Arise Intervention

 

 

An intervention should be a professionally directed activity that involves educating both the members of the intervention team (friends and family members of the person being addressed) and the subject (the person being addressed by the intervention). Individuals who suffer from substance use disorders often do not pay attention to the ramifications of their behavior as it affects other people, since they are so wrapped up in their own desires and substance abuse that they actually do not realize how their behavior impacts their family, close friends, and themselves. This is often mistakenly given the label that the person is “in denial”; however, that label results from older Freudian notions of defense mechanisms that are not entirely consistent with the understanding of cognition and attribution theory today.

The goal of the intervention is to broaden the subject’s understanding of how they are affecting others and how they are being viewed from other perspectives, and to give them the opportunity to accept help from a professional source and make changes before the situation gets even worse. Much of the process of the intervention is an opportunity for the group (friends and family members of the subject) to come together, share information with one another, get support from one another, and learn more about the particular issue displayed by the subject. The intervention is designed to be a process that gets everyone involved and tries to reach the end goal of getting the subject help. Interventions are generally not designed to be confrontational or a chance to vent frustration at the subject.

Unfortunately, many depictions in the media present interventions in this manner. There are some cases in which the subject is so wrapped up in their behavior, or their behavior is directly threatening the health of a minor or some other individual, that specific demands must be made regarding the person stopping their behavior. However, in most cases, the intervention team has limited power in getting the subject to agree to get into treatment.

Many models of intervention suggest that the team members decide on specific consequences for the individual if they do not get treatment such as no longer having contact with them, withdrawing financial support, etc.; however, these consequences cannot force an individual to change their behavior. Such consequences can only act as motivations for the individual to view their behavior objectively and commit to trying to change themselves. The general approach used in the intervention should be founded on one of concern and caring for the target individual and not one of retribution and punishment.

There are several different models of interventions that can be considered. One of the most important considerations individuals should make when deciding whether to hold an intervention or not is to ensure that they enlist the help of a professional interventionist or a professional mental health worker who specializes in the treatment of addiction. There are several reasons:

• Knowledge: Professional interventionists or mental health workers have a broader understanding of substance use disorders and of how to intervene in such cases than laypersons do. Utilizing their expertise and knowledge will result in an increased probability that the goals of the intervention will be met.
• An objective viewpoint: Having a professional direct the intervention injects an air of objectivity into the process. Professional interventionists or mental health workers are concerned for others; however, they are not driven by strong emotional ties to the person or by the need to “fix” or to control the person. This allows them to consider all sides of an argument, keep the interaction from being confrontational, and focus on the goal of the process.
• Experience: These individuals have experience in dealing with all levels of resistance from individuals who have substance use disorders. This allows them to actually anticipate many situations or barriers to the process and address them before they actually come up.
• Professionalism: A professional interventionist or mental health worker provides an air of professionalism and credibility to the intervention process. This can help the intervention to remain focused and achieve its goal.

 

One of the more prominent models used in organizing and staging an intervention is the ARISE model. According to several academic sources, such as the book Substance Abuse and the Family, the ARISE model is based on a model of family therapy formally known as the Rochester Model of family therapy. Now, it is is referred to as the Transitional Family Therapy theory (TFT). Thus, the ARISE model was previously referred to as the Albany-Rochester Intervention Sequence for Engagement, but also has become referred to as A Relational Intervention Sequence for Engagement (ARISE).

TFT is a non-blaming, nonjudgmental, and family approach to engaging individuals with substance abuse in treatment. The ARISE model was developed in reaction to issues individuals had with following through when they attempted to apply another well-known intervention model, the Johnson Model. Individuals attempting to employ this model of intervention often did not follow through because they believed that the intervention would risk their relationship with the subject as a result of forcing too harsh a confrontation with that person.

The ARISE model works on getting as many concerned others from the subject’s support network to engage in overcoming any resistance to treatment. This model is very apt to engage as many family members as possible in the intervention, as the research indicates that most individuals with substance use disorders still have close ties to their families.

The ARISE model is also the model that is heavily endorsed by the Association of Intervention Specialists (AIS), a national organization that trains professional interventionists and assists individuals in setting up and implementing a professional and successful intervention.

This model is based on a three-stage graduated continuum of intervention that begins with the least demanding option for the subject and increases the demands and effort in getting the subject into treatment if the person does not engage in treatment at the prior level. Thus, unlike many models of intervention and the stereotyped intervention model portrayed in the media, the subject becomes part of the process from the very beginning, whereas other models have initial planning and rehearsal sessions that do not include the subject.

The three stages the ARISE process are:

• Stage I: The first stage begins when a loved one contacts a mental health treatment professional, treatment program, or intervention specialist to get help for their loved one. The individuals discuss actually performing the intervention by getting as many concerned family members and friends involved as possible. In some cases, the very act of organizing the intervention gets the subject to agree to go to treatment; however, in most cases, an actual face-to-face meeting to plan the intervention is required. A mental health worker or interventionist helps to organize the support group, and the subject is encouraged to attend the first planning meeting and discussion. In their experience, AIS reports that as a result of this first meeting slightly over half of subjects decide to attend treatment.
• Stage II: The second stage of the intervention occurs only if the subject has not entered treatment as a result of the first stage. The sessions in Stage II are devoted to discussing the strategy, plans for the intervention, and determining if there are any other people who might be recruited for the intervention. In addition, these planning meetings attempt to determine concrete and enforceable consequences for the subject’s behaviors if the person does not enter treatment. The subject is encouraged to attend these planning meetings; however, they may not attend if they do not wish to. Typically, there are between one and five meetings in this stage, and the actual intervention is planned, rehearsed, and organized. If the subject attends these sessions and does not agree to enter treatment, the third stage is implemented. AIS reports that 80 percent of remaining subjects attend treatment following this stage.
• Stage III: The final stage is the controversial aspect of the ARISE model. A number of techniques from TFT are utilized, and the group presents their concerns to the subject as well as the decided-upon consequences for that person if they decide not to enter treatment. This stage is designed to be quick and efficient. AIS reports that 83 percent of remaining subjects enter treatment following the stage.

The ARISE model is designed to be completed relatively quickly despite all the projected meetings. The goal is to get the individual into treatment as soon as possible, and the model typically does this within 1-3 weeks, whereas other models take significantly longer.

 

Independent empirical studies of intervention models are surprisingly rare. However, a much cited study published in The American Journal of Drug and Alcohol Abuse in 2004 indicated that when the model was introduced to a number of individuals with different types of substance use disorders, it had an overall success rate of 83 percent in the sample. More than half of the individuals committed to treatment after the first stage. There were no significant differences observed in individuals committing to treatment by the type of substance use disorder they had, according to their age, or based on their gender, indicating that the model, when properly implemented, can be successful for a number of different individuals with different types of substance use disorders.

The ARISE model demands that all individuals involved in the intervention do an equal amount of work to become equally involved in the process. In addition, the model begins as a totally supportive approach and becomes more confrontational as the stages advance and the target individual refuses to engage in treatment. This helps to optimize motivation in both the subject and members of the intervention team, but the model never reaches the point of aggressive confrontation as depicted in many media outlets. Thus, this model is designed to be effective in reaching the goal of getting the person with the substance use disorder into treatment as quickly and efficiently as possible, but without significant strain on the person’s relationships with all individuals involved.

Finally, it is important to emphasize that this model is designed to have concerned family members, friends, and other individuals close to the person with a substance use disorder work together with either a professional interventionist or mental health professional (or both) to organize and implement the intervention. The methods, organization, and recruitment process are best implemented with professional help and not in an impromptu manner.

By using a professional interventionist or clinician and a targeted model to guide the group, concerned individuals can be successful in convincing a loved one with a substance use disorder to get help. Individuals interested in employing this type of model should contact a substance use disorder treatment clinic, substance use disorder treatment professional, or a professional interventionist to discuss an effective method of implementing the model for their particular circumstances.