Why should I hire an interventionist for a treatment pathway?

Nowadays, the term interventionist is becoming increasingly familiar in the context of a drug intervention, as seen, for example, on the RTL 4 programme “Verslaafd!”. These television programmes show only a very small part of the preliminary discussions, the intervention and what ultimately follows, mainly because such a format lasts only 45 minutes and is not a documentary. If we were to broadcast the process from beginning to end, including the intervention team’s discussions and consultations with the treatment team, it would quickly amount to around 100 hours, if not more.

To give you an idea of how it works, I will explain below what you can expect. There are officially several intervention styles that can be used, as well as combinations of them. I personally use the two in which I was trained: the Johnson Model and Arise®. Over the years, I have adapted these into my own approach, giving my intervention team and me the best chance of a successful process. By “successful”, we mean achieving the best possible outcome for the case as a whole, with the family surrounding the person with addiction considered just as important as the client. Sometimes this means taking drastic steps to safeguard the family and children. This is not always appreciated, and although I understand that, I do not always agree with it.

If the person with addiction, who at that point remains in active addiction, digs in their heels despite a sound plan being on the table that would enable them to accept the right help, it would be inhumane to leave the family around them empty-handed. They have worked towards this point and are themselves suffering terribly from the disease of addiction within their family system. The difference is that they are not the ones choosing to continue. The only option left is to support them in following their own path towards their own recovery. This never comes as a surprise, because it is clearly identified as one of the consequences in both the intervention documentation and the intervention itself. The position is that if the person with addiction does not accept the offer of help, the family has also “had enough” and will choose to protect themselves — for example, the person’s husband or wife. This does not happen without difficulty. It can sometimes create divisions among relatives within the intervention team, for example because the immediate family of the person with addiction, such as their parents, still wants to protect them, while we have set a clear boundary. That boundary is a professionally informed decision that should be upheld. Such division poses a risk to everyone, creates uncertainty and effectively deprives the person with addiction of a final push to listen to the offer and plan one more time. Unfortunately, this happens frequently, even though we made it very clear in advance what could potentially happen during these intensive processes.

To prevent this, before we begin I always try to tell the family a simple story. “Think of the intervention as a cake. The knife cuts both ways. On one side is the family — the household, parents, brothers and sisters — and on the other is the person with addiction.” This means that if the person with addiction does not accept our offer, we make sure that everyone else still benefits from the intervention. This philosophy comes from both the Johnson Model and the Arise® technique. The person with addiction now knows that the family is speaking with the intervention team. The family accepts help for themselves regardless of what the person with addiction does. This empowers the family or household once again. In fact, if the person with addiction remains in contact with the interventionists for weeks after the intervention but still does not accept the right help in full, it is entirely possible that the family will be advised to take steps towards permanent separation. This is almost always done in consultation with other professionals involved with the family, such as child protection services, because it is a “last resort” and extremely distressing, particularly when young children are involved. This also happens regularly.

When a person with an addiction does accept help as a result of the intervention, they are almost never intrinsically motivated. In my view, however, the same applies to someone with an addiction who seeks treatment themselves. After all, the addiction itself creates that cycle of use: regret, wanting to use even more, followed by regret again. The thought of treatment and stopping never truly becomes: “Now I’m going to take action and do it.” The part of the brain capable of taking action has been hijacked. When we look at Prochaska & DiClemente’s Stages of Change Model, the small difference is that the person receiving the intervention is still at the pre-contemplation stage, while the person who seeks help themselves is at the contemplation stage. In pre-contemplation, there is no intention to change the behaviour; the person may not even know or be convinced that there is actually a problem. In contemplation, the person is aware that there is a problem but has not yet committed to making a change. In both stages, they are not quite ready. From a motivational perspective, the intervention partly focuses on the negative consequences if nothing changes now, while also rapidly applying motivational interviewing. As I see it, after the vulnerable, authentic letters have been read during the intervention, there is a very small window of opportunity. At that moment, I usually ask: will you accept our help?

The difference between several family members trying to initiate an intervention themselves and hiring a professional team is fairly simple. As care professionals and an intervention team, we are not personally or emotionally involved with the person, and we are professionally trained for this work. He or she does not know exactly which buttons to press with us, as they do with the family. In addition, in many cases someone on the intervention team has been through this hell too, creating a sense of identification from one human being to another. And, last but not least, a thorough collateral history enables us to assess in advance which residential setting will suit the client best. Not all treatment centres are willing to welcome intervention clients with open arms. A good interventionist, often in combination with their own facility, can arrange for a client to be admitted immediately to a place where they will receive the best treatment and can genuinely be seen within a day or two—in fact, as soon as the person with the addiction responds positively. As a team, we then try to ensure that everything can happen quickly, leaving no new opportunity to back out. Because, of course, it remains frightening: the unknown. In practical terms, this means booking tickets, selecting a “recovery companion” where necessary (someone who travels with the client in a professional capacity), finishing the packing and sometimes heading to Schiphol that very same day. Our team ensures that everything runs smoothly; we have a travel department, case managers and a team on the other side of the world. Because, yes, in my view it is important during an intervention for the person to go to the other side of the world, with South Africa being my personal preference. A country of blue skies, deep seas, eternal mountains and an unmistakably healing effect on everyone who stays there. A country where people were introduced much earlier, through missionaries, to the philosophy of AA: the twelve steps to recovery through a spiritual programme. A place where, for at least 20 years, Dutch people and other citizens of the world have been welcomed with the distinctive hospitality of the South African People. Alongside the breathtaking surroundings, the knowledge and expertise in treating addiction are also that little bit more rigorous and confronting, and treatment feels more authentic at our partner clinics than at just any treatment centre. This does require considerably deeper pockets, because not only the intervention—the entire project—is privately funded, but the residential admission is too. Since 1 January 2022 and the introduction of the new Care Performance Model (ZPM), we have no longer sent anyone to South Africa through their health insurer. An intervention makes matters more complicated in any case, because the health insurer must first issue prior authorisation, which takes at least 2–3 weeks. The client and the intervention team simply cannot wait that long.

A question that is often asked is: how high is the ‘lasting success rate’—in our terms, remaining “clean and sober”, or, as it is commonly put, “getting clean”? I will gladly return to that in another blog. In brief, several components are essential for lasting recovery from addiction. These include complete surrender, abstinence—total abstinence from all mind-altering substances—and arranging one’s own long-term aftercare by attending “meetings” held by one of the anonymous 12-step fellowships after returning from residential treatment. It is important not only to attend these meetings, but also to immerse oneself in them and continue taking action.