Parenting advice – What’s important when it comes to teens, alcohol, and drugs

Parents often ask us what they can do to prevent their children or teens from becoming alcoholics, drug addicts, criminals, and the likes. I’ve been all of these and more, and so I’d like to share my insight with you now that I’ve made it over to the other side:

You can’t prevent anything – but you can educate, inform, prepare, and support.

My family breaths success; it also breeds its. My father was a star athlete who turned into a star doctor and a star family man. He also never drank alcohol and couldn’t care less about drugs. My mother was a beauty queen who always helped me get the best grades in school, even if it meant that she ended up doing my art projects for me and keeping me up all night so I’d finish my work. I’m not sure if it was my perception or my parents’ actual wish, but I always felt like unless I saved the world, I would end up a nobody. Drinking enough alcohol to black-out and consuming every drug on earth was never supposed to be on my menu.

A recent article I read in a monthly psychology magazine (see my post on it here) talked about this sense of perfectionism in our culture and its effect on teen depression, anxiety, and alcohol and drug abuse. Did you know that these are highest among more affluent teens?

Advice #1 – Shooting for good performance is important, but focusing on it as a sole measure of success can lead to trouble.

I got gifts for grades, and the best gifts came only with the best grades. Anything short of perfect was pretty much frowned upon and considered “less than my best.” It became impossible for me to actually enjoy anything but the school subjects I excelled in (math, physics, chemistry). It wasn’t until I graduated from college and did some of my own exploration that I learned to appreciate art, English, and history as worthwhile pursuits. It’s a well-know fact in developmental psychology that you don’t reward behaviors that are supposed to be appreciated in their own right. If you do reward them do so with small gifts, nothing large. Big gifts take away the perception that the activity itself brought about enjoyment.

Advice #2 – Parenting requires consistency and openness, but leave the preaching for church.

This constant need for perfectionism also lead to the repression of many issues in my family.

My parents fought often when I was a kid, screaming loud enough for me to take my sister away often and go play. We never talked about the fights so I never managed to learn about conflict, relationships, or resolution. We never talked about my stealing either, whether I was stealing from my family (mainly my father’s porn) or from the neighborhood toy store. The one time I got caught, my father sternly told me to return my new toy and to never be caught stealing again. I began stealing away from my neighborhood; it would be years before he’d hear about me stealing again. It probably would have been better to sit down and talk about what just happened.

Later on, when my mother would find my weed in my room, she would hide it so that my dad won’t find it because he would get mad. We call that enabling. When I was caught stealing at my work, my father didn’t want to tell my mom, so as not to upset her, so he never brought it up again. We call that denial. Neither of these work since they don’t teach a child anything except how to hide things properly and that even responsible adults lie.

But research shows us that preaching is not a good parenting technique so stay open and talk about struggles without being hypocritical and trying to teach lessons that are obviously forced. Kids and teens pick up on that very quickly but they’re ready to learn from their parents.

Advice #3 – Don’t let your sense of pride, or your ego, prevent you from dealing with real issues with your children. Parenting requires you to be the adult in the relationship with your children even when things don’t go your way.

By the time my parents were forced to confront reality, things in my life had spiraled way out of control. They received a call from my LA lawyer telling them that their son had been arrested for some pretty serious drug dealing. My bail was set at $750,000 and I was facing 18 years in prison. That’s pretty difficult to ignore.

Ironically, my arrest, court case, and the year I spent in jail brought my family closer together than we had even been during my teen years or my later drug addiction phase. Having to actually confront many of our issues allowed us to bring some actual intimacy into the family I had run away from so many years before. The important thing was that my parents didn’t pull out the “we told you so” card but rather helped me confront my demons and treat them. It was the best parenting I’d received in my life and it worked.

My parents did the best they could. I know that. Still, I can’t help to wonder if worrying a little less about how things “should be” and a bit more about the reality of parenting their deviant son may have prevented the latter part of this story. Then again, there’s no guarantee of that either. That’s the most important parenting advice I can give when it comes to teens and drugs…

Talking to kids about teen smoking: The FTAS (Family Talk About Smoking) paradigm

Newsflash: Kids don’t like being preached to – especially when it’s done hypocritically

A recent study assessed the impact parents have over the decisions their teenagers make concerning whether or not to ‘experiment’ with smoking cigarettes and to continue smoking in the long term, once they have tried it.

Experimenting with smoking represents a form of risk-taking for some teens while it can serve as the onset of long-term chronic cigarette smoking for others. Deciding which group a given teenager is a part of during the initial stage of experimentation is difficult, and figuring out whether it is possible to influence the trajectory of future behavior in teens is the focus of this line of research. The researchers theorized that variations in communication between parents and their teenagers might shine some light on these all-important issues.

So the researchers developed the Family Talk about Smoking paradigm, or FTAS, a method of standardizing the interaction and communication between teen smokers and their parents who had either smoked in the past or currently smoke. It’s a neat method that allowed them to study parent-teen interactions in a natural setting.

What is the FTAS – Assessing parent-teen communication

The FTAS is a 10-minute, semi-structured family interaction paradigm. It employs using a flip card the parent or teen are asked to read to one another. They take turns and each flip card initiates a conversation ‘trigger’ designed to stimulate smoking-related conversation. The cards focused on five triggers: a) “How people in our family feel about cigarette smoking,” (this is read by the teen), “My experiences with cigarette smoking” (by the parent), “How today’s teens make decisions about cigarette smoking,” (by the teen with this wording used to break open discussion without forcing teen to expose his own experience unless he wants to), and “What parent do if they find out their teen has become a smoker” (by the parent).

The families were given 10 minutes for each topic and were encouraged to use the entire time. Some families used the full ten minutes for some topics, and used less for others while other families sped through them all without lingering on specifics.

It may seem a little contrived and forced, but steps were taken to allow free-flowing conversations between parents and their teens. The FTAS discussion took place in the home environment in order to make the family more comfortable and there was a warm -up exercise to get everyone talking about their family life. When the time came for the FTAS discussion, the field staff left the room and observed the interaction remotely.

So, let’s look at what was measured.

A coding system was used to measure the:

  • Level of disapproval the teenager received from the parent
  • Just how clearly the parent elaborated on consequences for smoking cigarettes
  • Whether the parent conveyed to the teen that he expected she would or wouldn’t be a smoker
  • The quality of personal disclosure by the parent about his own smoking struggles or non-smoking

The teens and their parents were assessed initially and were then revisited 6 months after the baseline assessment to determine whether the family’s communication affected teen smoking 6 months later. It’s important to note: 90% of parents involved in the study had had some involvement with smoking at some point in their lives.

The patterns of communication between the teens involved in the study and their parent(s) varied depending on whether the teen (and his parent ) were smokers themselves. The teen’s receptivity to his parent’s attitude and communication about teenage smoking, and about his/her particular smoking, was directly affected by whether the parent smoked currently, or in the past, and what the parent’s attitude about it was as well as how openly the parent opened up to his teen about it.

While the study was a controlled assessment of teen-parent communication about smoking cigarettes, it’s important to note its implications for family communication about substance abuse, and other taboo issues. There’s no doubt that communication is extremely important when it comes to these topics and that open communication often leads to better outcomes than ignoring or avoiding these issues.

The results – Talking to teens about smoking can help if it’s done right

Communication patterns and their effect depended greatly on who the teen was speaking to – with mothers, expressing more positive expectancies about cigarette smoking predicted more persistent smoking while with fathers more disapproval during conversations predicted lower chances of persistent smoking.

The researchers found that non-smoking parents who had frequent and quality communication with their teenager about smoking had a consistently positive effect on reducing the chances that their teen will continue to smoke. However, the results revealed that if the parent smoked their influence through communication was much more complicated. For fathers, past smoking combined with a lot of teen disclosure predicted much greater likelihood of continued smoking – it’s the “war story” sort of effect with parent and teen sharing experiences and little disapproval leading to no reduction in experimentation. For currently smoking mothers the important factor was also disclosure but this time by the parent – if the mother shared little about her experiences, the effect on teen smoking was small but if she shared a lot, the odds of persistent teen smoking went way down. When non-smoking mothers talked a lot about the consequences of smoking, the probability of persistent teen smoking went up – kids don’t like being preached to.

What does it all mean?

Overall, the study’s results suggest that teens are highly suspect of hypocritical preaching and are very much influenced by communication patterns with their parents. Specifically, the study revealed that when a mother was a current smoker, if she communicated openly to her teenager that she had struggles about smoking and the difficulty of quitting, there was a positive effect on the teen’s eventual decision to stop. But for former smoking fathers and non-smoking mothers, talking at length about the teen’s experiences smoking and about the negative consequences of smoking respectively were not productive and actually increased the probability that the teen would still be smoking six months later.

As the authors note: “… current smoking mothers who are highly disclosing may acknowledge their own struggles around smoking and their difficulty asking their teens to “do what I say not what I do.” Openness about this struggle may help adolescents deal with the issue of “mixed messages” when a parent is a smoker. In contrast, the impact of maternal elaboration of rules may be attenuated when mothers have been active smokers because the parents’ own behavior is contradictory.” Reducing hypocritical messages and communicating openly about these difficult issues seems to be the way to go.

When taking all these findings into account it would seem that passivity on the part of a parent rather than communicating with the teen seems to be received by the teen as a silent approval of smoking. However a parent’s open and transparent sharing with his teen about his own regretted decisions, and the difficulty that has resulted, can have a very positive effect on the decisions the teen makes.

The bigger picture

If these things are true with cigarette smoking, would they not also be true regarding experimentation with other substances? Can parents open up about their experiences to their teens, expose their difficulties and vulnerabilities, and give the teen the gift of a loving parent’s experience?

Maybe more importantly, when thinking about the right ways to engage in teen-parent communication about difficult issues, a little insight into family dynamics that may have an impact on the discussion seems crucial. I often get questions from parents I know about the most appropriate way to talk to kids about drug use. This research seems to carry the following message – don’t preach if you haven’t been there and don’t be hypocritical if you have – open communication that guides the teen toward the desired behavior without letting them discount the impact of their choices seems the best idea.

Before we go, it’s important to note that this study used only a six-month follow-up and that future studies should really examine more long-term effects of family communication patterns in order to increase our confidence in these results. It’s possible that family communication can have a long-lasting effect or that it needs to be re-enforced on an ongoing basis. This study doesn’t tell us much about that.

Citation:

Lauren S. Wakschlag, Aaron Metzger, Anne Darfler, Joyce Ho, Robin Mermelstein, and Paul J. Rathouz (2010). The Family Talk About Smoking (FTAS) Paradigm: New Directions for Assessing Parent–Teen Communications About Smoking. Nicotine and Tobacco Research.

Will you get addicted? Signs of drug abuse

Everyone wants to know if they can become addictedEveryone wants to know if they, or someone they love will get addicted to alcohol or drugs.

• Parents want to know if their children are likely to become addicts, especially if there is a family history of addiction.

• Teens wonder if trying a drug will lead to a life of crime and shame.

So what are the signs of drug abuse?!

Unfortunately, I have to start with the answer you probably don’t want to hear: no single factor can be said to fully predict substance abuse. Instead, the equation can be thought of as an interplay of risk-factors and protective-factors.

Having family members with alcohol- or drug-abuse problem is an example of a risk-factor. The more risk-factors a person has the more likely it is that person will become addicted. Some risk factors interact to make the likelihood of addiction much greater than either factors alone.

Protective-factors are life events or experiences that reduce or moderate the effect of exposure to risk factors. Some examples of protective factors are: parental-monitoring, self-control, positive relationships, academic competence, anti-drug use policies, and neighborhood attachment.

Risk Factors Vs. Protective factors – An implicit battle

There are five categories of risk and protective factors including individual, school, peer, community and family. Examples of protective factors within the individual category include social skills and responsiveness, emotional stability, positive sense of self, problem solving skills, flexibility, and resilience.

Other aspects of the individual category include the gender and ethnicity of a person. Men are generally more likely to become addicted (likely because they are less prone for internalizing issues like depression). American-Indians are genetically more sensitive to the effects of alcohol, while about 20% of the Jewish population may have genetic variations that protect them against alcoholism. Overall, estimates regarding the genetic influence on addiction risk range from 40% to 80%. Much of that genetic risk lies in changes related to the functioning of neurotransmitters that play a part in the development of addiction such as GABA, serotonin, dopamine, NMDA. Those with mental disorders of all types are at an increased risk for developing an addiction.

Some factors, like stress, can be considered part of multiple categories. Individual variability in stress response (via the HPA Axis) would be part of the individual category, while levels of environmental stress can be part of the other four categories.

questioning-terrierThe home and school life of a child (part of the non-individual categories) can play a large role as either risk-, or protective-factors. If a child sees elders using drugs, they may view drugs as harmless, but children who are well prepared by their parents may better resist peer-pressure to use drugs. As we stated before, the earlier a person begins to use drugs, the more susceptible they are to harmless effects on brain structures and other bodily functions.

Certain methods of using drugs can also be considered risk-factors. Smoking or injecting a drug causes it to be more quickly absorbed into the bloodstream, producing an almost instantaneous high when compared with eating or drinking a drug. However, the quick rush of euphoria may soon dissipate and leave the user feeling the “rebound effect” making them crave the high again. This quick, short lasting, cycle is believed to encourage the user to want to the drug again in hopes of reaching that high.

Overall there is no one thing that can predict or protect against addiction. Instead, a combination of factors are always at play and the more aware a person is of these factors the more able they are to protect themselves.

Co-authored by: Jamie Felzer

Citations:

http://www.psychiatry.ufl.edu/aec/courses/501/risk%20and%20protective%20factors.pdf

http://www.drugabuse.gov/scienceofaddiction/addiction.html

http://www.aadac.com/documents/profile_youth_risk_protective_factors.pdf

 

Addiction during the holidays: Recovered or not, it’s important to be prepared

Holidays can bring on stress for someThe holidays are a stressful time for everyone. Between gift-giving, travel, and keeping up with all parts of the ever-complicated modern family unit, nearly anyone can find themselves driven towards the nearest coping mechanism, whatever that may be. However, for recovering addicts, or those still struggling with an active addiction, the holidays can be a particularly troubling season that can invite a destructive relapse. As with all mental and physical health issues, education and awareness are a powerful first line of defense. By going over some of the most frequently asked questions about addiction and the holidays, we can attempt to shed some light on these issues for addicts and their families to help combat them before, not after, they become bigger problems (like a relapse).

Why Are The Holidays So Difficult For Addicts?

Obviously, as just mentioned, the pressures of the holidays are difficult for everyone. But for addicts, these same issues of money, family and general stress are amplified, often because they are the same age-old issues that lie at the root of the addiction and the beginning of drug use and abuse in the first place. If the recovering addict has not had the opportunity to openly confront family issues in the past, either with the family itself or with a therapist or counselor, the potential for relapse can be great. A vast amount of research shows how stress can bring even long-dormant behavior back to the surface, which should serve as a warning to substance and behavioral addicts alike (like sex addicts or compulsive gamblers). On the other end of the spectrum, addicts without a stable family or group of friends are often left feeling alone and isolated during the holidays, another powerful source of the shame and boredom that can drive addictive behavior.

What Are Some Of  The Hidden Struggles That Can Intensify Addiction/Trigger A Relapse?

Most often, these struggles emerge from one of two likely scenarios. In the event of a still active addiction, attempts to hide the problem from friends and family and the resulting stress can, paradoxically, intensify the addictive behavior. And whether the addiction has been treated or not, gathering with family in a familiar place can frequently cause someone to face many of the underlying issues that can be the root causes of a drug addiction or compulsive behavior. To paraphrase Tolstoy, all unhappy families are unhappy in their own unique way, and whether one’s particular family is overly judgmental, enabling, angry, or whatever else, it can serve to restart self-destructive patterns of behavior. For some recovering addicts, there may be a family-imposed secrecy around the recovery itself, which can be trying at a time when the whole family is gathering, ostensibly to celebrate one another. Even the house (including the room where an addict used to act out) and certain family members (like that cousin they used to smoke weed with) can be important cues that may re-trigger cravings and old behavioral patterns. Additionally and importantly, if there is a family history of any kind of past abuse, this can obviously serve as a particularly powerful and insidious trigger for addicts, whether recovering or not. In fact, recent research suggests that these old, root stimuli may be much more powerful for drug addicts than re-experiencing the drug itself.

What Are Some Strategies For Surviving The Holidays?

First and foremost, one must be prepared. Since most people at least know and are aware of the potential issues that might arise within their own families, it is crucial not to try to “wing it.” If you know that your family is going to be asking lots of uncomfortable questions, practice some appropriate answers and don’t feel obligated to discuss any aspect of your recovery that you’re not comfortable discussing. If your family is overly focused on achievement or likes to bring up stories from the past that are triggering or shameful, rehearse your reactions to them. If you have a friend or significant someone who can help, do a little role-play trying out different answers and see how they feel as you actually say them out loud. It will never be exactly the same as you practice, but being prepared can go a long way towards taming the body and brain’s natural stress responses. Just as importantly, if you know you’re liable to encounter events or people that formerly facilitated addictive behavior, role play those likely scenarios and know how you plan on turning down or avoiding those substances or behaviors. For instance, figure out how exactly you’re going to tell your cousin you aren’t going to smoke in the basement with him before you have to actually do it. It will sound a lot less forced and strange the second time around and you will have already experienced some of the associated anxiety. If you’re going to be alone, make distinct plans for your activities and do the best you can to find healthy situations to participate in, even if they seem new or slightly uncomfortable at first. For instance, go ahead and join that group of strangers for a Christmas eve dinner or Christmas day movie instead of spending those times along. After all, uncomfortable or not, a new, healthy experience will be vastly preferable to sliding back into the same old destructive patterns of the past.

Should I Use New Years To Confront My Addiction?

Most everyone is familiar with the New Year’s Resolution as a method of planning major life changes. Of course, most everyone is also familiar with the limited success rate of these resolutions, and of the effectiveness of “going cold turkey” in general. Depending on the addiction, there are certainly things that individuals can do to help themselves- for example, research suggests that when trying to quit smoking setting a quit date and beginning to use replacement patches or supplements in anticipation of that date (in other words, while still smoking) can help reduce the amount of smoking while approaching that quit date, making it easier when the day finally arrives. If you’re planning to quit a “harder” drug than nicotine, you may want to set a whole schedule for reducing drug use prior to the quit date itself. The important thing is to be completely realistic in order for the change to stick. If you’re drinking a bottle of vodka a day, attempting to go completely dry within a week can be extremely dangerous to your health, and will not likely result in a permanent change. Once again, education and preparation are key. Prepare for any sort of quitting by looking online on sites like AllAboutAddiction and WebMD, and identify the medical and psychological issues that are likely to accompany your attempt. Look to see if your problem is one that you can handle alone, or if it is recommended that a doctor help you with the process. Remember that your goal should be lifetime change, not a temporary one. Though it might seem counter-intuitive, if your holidays promise to be especially difficult or stressful, you may want to hold off on trying to quit during them and look at them as a time to lay the groundwork for your post New Year quit attempt rather than going for a full on cold turkey try. Such pragmatism may well help you achieve your true goal.

“Addicted” – Recovered and Helping: The reality (tv) of addiction treatment.

With the success of shows like A&E’s Intervention and Celebrity Rehab with Dr. Drew, America has shown an almost insatiable appetite for television programs that deal with addiction. Whether this reflects the breadth and depth of the addiction problem in this country or a national appetite for tragedy and schadenfreude is open for debate, but regardless, TLC has now thrown its own hat into the ring with a new series, Addicted, that follows a trained family interventionist who is, herself, a recovering addict. Though the line between education and exploitation in such shows remains a debatable matter of personal opinion, it calls to our attention a crucial element in modern addiction treatment: the unique position of the recovering addict to make a positive difference in the lives of those still caught in the grip of dependency.

Hey, it’s what got me starting this website over three years ago.

Addicted on TLC – Addiction treatment reality

Kristina from the TLC show AddictedKristina Wandzilak, the main character of the TLC “Addicted” show, is a professional interventionist specializing in family-style interventions, targeted towards not only the addicts themselves but the families for whom having an addict as a family member has destabilized their lives and sense of control. The central philosophy of family-style intervention revolves around working not only with the addict but with the entire family to restore that feeling of control and healthy boundaries, after which, the theory goes, recovery of the chemically dependent individual can follow. Wandzilak’s faith in this style of addiction treatment is hard-earned; as a cocaine and methamphetamine addict, she cites her own mother’s ability to establish a firm boundary and “walk away” as the impetus for her to finally get clean.

Wanzilak’s story is a sadly common one. Falling in love with alcohol from her first drink at the age of 13, addicted to cocaine and methamphetamine by age 15, and in and out of treatment by 18, Kristina was clearly on the fast path to an early grave. Returning home after another escape from rehab, she was turned away at the door by her mother, a firm line she would later credit as the first step to her recovery. Though the next three years of her life would involve a continued spiral of cocaine and methamphetamine addiction, prostitution, and robbery, it was allegedly at a moment of complete rock bottom that her mother’s strength and grace in turning her away served as the inspiration for her to finally take control of her own life. After seeking her own addiction treatment, Kristina has now been sober since September 4, 1993 and calls this the greatest accomplishment of her life. In her words, she feels that if she helps families to embody the strength that her mother had in dealing with her, the addicts will be forced to “run into themselves” and thus find sobriety soon thereafter.

A note here – I’ve talked about the difference between positive reinforcement and punishment before, so I won’t go into it at length here, but I think it’s important to keep in mind the fine line between helping someone by keeping consistent boundaries and hurting them by refusing to help. With this show just starting, I really hope that this line is kep in mind and that the producers, and Kristina, don’t use it for ratings rather than helping those in need.

Where would addiction treatment be without recovered addicts?

The question stands- does Kristina Wanzilak’s or any other addict’s past with addiction make them more qualified to help those now suffering through the same issues? Many people feel that this is the case, including qualified specialists like Dr. Drew Pinsky, who takes most of the staff for his VH1 series Celebrity Rehab with Dr. Drew from a group of former addicts. Regulars on Celebrity Rehab with Dr Drew include technician Shelly Sprague and counselor (and program director of the Pasadena recovery center) Bob Forrest, both highly trained and qualified addiction specialists whose own experiences as addicts serves as a tool for understanding and gaining the trust of difficult patients, as well as promoting these people as living examples of the possibilities that await even the most seemingly hopeless cases. Sober houses are also overwhelmingly run by recovering addicts who can teach the newly sober a structured lifestyle and tricks to keeping focused on recovery. Our own Adi Jaffe, director of All About Addiction, is a recovering addict himself (check out his story on the Press tab). As we see recovering addicts step up to help those that remain trapped in a life of getting high, we are increasingly made aware of their unique ability to make a difference in lives that many had considered lost. Addicted on TLC is keeping that trend going.

Nevertheless, I don’t believe that having personal experience is necessary for becoming an addiction counselor or specialist, though it likely helps keep the motivation level high in a relatively stressful occupation. One thing is certain, seeing these examples of recovered addicts who are helping others is certain to do a lot of good to the addiction stigma I hate so much!

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)