Why Drug Abuse “Interventions” Work

The procedure helps enablers to quit enabling.

Posted Feb 09, 2021

 Family Confrontation by flat earth theater, CC BY-SA 2.0
Source: Wikimedia Commons: Family Confrontation by flat earth theater, CC BY-SA 2.0

In Jonah Berger’s excellent new book, The Catalyst: How to Change Anyone’s Mind, he discusses effective ways to get people to look at things in new ways. He also talks about why persuasive arguments and presenting new information to get another person to reconsider entrenched positions usually does not work. 

In the chapter called “corroborating evidence,” he uses a successful intervention with a drug abuser to illustrate how, in influencing others, having multiple people give information is often much more powerful than just one person speaking, especially when the multiple sources are all operating around the same time. 

The Intervention technique in substance abuse treatment involves an outside therapist coming in and coaching family members to write out a speech about how much they care about the users and how their behavior is hurting everyone. The family is instructed to avoid telling them what to do. Nonetheless, the therapist has a rehab facility lined up in hopes the object of the intervention will agree to do something about the “problem.”

They also give the addict the message, “If you want to be an addict, we can’t stop you. But if you want to get high, you aren’t going to do it here.” 

With families, Berger points out, several members have often over time asked, begged, yelled, screamed, and threatened. “All to no avail.” But then he relates the usual wisdom about this, such as “They (addicts) don’t believe they have a problem; They are “in denial.” Or even: "They may not remember wrapping a car around a lamp post” because they “blacked out.” Really? Like they can’t see the wrecked car?

Isn’t losing a good job or resorting to crime to finance an addiction considered by drug abusers to be a problem? They would have to have the IQ of a rutabaga to have missed that.

So what’s really going on here?

Berger attributes the relatively high success rates of family “interventions” to the number of people giving a similar message. He's partly correct. But he also seems subliminally aware that there is something else going on here. He states, “In order to get addicts to change, their entire ecosystem has to be altered. Without realizing it, friends and family members may be unintentionally enabling the problems. So for change to stick, the whole system has to change…”

Was the family the author described enabling the abuser, “Phil?" Quite so. In the author’s description, the family didn’t seem to think of him as an addict for extended periods, especially at first when he had a job and didn’t steal to support his habit. He did start to steal a bit later. They sent him to rehab 19 different times even though each time was unsuccessful. They repeatedly let him move back home. They had him sign a contract promising to turn over a new leaf, but all that did was to “train him to be a better liar.”

Hearing this, it might seem fairly clear why Phil might have thought his family was actually invested in him continuing to be an addict because they made it so easy! Unlike most of us, they know family members are not that stupid even if they deny it. Of course, I must put the usual caution here: Since I haven’t personally evaluated this family, I can’t say what follows with certainty, although IMO what I am about to describe is extremely likely.

Another hint that the above formulation may be on the mark is a statement by the book author that "family was everything to Phil." The author thinks that Phil realizing he was tearing the others to shreds was the motive for quitting. But again, how could Phil possibly think that this hadn't been the case all along? Because he thought the family needed him to be an addict!

In dysfunctional families with shared conflicts over certain behavior — for example, puritanical attitudes towards work and intoxication — several members are usually involved in either enabling or refusing to notice the addict’s problems. The addict is actually taking these behaviors as cues from the family to deny he has a problem. When one member occasionally seems to object to addict-like behavior, another family member may give the addict the opposite message.

In such a situation, this can become a game without end even more easily than when just two people are stuck in this game. No wonder the addict ignores the asking, begging, yelling, and threatening from any one family member.

When the whole family comes together to give the same message — that they all will no longer deny that the addiction has become a problem — and all clearly state that all of their enabling behavior is going to cease, their wanting him to stop becomes far more believable. So it isn’t just multiple sources of info as Berger assumes, but the fact that they are all indirectly acknowledging their own contributions to the addict’s continuing addiction.

The addict may still be skeptical. If Phil left yet another rehab program without success, and his parents still let him return home, nothing would stick. Fortunately, that didn’t happen with Phil.