What Is an Addiction Intervention?
It is a planned effort by family and friends to get someone with a drinking or drug problem to accept treatment. This article is about that family meaning. Searches for an interventionist in Ohio also turn up school intervention specialists, which is a different job.
The kind most people picture is the Johnson Intervention. Researchers describe it as “a therapeutic technique in which members of the person’s social network confront him or her about the damage the drinking or drug use has caused and the action they will take if treatment is refused” (Loneck and colleagues, 1996).
There are other ways to do it, and in a randomized trial one of them, CRAFT, got more loved ones into treatment than the Johnson model.
Three Approaches
| Approach | How it works | Group meeting? |
|---|---|---|
| Johnson model | Family and friends rehearse, then confront the person together, with consequences if they refuse | Yes, a confrontation |
| ARISE | Family members openly invite the person to a meeting and add effort only if needed; a confrontation is the last step | Yes, by invitation |
| CRAFT | A counselor coaches one family member over several sessions to encourage change and treatment at home | No |
ARISE stands for A Relational Intervention Sequence for Engagement. Its developers call it “a graduated continuum starting with the least demanding option/stage, increasing effort as needed to engage substance abusers in treatment/self-help” (Landau and colleagues, 2004). It was built to be “less confrontative, thereby avoiding the reactivity in clients and family members that such confrontational approaches have tended to evoke,” and to aim at “enrolling substance abusers in outpatient (as well as inpatient) treatment” (Garrett and colleagues, 1998).
CRAFT is Community Reinforcement and Family Training. SAMHSA, the federal Substance Abuse and Mental Health Services Administration, describes it as “a structured, family-focused, positive reinforcement approach, usually four to six sessions in length, that teaches family members and CSOs strategies for encouraging the family member who is misusing substances to change his or her substance use behaviors and enter SUD treatment” (TIP 39). CSOs are concerned significant others, the family and friends. Our article on enabling covers CRAFT in more detail.
Do Interventions Work?
The best comparison is a randomized trial of 130 family members, each given 12 hours of help with one of three approaches (Miller, Meyers and Tonigan, 1999):
- “The CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the more commonly practiced Al-Anon (13%) and Johnson interventions (30%).”
- The Johnson model’s weak spot was follow-through: “most CSOs decide not to go through with the family confrontation (70% in this study) and that among those who do, most (75%) succeed in getting the drinker into treatment.”
- “All 3 approaches were associated with similar improvement in CSO functioning and relationship quality.”
A 2010 review of four randomized trials found that CRAFT produced “three times more patient engagement than Al-Anon/Nar-Anon” (Roozen and colleagues, 2010).
The Johnson model has evidence on both sides. In a retrospective study of 331 outpatient cases, “Those who had undergone the Johnson Intervention were more likely to enter treatment than those in any of the four other groups” (Loneck and colleagues, 1996). The same researchers then found that “Those in the Johnson Intervention group were more likely to relapse than three of the four other groups” during outpatient treatment (Loneck and colleagues, 1996).
ARISE reported an “83% success rate (55% at Stage I)” in 110 cases at two New York clinics (Landau and colleagues, 2004). That study had no comparison group and was run by the model’s developers, so the figure is not directly comparable. It also found that “The more significant others involved, the greater the success of treatment engagement.”
In 2020 SAMHSA took the Johnson model out of its guidance for family therapy, TIP 39: “The Johnson Intervention, which was included in the previous version of this TIP, has been removed.” Its reasons: “this evidence is largely from 1999 to 2004 with no recent data in support. Also, it appears this model may do more harm than good, with several researchers noting that many families find it overly confrontational, judgmental, and blaming, and hence most families do not go through with the session wherein they actually confront the client.”
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) agrees in its Alcohol Treatment Navigator: CRAFT “has been shown to be more effective than confronting the person in an ‘intervention.’”
Why Confrontation Often Backfires
SAMHSA’s TIP 39 says: “People pressed into SUD treatment by confrontation are more likely to return to use than those encouraged to enter through positive reinforcement.”
A trial of counseling styles points the same way. With 42 problem drinkers, “The directive-confrontational style yielded significantly more resistance from clients, which in turn predicted poorer outcomes at 1 year,” and “the more the therapist confronted, the more the client drank” (Miller, Benefield and Tonigan, 1993). That study was about counselors, not families.
The picture is not one-sided. A 2023 review across addictions found that some family outcomes were better without confrontation techniques, while “Relationship functioning outcomes were improved by the inclusion of BCTs within the Confrontation of the Addicted Person to Engage in Treatment group” (Merkouris and colleagues). BCTs are behavior change techniques.
How to Plan the Conversation
Whatever approach you choose, the NIAAA’s Alcohol Treatment Navigator gives advice that fits:
- Prepare. “Think about what you’re going to say before you say it. Maybe even do a role-play practice with someone else.”
- Keep the tone kind. “try to adopt a nonjudgmental tone. Showing some empathy may lead to a more productive conversation.”
- Do not corner them. “Don’t gang up on the person or back him or her into a corner. You want your loved one to feel supported, not threatened.”
- Pick the time. Not when your loved one is intoxicated: “This conversation should wait until he or she is safe and stable. If your loved one is in crisis, call 911.”
Arrange the next step first. Know where the person could go for an assessment before you talk. Detox on its own is not enough: the NIAAA says “Detox alone is not the same as treatment” and “Research shows that people who go through detox without additional treatment are far more likely to relapse.”
Plan for withdrawal. Stopping suddenly can be dangerous. “When someone who has been drinking heavily for a prolonged period of time suddenly stops drinking, their body can go into a painful or even potentially life-threatening process of withdrawal,” the NIAAA warns. “Seek medical help to plan a safe recovery.”
Do You Need a Professional Interventionist?
Not always, but some families want help planning and running the meeting.
What Ohio licenses. Neither of the two Ohio boards that license addiction and mental health counselors has an interventionist license or certificate in its chapter of the Revised Code. What Ohio does license is counseling. Under section 4758.02, substance use disorder counseling for pay takes a chemical dependency counselor license or certificate, such as the LICDC or LCDC. Under section 4757.02, professional counseling and social work for pay take an LPC, LPCC, LSW or LISW license.
A private credential exists. The Pennsylvania Certification Board issues the Certified Intervention Professional (CIP), “A credential for professionals who have the primary role of facilitation and participation in substance use disorder interventions.” Applicants need two years of intervention work, 150 hours of education and ten interventions in the last three years, and must pass an exam. The board adds: “The CIP is not a marketer or recruiter for a treatment facility.”
Questions to ask an interventionist:
- Which approach do you use, and do you invite the person or surprise them?
- What training and credentials do you hold, and do you hold an Ohio counseling license?
- What is the fee, in writing, and what does it cover? We found no official source that publishes a typical fee.
- Do you receive anything from a treatment program you might recommend?
- How do you handle safety, including violence, withdrawal and suicide risk?
When a Family Meeting Is Not Safe
SAMHSA’s TIP 39 lists situations in which some family members should not be brought into treatment sessions. The same cautions apply to planning an intervention: “Such situations include when intimate partner violence has occurred, when child abuse or neglect has occurred, when individuals are currently withdrawing from substances,” and when the person with a substance use disorder is also struggling with psychosis or is suicidal.
Some risks to weigh:
- Violence. SAMHSA notes that an intimate relationship with someone who has a substance use disorder does not always involve violence. “However, intimate partner violence is common in such relationships and leads to negative, unhealthy dynamics.” If someone has been violent, do not confront them as a group. Get advice first, for example from 988, which takes calls about intimate partner violence.
- Suicide. A 2019 review in Alcohol Research: Current Reviews, the journal of the National Institute on Alcohol Abuse and Alcoholism, found that “AUD is a potent risk factor for suicidal behavior” (Conner and Bagge, 2019). AUD is alcohol use disorder.
- Overdose after a break. The National Institute on Drug Abuse warns that after time without using, “If a person uses as much of the drug as they did before quitting, they can more easily overdose because their bodies are no longer used to their previous level of drug exposure.” Our family guide explains how to get naloxone in Ohio and what to do in an overdose.
If the person may be a danger to themselves or others because of a mental illness, Ohio’s emergency hospitalization law, section 5122.10, lets certain professionals and police officers take them to a hospital for an examination. A family member cannot do that. Our guide to the Baker Act and the pink slip in Ohio explains how it works. In an emergency, call 911.
The 988 Lifeline is for more than suicide. The 988 Lifeline’s get-help page says “People do not have to be suicidal to call. Reasons to call include: substance use disorder, economic worries, relationships, culture and identity, illness, intimate partner violence, depression, mental and physical illness, and loneliness.”
If the Answer Is No
The NIAAA suggests giving the person time: “Maybe your loved one just needs a break from the discussion. Give him or her some time to think more about it.” And “If your loved one will talk but just doesn’t like the choices you’ve offered, you can ask again what kinds of help he or she might be willing to try.”
In the meantime:
- Look after yourself. Free family programs such as Al-Anon, Nar-Anon and SMART Recovery Family and Friends are covered in our article on enabling.
- Stop the behaviors that shield the person from the results of their drinking or drug use, as that article describes.
- If their use has become dangerous, Ohio’s Casey’s Law lets a spouse, relative or guardian ask a probate court to order treatment. Our guide to Casey’s Law in Ohio explains how.
Where Leora Behavioral Health Fits
Leora Behavioral Health is an outpatient provider in Columbus and Dayton. It does not provide overnight or emergency care.
A family member can call admissions on someone else’s behalf to ask how an assessment works and what the person should bring. The first visit is an assessment, which recommends a level of care.
If outpatient care fits, Leora runs partial hospitalization, Monday to Friday, 9:00 am to 4:15 pm, and intensive outpatient, three hours a day, three to five days a week. Leora also offers ambulatory detox for mild to moderate withdrawal, with no overnight stay. Leora accepts every Ohio Medicaid plan and every commercial carrier, and admissions can check coverage on the call.
Leora’s page for families has more on helping someone who does not want treatment.
If Someone Is in Danger Right Now
If someone is in immediate danger, call 911.
For a mental health or substance use crisis, call or text 988.
