According to the National Institute on Drug Abuse (NIDA), family interventions are specific types of substance abuse interventions where the intervention team consists of family members and close friends of the person who is the subject of the intervention. A substance abuse intervention is a concerted effort by individuals to convince a person to seek treatment.
Interventions have been given some exposure through the media and on various TV programs, and they are often portrayed as being far more confrontational than they should be if they are to be successful. There are several different models of substance abuse interventions. One model that has received substantial publicity is the Love First intervention.
The Love First Intervention
The specific features of the Love First intervention are outlined in the book Love First: A Family’s Guide to Intervention by Jeff Jay, a professional interventionist and certified addiction counselor and his wife Debra Jay, an author and lecturer. The book was first published in 2000, and a second edition was published in 2008. The book is largely responsible for the popularity of this intervention method, which does not differ significantly from several other intervention methods.
According to the book, the Love First intervention model is an attempt to get the family and friends of an individual with a suspected substance use disorder to come together and develop a concrete plan to get the person involved in treatment. The information in this article about this model is taken from the second edition of the book.
- The team makeup: There should be between three (suggested minimum number) and seven (suggested maximum number) team member participants. The team participants should be family members, close friends, employers, and even healthcare professionals who know the individual. One member of the team is selected to be the team leader, and some teams may wish to hire a professional interventionist who is trained in this type of intervention to lead the team. Team members should not be minor children, friends of friends who do not know the subject well, and non-involved observers. The team will typically have several meetings before actually performing the intervention.
- Letter writing: Each member of the intervention team is asked to write a letter, referred to in the book as an “intervention letter.” The letters are the core component of the Love First Intervention. The letter should have four specific sections:
- The first section should be a summary of the relationship between the writer and the person with a substance use disorder. This section can include whatever information the writer wishes to use, such as how the two met, different types of experiences the writer and the person have shared, how much they care for one another, etc.
- In the next section, the letter should list specific occurrences within the last year where the individual’s substance abuse has led to an embarrassment or another emotional reaction in the writer.
- In the next section of the letter, the writer encourages the person with the substance use disorder to look at the consequences of their substance abuse and enter treatment. This section is labeled “statements of concern” and often concentrates on the health issues associated with substance abuse. These statements of concern are not threats but instead consequences of prolonged substance abuse. These statements are designed to convince the person to enter treatment. The writer then encourages the person to commit to treatment.
- In the last section of the letter, the writer outlines the types of consequences that will be placed on the person if they do not change their behavior by entering treatment immediately. This section is often written on a separate sheet of paper and referred to as “the bottom line” by the team. The consequences can be numerous, such as cutting off all contact with the individual, not supporting them financially, trying to get custody of dependent children, etc.
- Rehearsals: Once every member of the team has completed their letter, they read the letters to one another in order to fine-tune them. Threats, hostile phrases, name-calling, etc., are removed from the letters, and the team members attempt to promote positive approaches. Often, the team leader will organize the team so individuals who have written the most emotional letters or who have the most influence on the person will read their letters last.
- Preparation for treatment: Each letter concludes with an encouraging note to persuade the individual to enter a treatment facility that day. The team members choose the inpatient treatment program that they think is most appropriate for the individual and strongly encourage the person to enter the treatment program right then and there. Team members will typically:
- Make sure the treatment program is appropriate for the person by confirming it is covered by insurance or financially feasible, the program fits the needs of the individual, etc.
- Pack a suitcase for the individual so they may leave immediately.
- Arrange to have an admission appointment already in place at the chosen facility.
- Arrange for all of the individual’s responsibilities to be taken care of while they are in treatment, such as childcare issues, boarding pets, and even contacting the individual’s employment (when it is legal and appropriate to do so).
- Prepare the facility by sending the intervention letters there, discussing issues with the admissions department, and paying any initial copayments.
- Arrange for transportation to be available from the meeting to the treatment facility so the individual has no time to think things over and change their mind.
- The actual intervention: The intervention takes place at a neutral meeting site, and the actual intervention is planned and structured in advance. The addict is unaware of the reason for the meeting, and once the person is there, the team leader introduces the individual to the purpose of the meeting. After the introduction is completed, each team member reads the first three sections of their letter out loud in the specified order. The “bottom line” portions of the letters are not read at this time.
At any point during the reading of the letters, if the individual agrees to enter treatment, the meeting is terminated, and the individual is taken to their treatment program. If the individual refuses to enter treatment after all the letters have been read, then each team member reads the “bottom line” section of the letter out loud. Once these sections are read, the individual is given the choice of entering treatment or suffering the consequences. At this point, all family members and friends must be committed to following through with their stated consequences if the person decides not to enter treatment.
Because this is a confrontational intervention, the subject may become very upset, get angry, or try to leave. If the individual becomes reactive and angry, the person who is currently reading their letter simply waits for the person to stop talking and then continues reading. If the subject attempts to leave the intervention, one or two team members accompany them and encourage them to come back to the intervention. If the person does not return, the team members are forced to go ahead with their proposed “bottom lines” without notifying the individual. In some cases, an additional meeting may be scheduled.
There is no formal timeframe for an intervention. They can be relatively brief if the person agrees to treatment early in the process, or they can last for several hours. According to Love First: A Family’s Guide to Intervention, 95 percent of the time, team members don’t read their “bottom line” statements. This seems to be an estimate based on anecdotal evidence, as there appears to be no solid statistics regarding these figures. In addition, there appears to be no significant impartial research data regarding the effectiveness of this technique.
The written letters that have been sent to the treatment program remain available for both the person’s treatment providers and for the person in treatment to review if they believe they need to do so. For instance, if the individual attempts to leave treatment prematurely, their therapists can have them reread the letters. The individual can also review the letters to strengthen their commitment to recovery. If the individual leaves treatment or has a relapse after completing treatment, the team members may perform another intervention.
Does the Approach Work?
There does not appear to be any significant empirical data other than anecdotal information provided in the book regarding the effectiveness of the Love First intervention model. The “bottom line” section of the Love First intervention model qualifies it as a type of confrontational intervention where team members make demands of the subject of the intervention and attempt to impose strict consequences on them if they do not comply.
There is some research investigating the effectiveness of confrontational interventions. For instance, a 1989 research study suggested limited success rates for interventions that were confrontational, and several follow-up studies have suggested that even though confrontational interventions may have some success in getting individuals to enter treatment, those who enter treatment as a result of confrontational interventions appear to have higher dropout rates than those who have experienced more supportive interventions. It is hard to generalize this research to the Love First intervention model because these previous studies looked at intervention styles that may have been harsher in nature than the Love First program. However, research studies looking at success rates of other models of interventions, such as the Johnson Model (perhaps the first formal intervention model), also suggest limited success for these interventions because team members often do not follow through with the actual intervention.
One potential factor in performing a successful intervention is for team members to continue to provide strong support for the individual while they are in treatment. Team members who continue to work with the individual to keep them involved in aftercare following structured treatment contribute to the long-term success of an intervention program. Individuals who simply complete inpatient treatment programs and do not become involved in aftercare once they are released relapse at rates that approach 100 percent.
The Love First intervention model encourages team members to remain involved with the person after the intervention and to attend 12-Step meetings, such as Al-Anon, to keep supporting their loved one. This type of continued involvement could contribute significantly to the individual’s successful recovery.