"I started drinking in eighth grade, and I drank heavily from day one," she recalls. "I never went out for just one drink, even for business." During her 20s, she lived in New York City and was able to hide her habit from her family members by avoiding them as much as possible. But when she moved back to her hometown in New Jersey, it wasn't as easy to keep her big secret—and, at the same time, alcohol was clouding her mind to the point that she started to fall behind on her bills and other responsibilities. Naturally, her loved ones started to worry.
Then one summer, Peg* returned home from a trip to Ireland and found her brother and mother waiting at her house. "They said, 'We think you should get help,' and they had paperwork with them from a [treatment center] called Hazelden," she says. Caught off guard, Peg blew up, ordering them to leave and refusing to consider their offer. "At that time, although I knew I needed help, I just didn't think I could stop drinking," she explains. "I was afraid I'd lose my relationship and my job."
But over the next few months her situation got progressively worse, to the point that her boss caught her drinking on the job. That weekend, Peg's aunt asked her to come over. Once again, when she walked in the door she was met by several familiar faces—her childhood best friend, her brother and sister, and a few other family members—as well as one unfamiliar one. That person was an addiction professional, brought in by Peg's family to help convince her, yet again, to get help for her drinking problem. If she didn't agree, they said, they'd essentially cut off contact with her.
For the second time, Peg found herself the subject of an intervention—a structured process in which a person (or group of people) steps in to interrupt some kind of negative behavior pattern that they've witnessed in a loved one. Although most people associate interventions with addiction and substance use disorders, they're also considered a strategy for helping people with mental illness and eating disorders who are resistant to treatment. "An intervention can be as simple as addressing and challenging a behavior—pointing out a pattern and offering treatment," says Justine Jones, MSMFT, primary therapist at the Northeast Addictions Treatment Center in Massachusetts.
Although most people associate interventions with addiction and substance use disorders, they're also considered a strategy for helping people with mental illness and eating disorders who are resistant to treatment.
In other cases, like Peg's, interventions also come with an ultimatum: Either follow the treatment plan laid out by loved ones or prepare to be cut off from family and friends, financially and socially. "Ultimatums are necessary at times, especially if you have someone very resistant to getting help," says Jones. "Even if they go to treatment just to have a place to stay or to appease their family, there is still a likelihood that they could have a breakthrough while they're in treatment, even if they didn't want it for themselves. It gives them a chance to stabilize, get sober, and do some reflecting."
It's important to note that not all mental health professionals believe the intervention model is helpful. "Interventions in the sense of planned, surprise confrontations are not backed by research," says Samantha Arsenault, vice president of national treatment quality initiatives at addiction nonprofit Shatterproof. She points to the U.S. Surgeon General's Report on Alcohol, Drugs, and Health, which states that “the type of ['interventions'] sometimes depicted on television—a model developed in the 1960s, sometimes called the 'Johnson Intervention'—have not been demonstrated to be an effective way to engage people in treatment. Confrontational approaches in general, though once the norm even in many behavioral treatment settings, have not been found effective and may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual.”
"Confrontational approaches in general [...] have not been found effective and may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual.” —U.S. Surgeon General's Report on Alcohol, Drugs, and Health
Jennifer Nicolaisen, executive director at addiction treatment program SeekHealing in North Carolina, agrees. "The concept of traditional intervention directly exacerbates the root causes of addiction: feelings of loneliness and social isolation," she says. "The latest research very clearly shows that social isolation drives addictive behaviors. During an intervention, there's an acute experience of 'us versus them' that occurs. This only enhances the experience of social isolation already burdening any person struggling with serious addiction issues."
That said, there's another cohort of addiction specialists that believes interventions can be a turning point for some people, when executed with kindness and compassion under the guidance of a licensed professional. A small 25-person study from the 1980s on the Johnson Intervention model found that its biggest pitfall is that families often back out of executing the intervention in the first place—those that did hold the intervention had "better outcomes" than a control group.
When is it considered appropriate to stage an intervention—and what is the process like?
Not everyone who's dealing with substance abuse or mental illness is necessarily a candidate for a formal intervention, says Jones. Often, an honest conversation with one person in their life is enough to open their eyes to a problem they never considered. But that's not always the case. "Once their behavior becomes more pattern-like, it may take more people in their life to speak up and hold them accountable," she says. "For example, if you have a man or woman in their 20s who has been [abusing drugs] for over a year—they're living with their mother, their job is suffering or their relationships are suffering—it might be a good idea to bring in several family members to say, You need to seek treatment or you can't stay here any longer."
That's where Sarah* found herself last summer. One of her close friends, Amanda**, had been on a downward spiral for the past five years, dealing with alcohol and prescription drug use, and addictions to sex and shopping. "Every time we spoke to her, something catastrophic was happening," says Sarah, who adds that within the span of a year, Amanda had been fired from three jobs and crashed her uncle's car, fleeing the scene of the accident and telling family members that the car had been stolen. After reaching out to Amanda's mother and uncle with the help of another friend, the group decided to stage an intervention with the help of a therapist. "When you've tried so many times and so many ways to fix the problem and you realize it's not changing in any way, the only thing you can do is step out and let someone who knows more than you handle it," Sarah says.
Through interviewing addiction experts for Amanda's intervention, Sarah learned that some take more of a confrontational, tough-love approach than others. "Some of the therapists we talked to said there needed to be a bag packed and she needed to [go to an inpatient treatment facility] right away," she recalls. This was the case with Peg's intervention, and for her, it was effective. "I wanted to wait a day, but they said no, it's now or never," she says. "I guess they caught me at the right time, because I just knew I couldn't do this anymore and I agreed to go." That same day, she was boarding a plane to Minnesota for a three-week stay at Hazelden.
But Amanda's friends and family agreed that kind of approach wouldn't work for her. "She was already existing in a place where she didn't feel loved or cared about, so having someone come in military-style and throw her into a program wouldn't have worked," Sarah says. "We sat for a while and talked about what it would look like if we pulled her out of her job [to go to treatment] and also what it would look like if we didn't pull her out of her job. There was a lot of care on our end about what it would look like for her, because she wasn't 17 years old—she was 38. I think it really helped that she knew we weren't trying to strip her life away from her. It was more about How do we get you on the other side of this and thriving?"
Amanda tried to leave almost immediately when she walked into the intervention—and she remained mostly silent and shut down while her friends and family told her what they loved about her.
After discussing it, Amanda's friends and family members decided that intensive outpatient therapy would be the best option for her, and they worked with the therapist to come up with a plan of exactly what the logistics would entail. This is a crucial part of any successful intervention, says Jones. "It's already an anxiety-provoking situation, so if you go in unplanned and offer treatment but there's no plan in place, that would be a great opportunity for them to come up with a way to back out of it—like, How am I going to afford treatment? Where am I going to go? How am I going to leave work?"
Sarah recalls that Amanda tried to leave almost immediately when she walked into the intervention—and she remained mostly silent and shut down while her friends and family told her what they loved about her, shared memories from happier times, and expressed how concerned they were about her behavior. However, she did accept their request to start a treatment program, since the group made it clear that they weren't willing to keep bailing her out going forward. "Every single person she had lied to or borrowed money from was in the room saying it ends here," says Sarah. "I think she was really scared and realized she was about to lose every resource she had."
What if the intervention doesn't work?
Of course, for every successful intervention there are many others in which the person doesn't agree to their loved ones' ultimatum. "The emotional response is unpredictable," says Jones. "The person could break down and admit they need help, or they may decide not to seek treatment—or stop speaking to their loved ones and leave."
Although this is often scary for the person's friends and family, Jones believes that continuing to stand by while the person engages in destructive habits is an equally dangerous route. "Enabling doesn't necessarily mean that the family is buying them drugs and alcohol," she says. "It can be as simple as allowing them to live with you, giving them money, or making their lifestyle easier for them. Families think they're being helpful, but this [kind of behavior] won't help them get better." The only time she doesn't recommend offering an ultimatum is when a person is in an unsafe relationship, as it can put both the family and the intervention subject at risk of harm.
"Enabling doesn't necessarily mean that the family is buying them drugs and alcohol." —Justine Jones, MSMFT, primary therapist at NEATC
Peg says that her intervention probably wouldn't have ended the way it did if her family hadn't stood strong with their ultimatum. "They were like, We've done everything we can do and we're rooting for you, but you have to do the work," she recalls. "It's about being responsible for yourself, and I think that's something a lot of people don't do when they're the subject of an intervention." She's witnessed this firsthand—her family more recently staged an intervention for her cousin, who's also battling alcoholism, but he chose not to enter treatment.
That said, she still feels that it was a good thing to do, because it helped the family set boundaries around behaviors that were impacting them, too. "I don't think interventions are only good for helping the person who has the sickness," she says. "I think it's also for the family to say Here's my bottom line and I'm sticking to it, because you're [hurting] me."
Not that sticking to those boundaries is easy. Ben* and his mother made the difficult decision to cut off contact with his father when he refused treatment for an alcohol use disorder after multiple interventions and ultimatums. “I got the impression that he felt the standard treatment model was a formula that didn’t fit him—he said, ‘I’ve done that and it doesn’t work,’” says Ben. (His father went through the Alcoholics Anonymous program when Ben was a child and sought treatment—following an intervention—and stayed sober for almost a decade before relapsing.) But eventually, Ben and his mother reached a breaking point. “I remember my mom saying she couldn’t continue to give any more of herself to this disease,” he recalls. And that’s how Ben felt as well. “After several years of continued drinking—years of being angry and yelling conversations over the phone—it didn’t feel like I was talking to him anymore,” Ben says. “It was harder to talk to him sometimes than to not talk to him at all, which was awful, too. I also hoped that [walking away from the situation] would maybe change something.”
In Ben’s case—and many others like his—that didn’t happen. His father died of complications related to alcoholism two years after their last conversation, at the age of 61. Ten years later, Ben still struggles with the emotions around his decision to uphold the boundary he set. “I know I did the right thing at the time, but there’s still a part of me that feels like I abandoned someone I love,” he says. “I wonder, would it have made a difference if I’d stayed in touch? I don’t know.”
Jones says feelings like this are common when a person declines treatment for substance use. “People think that if they can keep tabs on their loved one, they can control their behavior, but that’s just a delusion,” she says.
Whether or not a family chooses to give an ultimatum, experts agree that the most important thing is to talk to the person who’s battling addiction or mental illness and encourage them to seek help. "It's best to connect someone to a health care professional for a full assessment," says Arsenault. Adds Nicolaisen: "The most helpful approach is to create a context for a genuine conversation where they feel safe enough to openly discuss what they get out of their habit and what they don't like about it," she says. "When these conversations can happen without judgement, trust can be established. With trust, both parties can establish strategies that might work better."
"The most helpful approach is to create a context for a genuine conversation where they feel safe enough to openly discuss what they get out of their habit and what they don't like about it." —Jennifer Nicolaisen, executive director at SeekHealing
Ultimately, both Peg and Amanda's intervention stories had happy endings. Peg is now nearly 14 years sober, married with three children and a thriving career—and her relationship with her family is better than ever. She says that if it weren't for their intervention, she might not be alive today. "I didn't care what happened as long as I could drink. I was resigned to living on the streets," she says. "My physical health was terrible at the time. I don't know that I would have made it much longer."
Amanda chose not to be interviewed for this story as she's still coming to terms with her past transgressions in therapy. But according to Sarah, Amanda is making great progress, has made amends with her friends and family, and is in a healthy new romantic relationship. Stories like these are what convince therapists like Jones that well-planned interventions can be beneficial when other attempts to help a loved one fail. "If there's a serious problem going on in someone's life and the intervention is coming from a good place, it can always be warranted, even if the initial response is negative," she says, noting that helplines exist to offer support and connections to families who are considering an intervention. Adds Peg: "Whether you're the person with the problem or a family member, there's help out there."
If you or someone you know is in crisis and needs help, please call 1-800-662-4357 to reach the Substance Abuse and Mental Health Services Administration for confidential and free treatment referral information.
*Last name has been withheld to protect source's privacy
**Name has been changed to protect source's privacy
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