An intervention is an attempt by concerned family members, friends, and other loved ones of an individual with some type of a mental health issue, such as a substance use disorder, to discuss the ramifications of their behavior with the person and to convince the person that they need to enter treatment. An intervention is supposed to be performed in a nonconfrontational or nonthreatening manner, and it has the goal of “waking up the person” or enlightening them as to the destructive nature of their behavior.
This goal is accomplished by having the group of concerned others, or the intervention team, individually take turns and discuss the person’s behavior with them and explain how it affects them on a personal level. The hope is that when the individual with a substance use disorder learns of the ramifications of their behavior, they will see that their actions are destructive and out of control, and that they need help. The strength of the intervention is accomplished by using a nonthreatening confrontation and the expression of concern and caring for the subject.
The Development of the Johnson Intervention Model
Several different models of formal interventions exist. The first organized model of intervention and probably the most popular model of intervention that is used today has become known as the Johnson Model. This model is named after an Episcopal priest, Dr. Vernon Johnson, who himself was a recovering addict. He counseled a number of individuals with substance use disorders.
Dr. Johnson decided that the best way to coax an individual with a substance use disorder into getting help is to get concerned loved ones to approach them and address them in a nonthreatening manner regarding the ramifications of their behavior. He believed that when the individual was confronted by this group of concerned loved ones, they would become enlightened regarding their behaviors and the effects of their behaviors on others, and this would help to motivate them to seek treatment or would at least make them view and address the issue of their substance abuse.
Johnson described the initial aspects of his model in his book I’ll Quit Tomorrow. Dr. Johnson’s efforts to organize and plan a strategy using loved ones to get a person to seek treatment for their substance abuse problem is most likely not the first form of intervention implemented; however, it represents the first organized technique for this approach. In addition, the Johnson Model was certainly one the first models of intervention used by loved ones to address and challenge an individual with a substance use disorder to look at their behavior that emphasized concern and caring as opposed to using harsher forms of confrontation and accusations.
How Does the Johnson Model Work?
Although the model is implemented differently in different contexts, there are initially three planning sessions before the actual intervention is implemented. The first planning session occurs when one or more concerned individuals discusses the need for an intervention and enlists the help of an addiction treatment professional or interventionist to plan the intervention. These individuals get together and decide who would be appropriate to include in the intervention team.
Once the intervention team is identified, they are contacted, and a couple more planning sessions are implemented to determine the exact time the intervention will be performed, to discuss the dangers of enabling an individual’s substance abuse, to determine how the concerned individuals will address the subject during the actual intervention, and to organize and rehearse the various aspects of the intervention. The final stage involves the actual intervention with the subject, the group of concerned loved ones, and the professional therapist or interventionist.
The components of the Johnson Model are outlined below:
- The intervention team: The intervention team should consist of family members who are actively involved in the life of the individual, colleagues of the individual who interact with that person regularly and are affected by that person’s substance abuse, loved ones, and other important friends who are actively involved in the subject’s life. The person who moderates and organizes the intervention with the group should be a professional substance use disorder treatment specialist or a professional interventionist. Depending on the situation, this person may or may not be personally acquainted with the subject. This should be the only person participating in the intervention who is not personally acquainted with the subject.
- Planning sessions: As mentioned above, there should be several planning sessions to organize the intervention; most often, there are three. During planning sessions, the team of concerned loved ones is instructed to write letters describing how the subject’s substance abuse affects them, why they think the person needs treatment, and consequences that will be imposed on the person if they do not enter treatment. The letters are read out loud to the group, and members of the group help to edit and fine-tune them to delete material that would not facilitate the process of the intervention, such as accusations, emotional statements that are not based on facts, and other types of material that are not consistent with the spirit of the intervention. Planning sessions do not include the subject of the intervention.
- Singular focus: The only thing that should be discussed in the letters, during the planning stages, and during the actual intervention is the substance use/abuse of the subject. No other issues should be discussed. The reason for this is that it is easy for the intervention to get off track when individuals begin discussing past experiences that are not related to substance abuse, issues the subject may have with being depressed or unemployed, etc.
- Evidence-based information: There should be no speculation, implied accusations, or guesswork related to the subject via the means of letters, treatment, or other options. All information should be based on actual experiences and concrete evidence.
- A caring focus: The intervention should be focused on the concerned loved ones’ concern and care for the subject. There should be no yelling, blaming, accusing, etc. The goal of the intervention should be for the intervention team to explain their concern for the subject and to convince that person that they need help. No other agenda is allowed.
- The ultimate goal: The intervention team must agree that the primary goal of the intervention is to get the subject into treatment for their substance use disorder. Because of this, the intervention team should develop a list of at least three viable treatment options.
The model is often implemented differently depending on the therapist or interventionist involved; however, the basic model includes the components of intense planning, a focus on caring, the goal of getting the individual into treatment, and the offer of viable treatment options. If the intervention group does not present the subject with the more than one viable treatment option and asked the individual to make a choice, it is almost assuredly doomed to failure. This makes conceptual sense to most people. When an individual is given the option to search out and choose their own treatment options and to “wait until tomorrow” to get into treatment, very often, tomorrow never comes. Thus, successful applications of the Johnson Model get the individual to commit to one of the viable treatment options presented to them, immediately make arrangements to get that person into treatment, and a member of the intervention team escorts the individual to treatment.
Does the Johnson Model Work?
Research has suggested mixed results regarding the effectiveness of the model. An early study on the Johnson Model and other models of intervention published in the American Journal of Drug and Alcohol Abuse indicated that a nonconfrontational intervention style was more successful than a confrontational one (the Johnson Model is nonconfrontational); however, nearly 70 percent of social network interventions were not implemented past the planning stages. Often, during planning, many of loved ones fear that being part of the intervention will jeopardize their relationship with the subject or believe that the intervention is too confrontational despite the Johnson Model’s emphasis on caring. This failure to actually perform the intervention has led to the development of other intervention models that are more focused on completion.
Another early study published in the American Journal of Drug and Alcohol Abuse indicated that individuals exposed to the Johnson Model were more likely to enter treatment than individuals referred from other sources; however, they also were more likely to relapse. The researchers also concluded that individuals referred via the Johnson Model may be more likely to be retained in treatment after relapse than individuals who are referred for treatment from other sources.
Finally, a more recent and larger study published in the Journal of Marital and Family Therapy reaffirmed the notion that a good proportion of individuals attempting to stage an intervention based on the Johnson Model did not follow through to completion; however, when the intervention is performed, it is relatively successful at getting the subject into treatment.
The take-home message from the research regarding the Johnson Model is that there must be some strong incentive for the group of concerned loved ones to actually go through with the intervention, or it appears that many times the intervention gets into the planning stages but is actually not implemented. However, once the intervention is implemented, it is fairly successful in getting individuals with substance use disorders to consider treatment and even to enter treatment. Even though previous research has suggested that individuals who enter treatment as a result of being exposed to a Johnson Model intervention may relapse more frequently, relapse rates for substance use disorders are high across the board. It is doubtful that the referral process significantly affects overall relapse rates in individuals with substance use disorders.