Confronting an Addict – Confrontational Intervention Model

During an intervention, loved ones confront a person who is in the process of engaging in some form of self-destructive behavior to encourage the person to get help.

Typically, the group consists of family members, friends, and colleagues who very close to the person. In many cases, a mental health professional or a professional interventionist will also participate in the process. The typical format of an intervention is for the group of concerned individuals to get together, plan how they will stage the intervention process, and then actually perform the intervention.

Interventions have been popularized by the media and are often presented as being somewhat overly dramatic and animated.  Interventions that are effective are typically more controlled, although these processes can become quite intense. There are a number of different models that dictate the exact approach and focus of the process. Perhaps the earliest and still one of the most common approaches is the confrontational intervention.

What Is the Confrontational Intervention Approach?

doctor consulting with family about needing to stage an intervention
First of all, it should be noted that technically all interventions involve some form of confrontation in that the intervention group confronts the person with the reasons that they believe the person’s behavior is dysfunctional and details on how it affects everyone involved. The confrontational intervention was historically just that; the intervention group would essentially ambush the person, make accusations, and make strict demands of that person. At one time, there was some professional support for a stricter confrontational approach even though the approach could become relatively harsh.

Traditionally, a confrontational intervention included the elements outlined below.

  • The process would begin when members of the individual’s family and/or friends met to discuss the person’s behavior and how they would put together an intervention.
  • The intervention group might also meet with a mental health care professional who specializes in the treatment of substance abuse or with a professional interventionist, a person trained in organizing and running interventions.
  • The meeting would take place in a neutral location and would not include the subject of the intervention.
  • The professional interventionist or mental health worker would direct the initial meeting and explain the intervention process.
  • The group would plan the intervention, such that each individual in the group would write a short script of what they would say. Group members would then review each other’s scripts to make sure they were all consistent, discuss with the professional how to organize and run the intervention, and decide on a date, time, and location for the intervention to be performed.
  • The subject remains unaware that the intervention is going to occur. The person would then be brought to the location on the specific date and time of the intervention, unaware of what was about to happen and then would be “confronted” by the group.
  • The subject is told they must listen to the group.
  • Each member of the intervention group would read their grievances regarding the person’s behavior. In the more traditional confrontational approach, these grievances often included a list of character flaws, accusations, and other negative aspects that the author associated with the individual.
  • In some earlier approaches, the subject was actually called names and dehumanized to some extent.
  • Demands were made on the person to enter treatment, and in some cases, the person was escorted to treatment immediately following the intervention.
  • Consequences for not attending treatment were explained to the person by each individual. These consequences could things like a loss of privileges, dissolution of a friendship or relationship, isolating the person from their children, isolating them from other family members, and monetary penalties.

Modern Changes to Approach

A small number of research studies, such as an article published in the American Journal of Drug and Alcohol Abuse in 1989, provided some limited support for these harsher, more confrontational interventions. However, subsequent research studies indicated that while harsher forms of interventions may result in a number of individuals entering treatment, individuals who are subjected to harsh confrontational intervention techniques have significantly higher dropout rates from treatment than individuals who experience more supportive forms of interventions. The general approach associated with confrontational interventions is now more supportive in nature and less accusatory.

In modern versions of the confrontational approach, certain aspects have changed.

  • The techniques used in the intervention rarely involve humiliation, accusations, and pointing out the person’s flaws.
  • The subject of the intervention is still required to listen to grievances from the members of the group. The grievances will typically consist of actual instances of how the person’s addictive behavior has affected the person talking.
  • The members of the intervention group typically express their love and concern for the person and attempt to illustrate how the addictive behavior has been damaging.
  • Complete honesty and sticking to factual information are emphasized. The members of the intervention group are instructed not to make inferences but to point out actual examples of behaviors that the person has engaged in.
  • The focus is less on formally accusing the person and forcing them to comply with treatment; however, many confrontational models still use an approach where the members of the intervention group lay out specific consequences if the person does not get treatment for their substance abuse.
  • In many cases, once each person has expressed their concern, the group will provide the subject with a list of potential treatment choices to consider.
  • At the end of the process, the person makes a decision whether or not to enter treatment.

Increase Probability of Intervention

The overall approach to interventions suggests that the probability that an individual will enter treatment, and stay in treatment, following the intervention is increased by:

  • Using motivational techniques rather than confrontational techniques
  • Avoiding blame
  • Suppressing anger
  • Emphasizing love and support
  • Getting the subject of the intervention involved in the planning process
  • Placing less focus on the individual and their specific problems and more focus on the effects of the behavior on the family system and friends
  • Making consequences personal rather than general
  • Keeping the focus on dignity and respect for all members involved

Confrontational interventions are typically only performed one time, whether or not the individual chooses to enter treatment. Some people may attempt to perform another intervention at a later date if the subject of the intervention refuses treatment.

The core of any intervention is the use of constructive communication. Interventions are no longer viewed as opportunities for group members to vent or attempt to threat or force someone to comply with the demands of the group. Instead, the confrontational intervention is designed for concerned individuals to honestly and openly share their feelings and to get the subject to listen and understand how their behavior is affecting family members and friends.

Often, subject of the intervention has objections, excuses, or explanations for their substance use, and in many cases, these may seem rational or logical. However, frequently, such explanations are easy for a trained professional to refute. The participation of a professional interventionist or mental health provider can be invaluable to the process.  This person can assist the group in handling objections in a constructive and honest manner. This results in a confrontational approach that offers more support and positive interaction than the traditional approach.

The Evolution of the Confrontational Intervention

Initially, confrontational interventions were harsh and caustic. More recently, confrontational interventions involve a more moderate approach. The intervention will still confront the person with the substance use disorder; however, the approach is based on understanding and overall concern.

Current approaches used by confrontational interventions are also more interactive, and this results in more efficient communication between the group and the subject of the intervention. The ultimate goal of the confrontational intervention is to point out the effects of the person’s substance abuse and to get them to acknowledge the issue and consider treatment. Most confrontational interventions require individuals to make a commitment to treatment on the spot.

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