary patients.

Family members are often hesitant to take the step of using an involuntary court commitment. One major reason is a fear that their loved one will never forgive them. Also, there may be subtle and not-so-subtle threats made by the addict if the possiblity of involuntary commitment arises. It is best to consult with a professional on this matter.

If the recommendation is made to proceed with commitment, family members should remember that addiction is a progressive and extremely destructive disease that may be fatal. Short of recovery, nothing good is going to come of the situation. The most loving thing they can do is to get the addict into circumstances where it is possible for recovery to occur, and many addicts who are court-ordered to treatment by family members eventually come to see this.

Another concern that family members frequently express about court-ordered commitment comes from the erroneous belief that the addict has to admit the problem and ask for help before entering treatment, so that there would be no use in committing someone to involuntary treatment. Although it is correct that at some point an addict has to take personal responsibility for recovery, it is also true that every addict - even someone in deep denial - has some degree of ambivalence about the addiction. The addict may desperately want to get rid of the addiction but not believe that it is possible to recover, or may be fearful of giving up the option of getting high because of painful inner conflicts or past trauma. In a treatment setting, even if the person arrives involuntarily, these issues can be addressed. Long-term outcomes for addicts who come to treatment voluntarily and for those who are intially court-ordered are actually about the same.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information