A&E’s Intervention – Joey, the middle class, heroin addiction, and hepatitis C

A&E’s Intervention built quite an initial popular following for itself by choosing subjects with disarmingly unique stories and addictions. However, as the show has progressed, it has found strength in an ability to show America the true face of addiction: the so-called normal, everyday people battling their demons in private.

Heroin addiction doesn’t understand “class”

Joey, a 25-year old father from Pennsylvania, stands as a prime example, a young male who grew up with a supportive family in a comfortable suburb and nevertheless found himself in the grip of heroin addiction. By his own account on Intervention, Joey began experimenting with drugs at the age of 13, and by 15 was regularly smoking marijuana. By 17, he was using ecstasy, LSD and had developed a heroin addiction, which several trips through a 12-step rehab program did little to slow. As his tolerance for heroin built, Joey found himself shooting heroin at the rate of up to 7 bags a day to maintain his high. Despite steady work as a tattoo artist, his money was increasingly feeding his heroin addiction, preventing him from even making his child support payments. Sharing dirty needles had also most likely been the cause of his recent contraction of Hepatitis C, an infection that now shows up in a staggering 80% of all regular injection drug users.

A&E’s intervention – A glimpse into the face of addiction

As per the show’s format, this episode revolved around a forthcoming intervention planned by Joey’s family, who were growing more and more desperate as his heroin addiction continued to eat away at his life. In accordance with the Johnson Model, the classic standard of addiction intervention, the family resolved to present Joey with an ultimatum- either he could voluntarily enter rehab treatment, or he faced losing contact with all of his family members, losing any rights to his young daughter, and could even face jail time for violation of his probation.

Even with the gravity of the consequences facing him, Joey’s heroin addiction was such that he still could not come to terms with his situation. Anticipating the intervention, he ran, going into hiding for two days while his family camped outside of his home, his job, and the homes of his friends, waiting for the chance to confront him with reality. Ultimately, they spread the word that they were prepared to have him arrested. With nowhere left to turn, Joey finally resolved himself to rehab, though not without one final fix.

Difficult recovery and relapse

Though the treatment originally seemed to take well, giving Joey 9 months of sobriety, he was depicted on the program suffering a late relapse. This time, he willingly returned to treatment. According to A&E’s Intervention, he has now been sober since April 25, 2010.

Joey’s story resonates because of how tragically common his themes are: the complete loss of personal wealth, the hardship that the addict’s behavior has on family and friends, and the willingness to put oneself in extremely dangerous situations for the chance to use just one more time. Time and again, Joey demonstrated an extreme lack of caution as he shot up heroin with dirty needles, putting himself at risk for Hepatitis, HIV, and any other number of serious diseases. This brings up the issue of so-called “harm reduction” programs designed not to prevent injection drug users from using, but rather to provide them with clean needles and education in order to minimize the threat to public health and guide, not force, the addict towards potential treatment. The long-standing counterargument to such programs has been that they implicitly condone drug abuse, but research has shown that needle exchange programs do not increase drug abuse but merely decrease disease and dirty needle use. In this way, it is increasingly becoming regarded as analogous to sex education and the distribution of birth control, another common-sense public service that has too often fallen victim to the agendas of culture warriors.

Though for some a lurid escape, it has become increasingly clear to us at A3 that A&E’s Intervention, by presenting a straightforward view of the true complexity of modern drug use and addiction, has become an invaluable tool for those attempting to understand the face of this issue. As is usually the case with television content though, it pays to go a little deeper, and hopefully the show motivates people do just that.

A&E’s Intervention: The Johnson Model, Motivational Interviewing, and more

A&E’s “Intervention” is a reality series that follows one individual struggling with addiction per episode.  Family and friends gather with an interventionist toward the end of the episode and an intervention is planned.  The addict is then given a choice between leaving immediately for rehab or risk losing contact, financial support or some other privileges from their family and friends.

All interventions are not the same

This style of intervention used in A&E’s “Intervention” is known as The Johnson Model (JM), as thought up by Dr. Vernon Johnson in the 1960s. This intervention model has, because of the show, become the most recognizable version of addiction intervention.  An interventionist using this style aims to abruptly break the denial that is harbored by the chemically independent individual.  By assembling loved ones and presenting an ultimatum, the addict is forced to hit “bottom”, in hopes of pushing them toward recovery and avoiding further destruction.

There are alternative intervention approaches, including Motivational Interviewing (MI), and CRAFT (Community reinforcement and family training).  These relatively more recent and less confrontational approaches also employ professional counselors or interventionists who seeks to move the addict into a state in which they themselves are motivated to change their behavior (MI) or who focus on teaching behavior change skills to use at home (CRAFT).

By using common psychological techniques such as mirroring and reflecting, MI practitioners gradually make the client face the consequences of their action, taking the burden of motivation away from loved ones. CRAFT practitioners, on the other hand, use a manual-drive method to improve the addict’s awareness of negative consequences, reinforce non-drinking behavior, and improve communication skills and participation in competing activities. Both methods also prepare family members (or friends) to initiate treatment, if necessary, when the patient was ready. Though far less dramatic and “TV worthy,” MI has been shown in research to be very effective at increasing clients’ motivation to change in many different setting including addiction. It’s also my favorite technique because it allows for amazing, non-confrontational, change.

Some of the reasons to question the confrontational Johnson Model used in A&E’s “Intervention” have to do with the fact that although they’ve been shown to increase treatment entry rates once a successful intervention has been performed, they haven’t been shown to do much for treatment completion rates. Even more important is the fact that multiple studies have found that a small percentage of those who seek consultation in this method actually go through with the family confrontation portion. Instead, the more collaborative and supportive MI and CRAFT methods have greater participation and have been shown to provide even better treatment entry as well as improvement in communication and overall relationship satisfaction between the families and the addicts (which JM interventions provide as well). Additionally, a significant portion of individuals who enter treatment after a JM intervention end up leaving treatment early or relapsing quickly since they themselves have not yet internalized the motivation to quit.

Pressure and shame can backfire

This phenomenon can be seen in Corinne’s episode of A&E’s Intervention.  Addicted to heroin and crystal meth, Corinne had lost control of her life and her family was desperate to save her.  Corinne is a diabetic and had not been taking her insulin for years, using her needles to shoot-up instead. When Corinne overdosed nine months prior to taping, Corinne’s family knew they needed to intervene.  During taping, an interventionist was brought in to meet with the family.  She helped them to plan out how they will address Corinne.  She started by emphasizing how desperate the situation has become and encouraged them to be forceful with Corinne. She explained that this is a life or death situation and that if Corinne refuses treatment, they might consider turning her in to be arrested.  As Corinne arrives, she reacts harshly and explains that she is not “ready” for treatment.  She flees the room for a short time only to return and agree to go into rehabilitation as they had requested.

As is too often the case, Corinne struggles at the first treatment center and is quickly transferred. Eventually after getting clean, her family is overjoyed.  Unfortunately this is short lived when three weeks after taping, she relapses several times. As usual, I think it’s important to know every tool available when considering how to help an addict – that’s why I believe that knowing about MI and CRAFT (as well as other intervention methods) in case the more popular Johnson Model Intervention doesn’t work is crucial. It’s a matter of life and death.

Citation:

Miller, W.R., Meyers, R.J., and Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: Comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688-697.

Rollnick, S., Allison, J. (2003) Motivational Interviewing, in The Essential Handbook Of Treatment and Prevention of Alcohol Problems (2003)