Tough Love

Brenda had been an alcoholic and drug addict for nearly 30 of her 44 years. Hers was a seemingly hopeless situation that had devastated her large Iowa farm family. But last winter marked a new low.

Brenda's husband, also an alcoholic, was arrested for beating one of her sons. When her family walked into her home to take her children, they found Brenda's three teenage boys caring for their 3-year-old brother. Every door in the house had been busted through with a fist. Brenda—a bright and creative woman who managed to hold teaching jobs all those years—was drinking up to 28 beers a day.

"I think everyone had given up on her," says Kathy Kleinschmidt, her sister. "But we all agreed it would be immoral not to do something, because someone was going to die."

The family decided to stage a confrontation in the hopes of forcing Brenda into treatment. Such a dramatic approach is popularly called an "intervention," although in the psych biz the term refers more generally to the use of any therapy. The technique—in which loved ones converge upon the addicted person and collectively urge him to quit—has gained visibility, thanks to A&E's Intervention, the documentary series that chronicles addiction in stark and sad detail. The ultimate goal of a formal intervention, ideally led by a licensed therapist, is to convince the addict to enter rehab immediately.

The technique has currency in the industry that has grown up around addiction treatment, but no hard data exist on its effectiveness. By contrast, lighter-touch approaches such as motivational interviewing conducted by licensed therapists have been shown to reduce alcohol and drug use. Many psychologists contend that the confrontational approach can backfire, ultimately fueling resistance on the part of the substance abuser. Those who stage interventions insist that a large percentage of their clients do enter treatment.

Facing The Facts

Strong defenses and a sense of denial are hallmarks of the substance abuser's psychology. "Addicts don't deny that they're using," says Bob Poznanovich, CEO of Addiction Intervention Resources, a Minnesota-based company that, for a hefty fee, specializes in arranging interventions. "They deny that it's hurting others."

That's why an intervention can be more effective than a one-on-one conversation: The addict is caught off guard and emotionally disarmed. Everyone he cares about explicitly spells out how they've been hurt. While expressing love and concern, the interveners also outline concrete repercussions should he refuse treatment.

"Pain and consequences are motivators for an addict," says Poznanovich. "You'd think jail and homelessness would be, but they're not, especially if the addict has been bailed out of bad situations again and again." And because the logistical details of entering rehab are set, the addict can easily surrender and allow others to take care of him.

An Emotional Maelstrom

Jerry Wittman, an alcohol and drug counselor and director of the Reno, Nevada-based Intervention Solutions, starts the process by giving the family a group homework assignment: Each person is asked to compose testimonial letters to read aloud at the meeting. Next, they each decide what consequence the addict will face if he or she refuses to begin treatment, such as "I will file for divorce."

The counselor then helps the group choose a residential treatment program. Insurance and money matters are ironed out. (Poznanovich's group charges $2,750 to $5,550, which does not include the cost of rehab. Most insurance plans do not cover interventions.) Finally, the group has a role-playing session in which they read their letters. Rehearsals tend to be emotionally fraught, says Wittman. Running through the scenario ahead of time dampens the intensity of the actual intervention and renders it more manageable.

Every intimate friend or family member should be present, but it is not a case of the more, the merrier. Morning is best, since the addict is slightly more likely to be sober. A hotel room makes for a neutral setting.

Last January, Kathy, her four siblings, their spouses, her parents and Brenda's three eldest sons all convened in Iowa along with a facilitator from Poznanovich's company. Brenda, who was watching television when the crew arrived, screamed at the therapist, but did not flee. Her family began reading their statements: "Your reputation is ruined," someone said. "You don't look well at all," said another. Then her eldest sister said something that cut through Brenda's rage: "You don't love your children." At that, she stood up and began sobbing.

Her 13-year-old son was the last to read. "I just want to be a kid," he said. "I don't want to be a grown-up when I'm not a grown-up." When the facilitator then asked if Brenda was ready to accept treatment, the boy squeezed his eyes shut and mouthed, "Please, please, please," until Brenda said yes.

No Surefire Solution

Brenda successfully completed rehab and the family was brought closer together by the experience. But interventions are emotional powder kegs that can go horribly wrong. "There are cases when a person is never seen again and where families are broken up," says Alan Marlatt, professor of psychology at the University of Washington. "It can make them want to drink more."

Bruce Cotter, author of the book When They Won't Quit, became disenchanted with the technique after leading many interventions. "I walked into a lot of volatile situations," he says, recalling an incident in which a father lunged at his heroin-addicted son. "I began to see a contradiction: You have half a dozen people telling you, 'I love you with all my heart, but you're a no-good SOB' It can be humiliating and degrading for the person, who is, after all, sick."

Cotter favors a modified approach: Family and friends still get together, write their letters, determine consequences and choose a treatment facility. But only a therapist meets with the substance user. Under these circumstances, people are more candid and can choose whether to go into treatment without feeling coerced, Cotter says. He finds that those who enter rehab after a one-on-one intervention arrive less angry and more receptive to change than those who enter after a group confrontation.

Just The Beginning

Even if an intervention succeeds in getting the abuser into treatment, it is only the first step in what is destined to be a hard road to recovery. The majority of alcoholics and addicts who eventually recover suffer at least one relapse along the way, which is why it's important to have a supportive after-care plan in place.

Brenda spent four months in a halfway house after rehab, and now goes to four AA meetings per week. She divorced her husband and moved into a new home. Says Kathy, "Every angle of Brenda's life has been torn apart and rebuilt."