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NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan in Washington.
Too often, drugs and alcohol can outweigh love, concern, common sense, even self-preservation. Desperate families find themselves in a painful, frustrating competition for the heart and mind of an addict: he's a different person now, I can't talk to her without her shouting.
One method some families try when they're at the end of their rope is intervention. You may have seen the reality series of that name on A&E. There was a storyline about it on "The Sopranos." Intervention is when concerned family and friends confront an addict.
There are two widely shared ideas about addiction and recovery that challenge the notion of intervention, though. First, that an addict has to hit rock bottom before he or she can start on the road to recovery and second, that treatment doesn't work unless the addict is willing to admit that there's a problem.
Bob Poznanovich believes both those ideas are myths. Poznanovich is the CEO of Addiction Intervention Resources. He joins us now from Minnesota Public Radio in Saint Paul, Minnesota.
Nice to have you on TALK OF THE NATION today.
Mr. BOB POZNANOVICH (CEO, Addiction Intervention Resources): Thank you, Neal. Nice to be on.
CONAN: And why is it a myth that somebody has to hit rock bottom before they can start back up?
Mr. POZNANOVICH: Well, I'm not sure why it's a myth or how the myth got started. But it's one of the biggest barriers, I think, to getting people help and one of the reasons that people stay sick. You know, it's really cruel to think in society today that somebody who is sick with an addiction - and I think it's important to recognize that, you know, addiction is a medical illness that's been recognized as such by the American Medical Association since 1956, has to somehow get worse before they get better. In no other illness would we suggest that somebody had to get worse before they get better. If you had diabetes, we wouldn't suggest that you have to lose a leg before we're willing to get you help.
CONAN: And the other part of that equation is the idea that for treatment to work, the client, the addict, has to be willing to admit that there's a problem.
Mr. POZNANOVICH: Yeah, once again, that's a myth that I'm not sure where and how it started. But that one couldn't be more untrue. There was a 20-year study done by one of the largest treatment centers in the world by the name of Hazelden who actually showed outcomes were higher for people that were intervened on than those that weren't.
CONAN: So, in other words, outcomes were better for those who were put into programs against their will?
Mr. POZNANOVICH: Right. And no matter what method of intervention it was, that people who go to treatment through an intervention process have more potential relapse doors closed, people know where they're going, there's less opportunity for them to hide what they've been doing. There's usually more people involved in their recovery and more people holding them accountable to do so.
CONAN: We're talking today about intervention. Do you have experience with it as someone who intervened with somebody else? Or somebody who's been intervened with? Give us a call, 800-989-8255, e-mail is email@example.com, you can also join the conversation on our blog, that's at npr.org/blogofthenation.
I should mention, later in the hour, we'll be talking about Venezuela's military which mobilized today. That, following a Colombian raid into Ecuador over the weekend. So we'll be talking about tensions in South America.
But our main focus this hour is on addiction and intervention. Again our guest is Bob Poznanovich, the CEO of Addiction Intervention Resources.
And as I understand your company, you do, well, sort of the approach - the approach to intervention, helping families decide how to go about this. How does that work?
Mr. POZNANOVICH: Well, families that call us, as you said in the introduction, are desperate. Something happened recently in their family, with somebody they love, and they're looking for help to reverse the situation. What we do in general is provide them support and we give them hope that they can do something, that they don't have to wait and they don't have to do nothing. That if they're willing to confront the addiction head on, that we're able to reverse that problem.
CONAN: I think all of us are familiar with that, you know, dramatic scene. And it's so dramatic, it's been used in, not just "The Sopranos," but a lot of other dramatic productions. And that's where the addict is confronted. But it doesn't begin there, there's got to be preparation.
Mr. POZNANOVICH: No, most of the work that we do is actually with the family and less with the addict. You know, addiction is really a family illness and affects everybody negatively who is associated with the addict, and the addict typically is not getting sicker by themselves without some help by the family. That help is typically in the area of enabling and other behaviors that allows the addict to stay sick.
So, one of the things that we try to look at immediately is, you know, what is the situation that the family's in and assess the situation from a health and safety perspective to make it - so that nobody is at immediate risk. Then we try to understand exactly what's been going on from a history perspective of usage, how the family has been enabling this person and we start to look for ways that we can put together a very powerful team that's going to have an influence on this person so that when we have a chance to meet with them, that we're able to make it very, very difficult for that person to say no and not accept help.
CONAN: And we want to talk to callers on the subject of intervention, but I should mention, Bob Poznanovich, you have a first-hand experience with this yourself, as a former addict.
Mr. POZNANOVICH: Yeah, it was a cold day in Chicago one day when I showed up at my mother's apartment and was surprised that she somehow found the strength and the message to confront me, and with her was my brother. And they approached me on a topic I never thought they would, which was my addiction. And she had received some advice on how to talk to me and what to say and how to help me, and what to do. And it was from that intervention that I went to treatment a few days later and last month I celebrated my 13th year of continuous sobriety as a result of that.
CONAN: Congratulations. I know…
Mr. POZNANOVICH: Thanks.
CONAN: …there's more to that story than that. But I want to get to some callers too. 800-989-8255. E-mail firstname.lastname@example.org. Let's start with Emily(ph). Emily calling us from South Bend, Indiana.
EMILY (Caller): Hi.
CONAN: Hi, Emily.
EMILY: Well, I was just - I was addicted to cocaine about a year ago and -a little over a year ago and actually just had some friends whose parents have been through that and they talked to me about it and just what it did to their lives and how it, like, basically ruined what could have been and it really helped me and I've been clean for over a year now.
CONAN: Congratulations on that.
EMILY: Thank you. But the intervention is what you credit for making you change your behavior?
EMILY: Mm-hmm. It's just my family was really supportive and my friends really, even my friends who did it, they just were happy to see me. They wanted to see me not do it, not fall into what they were into and just one of my closest friends I grew up with, her mom really helped me because she had gone through it for years and years and she's clean now also.
CONAN: Some people also, when confronted, though, resent people, well, poking their nose into a very important part of their lives.
EMILY: Right. I think that what helped me was the fact that my family was always there for me and if they weren't - if they support, like, let me go on with the habit for that long, they didn't really know about it. Once they found out, they were already into it. But a lot of the families, like, I've seen the show and they knew about it and they didn't do anything and then all of a sudden, out of nowhere, they're just sick of it. And addicts need to see, I believe, that they're there for them the whole time and not just at one point.
CONAN: And not just at a breaking point, at some point, yeah.
CONAN: Emily, if the situation arose, would you intervene on somebody else?
EMILY: Yes, I'd like to think I would. I know it's hard and you don't know how they're going to react. But I don't want to see someone fall into the same pattern or a worse pattern than I have.
CONAN: Thanks very much for the call, Emily, and good luck.
EMILY: Thank you.
CONAN: Appreciate it. And Emily's story, it doesn't seem that she needed to hit rock bottom, Bob Poznanovich.
Mr. POZNANOVICH: Well, what I liked about what Emily said was is that her family was there for her and as soon as they realized there was a problem, they took action. I think that that's the exception, that families who are confronted with an addiction don't know what to do and when they turn to people for advice, they are often given the wrong advice and, you know, you touched on a couple of them, Neal, which was that, you know, you have to hit bottom and treatment doesn't work, but there's, you know, there's a lot of people who still believe that this is a willpower issue and that the same will that got you into this problem should be able to get you out of this problem. And they don't know what to do or they get advice from people that say, you know, intervention doesn't work and you can't do anything at all. In fact, that might make matters worse. And I think that's what keeps families stuck and sick is if they get sometimes the wrong advice.
CONAN: Let's talk with Bill(ph). Bill is with us from Rock Hill in South Carolina.
BILL (Caller): Yes, I'm calling because number one, I affirm and embrace, although I know very little about it, I affirm and embrace the intervention program that I'm hearing about and encourage it in the sense that there happens to be, you know, no limit on how, if anybody can find a way to get people out of addictions, please do it. The one thing that I want to qualify or try to bring perspective on is to encourage that the person who's speaking not keep talking about hitting bottom as if bottom is a static, fixed point. In other words, the Alcoholics Anonymous book that, you know, so many have had success with AA, makes a very clear point that the bottom is a relative place and the whole goal of the program is to more and more push the bottom up, so to speak, so all bottom means is that a person comes to the recognition that he or she needs help, I think that it's important to understand that in the discussion so that we don't…
CONAN: To be fair to our guest, to Bob Poznanovich, he was not the one talking about hitting bottom, that was me and posing it as a question to him. So, I'm sorry if I confused you on that point, Bill.
BILL: Okay, I do appreciate that clarification.
CONAN: Okay. Thanks very much. And do you have personal experience with this?
BILL: I do and I happen to be a recovering alcoholic who never did, you know, get falling out drunk and bum around the streets and all that sort of thing. And so, the matter of understanding that having an addiction problem doesn't necessarily mean just being, you know, at the very bottom of the pit, so to speak, is significant and meaningful to me.
CONAN: And were you intervened? Did somebody tell you you've got to stop?
BILL: Well, it just so happened that a person who was involved with AA happened to be telling his story, I don't think he even knew from any concrete way that I had a problem. But in that sense, that was an intervention. But no, I was not intervened with in any way, where for a family came and said let's do something about this character.
CONAN: Okay, Bill. Thanks very much and again congratulations.
BILL: Thank you. Bye-bye.
CONAN: Stay with us, we're talking about intervention today when a loved one seems lost to drugs or alcohol. Sometimes, staging a confrontation with friends and family can work as a last resort. If you've participated in an intervention, tell us your story - maybe not even as a last resort, maybe as a first resort. Tell us your story, what worked, what didn't. We're taking your calls at 800-989-8255, e-mail is email@example.com. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.
Witnessing the disintegration of a loved one addicted to drugs or alcohol is heartbreaking, but helping people to confront a consuming addiction can be extremely difficult. Sometimes the only way to help is by staging a drug and alcohol intervention. Our guest today is Bob Poznanovich, CEO of Addiction Intervention Resources, a behavioral health consulting company. If you've had an intervention on either side of the equation, tell us your story. What worked, what didn't? 800-989-8255, e-mail us firstname.lastname@example.org and you could read whatever listeners have to say on our blog at npr.org/blogofthenation.
Let's go to Cheryl(ph). Cheryl is with us from Redding in California.
CHERYL (Caller): Hi. I think I'm losing your signal. Please let me know if you can hear me.
CONAN: Yes, you're on the air, go ahead.
CHERYL: Oh, good. My younger brother who has been addicted to meth, off and on, for the last 20-some years and had been clean for at least 17 years and then started again. Recently, he took his own life, and we were able to intervene and stop him the first two times he tried. And this time, he planned it very, very well so it wasn't - we didn't know that he'd made these plans and...
CONAN: And what part did intervention play in this - and first, we're terribly sorry, your brother's death, but was there an intervention?
CHERYL: Well, intervention actually worked in the beginning because many years ago I helped him get into a program and that's when he was able to stay clean and he became a counselor for drug and alcohol-addicted people and then when he got into a relationship with someone who was not very stable, then his problems seem to come back. Plus, he had a lot of health problems too, but...
CONAN: Bob Poznanovich, as I understand it, meth is one of the most difficult drugs to shake.
Mr. POZNANOVICH: Well, it's sure - I don't know, you know, statistically if the outcomes are any different for methamphetamine recovery rate. But I could tell you from our statistics that it is the most difficult of the interventions that we perform. About nine out of 10 times that we intervene across all addictions, the individual who's addicted does accept help and goes to treatment. However, when we do methamphetamine interventions, it's only about half of the time that they accept help. So it is a little bit more difficult, it's a bit more dangerous and we typically have to use some other form of intervention first which, you know, might be a lockdown psych ward because extended use creates psychosis and other issues that are really hard to break through during the intervention process.
CONAN: Again, Cheryl, we're terribly sorry at your brother's loss. It's a very sad story.
CHERYL: Thank you. We did try the psych ward avenue and I think - I've pondered on this these last three weeks since he died and individual choice has a lot to do with this on the part of the person who is addicted because methamphetamine addiction changes the brain chemistry, and it is so difficult for people to overcome that it is a lifetime of vigilance to try to overcome it. My comment would be that we can do - we can intervene and we can try to do everything we can. But in the end, it is the choice of the person who is addicted and it is the choices that they make.
CONAN: Cheryl, thanks very much.
CHERYL: Thank you.
Mr. POZNANOVICH: Neal, Cheryl makes a really good point about choice and that's an important of our philosophy with regards to what we do and what we say in the intervention session with the person who's addicted as well as the family. That we're not going to try to force anybody to go to treatment, I mean, the "Sopranos" episode did a lot to kind of hurt the image, I think, of intervention. It's not that.
An intervention is a very, very loving and caring family meeting that's held out of dignity and respect for somebody who's sick and what we're there to do is to honor choices. We're there to offer our loved ones help and we're going to offer it in a way makes it hard for them to say no. But since we can't force anybody to change, we can't force anybody into treatment, that we're going to ask them to make a choice. And sometimes that's a difficult choice. That choice might be for them to either stop using drugs or to stop seeing this family. And likewise, as a family member I get to make a choice too, that if you're not willing to change your behavior, then maybe I have to change my behavior. Maybe our relationship will be different as a result of the choices you don't make or you do make. So it is about choice.
And I think what's important and I think we could hear it a little bit in Cheryl's voice was that there was, you know, a sense of loss but I think that there was also a sense that they tried to help and they did something. And one of the things that we try to get families is on some level, off the hook. They can't make anybody do anything, but they could surely drive that lifeboat up to that person's home and, you know, offer him a lifeline and help to get in that boat and then make all the resources available to them. At some point, if they want to take it or not take it, that falls on them but at least the responsibility is off of us.
CONAN: Joining us now is Lisa Najavits. She's a clinical psychologist with the VA Boston Healthcare System and she joins us from member station WBUR in Boston, Massachusetts.
It's nice to have you on the program today. Thanks very much.
Professor LISA NAJAVITS (Clinical Psychologist, VA Boston Healthcare System; Psychiatry, Boston University School of Medicine): Thank you.
CONAN: In your experience, intervention, is it a useful technique?
Prof. NAJAVITS: There's no question that it can be useful. The vast majority of addicts do not get into care on their own. Rates show 90 percent will not enter treatment or even self-help on their own. And so, there is a really nice literature base on this point showing that some interventions can be very helpful. You can really leverage the power of the family to help the person wake up to what they're doing.
On the other hand, what we have to emphasize is the literature at this point needs to be improved. There are a lot of companies out there, for example, doing these interventions not collecting data in any sort of rigorous way or even at all. And so, I think, one of the key questions is, the business model perspective versus the public health perspective.
CONAN: And business model is obviously represented by a company like Bob Poznanovich's and the public health model would be...
Prof. NAJAVITS: Yeah. Well, there are a lot of families and addicts who cannot pay a four to six thousand dollar price tag to have this kind of intervention. And there are many addicts who do not have family members who are intact or supportive of them or non-using. There are a lot of people with co-occurring disorders. The vast majority of addicts have one or more mental health disorders. And so when you start to look at the complexity of it, I think the public health perspective is, how do we create access to helping any addict enter the kinds of treatment they need at low cost or free? How do we help people who may not be the prime candidates for these kinds of interventions? You know, it raises a lot of questions.
CONAN: Mm-hmm. I also, presumably some people are well-prepared in advance for their intervention; others may do it even spontaneously. The preparation, would that be important?
Prof. NAJAVITS: Yeah, what you see generally is that interventions have really been elaborated in positive ways over the years. Early interventions, and I think what a lot of the public thinks of as an intervention, is a harsh confrontation by family, sprung as a surprise on the addict. And the data actually show that those kinds of interventions can actually have very limited impact at best and sometimes incredibly negative impact. You can actually drive a person even further from treatment with attempts like that. So I think in recent years, what people have done is soften them to be more supportive, provide more preparation, focus on helping the family members get treatment themselves in some cases, shorten the duration of the intervention, basically ways to improve the models.
CONAN: That sounds a lot like what Bob Poznanovich was talking about just a moment ago.
Let's get another listener on the line and this is Beth(ph). Beth with us from Martinez in California.
BETH (Caller): Hello.
CONAN: Hi there.
BETH: I called because I'm the mother of a person who was a meth addict and -God willing - she is no longer one. But I want to say that the truth is, is that when you do family interventions, that you don't know exactly what's going to happen next and we've done one and it required that I had to make a next step which was to remove my daughter from my home. She's in her 30s and she was on the street for a long time. And it was very, very, very hard on everybody. The kids who helped me make the - do the intervention were people who know something about drugs, it wasn't like they didn't and she knew they knew something about it. And I think one of the things we always have to look at is the underlying issues because I think that often when they get clean - which my daughter did, thank God - but you need to know that they're going to have some other kind of problem. If they didn't solve the underlying problems, as the other lady said, you are going to have another problem and you're not sure what it's going to be or the next time or how you're going to deal with it the next time.
CONAN: As I'm understanding your story, Beth, your daughter lived in your home and...
BETH: She did.
CONAN: ...and there was an intervention and part of that is an ultimatum, either, you know, you...
BETH: Well, no. I didn't use that as an ultimatum. We said we have a program for you. We will support you. We will financially take care of anything you need to have taken care of. We will do what you need to have done to get yourself out of this pattern. And she screamed and ran out the door. And I told her when she came back that she was going to stay out the door.
CONAN: And that's not easy, is it?
BETH: It sure wasn't.
BETH: It was probably the hardest thing I've ever done in my life.
CONAN: Mm-hmm. And how long did that last before she sought help?
BETH: She was on the street for about three months and she came back and said she would get help. And within a month, she was in a program that was a three-month program. And it was a very good program.
CONAN: So ultimately, it succeeded?
BETH: It succeeded in the sense that she is no longer a meth addict but...
CONAN: She just have the...
BETH: ...she's not a well person.
CONAN: ...underlying problems.
CONAN: And Bob Poznanovich, I was wondering, those two things, first of all, not succeeding, at least not right away and the underlying problems that both Beth and Lisa Najavits were talking about.
Mr. POZNANOVICH: Well, you know, I think that the caller had a really good point about not all interventions result with the individual going to treatment immediately. But this family decided to set a boundary and they held that boundary and they were stronger than her daughter's addiction. And despite how hard it was for her, the family was willing to fight that fight. And ultimately, the family by being strong was stronger than the addiction.
But the goal, you know, is not to get somebody just to go to treatment. The goal of intervention is to get somebody into recovery and to get somebody to have a happy and productive life and be happier and more productive than they ever were.
You know, the whole social issue that does arise that Lisa brought up is it is sad. It is sad that there isn't more dollars available to help more people including people with a combined mental illness as well as an addiction, or that intervention or intervention resources aren't available outside of the self-pay network.
BETH: That is absolutely true. It is very expensive experience. And even if you have a county that can provide those experiences, you still know what it's costing and that kind of intervention done, and you know somebody is paying for it including you who's paying your taxes, you know?
Prof. NAJAVITS: I think the good news is...
CONAN: Go ahead, Lisa. Yeah.
Prof. NAJAVITS: I think the good news is that there are university-based and non-profit-based interventions that perhaps get less attention. But really the vast majority of research on these interventions has been done and the vast majority of these sort of better models have been created in non-profit environments. And so I think there's a lot of hopefulness that some of these interventions can get out more.
CONAN: Beth, thanks very much for the call.
CONAN: And good luck to you and to your daughter.
BETH: Thank you very much.
We're talking with...
Mr. POZNANOVICH: Yeah, the other - sorry, but...
CONAN: We're talking with Bob Poznanovich of the Addiction Intervention Resources and also with Lisa Najavits, a clinical psychologist with the VA Boston Health Care System.
And you're listening to TALK OF THE NATION from NPR News.
And let's get Jerry(ph) on the line. Jerry with us from Bentley in Louisiana.
Jerry, are you there?
JERRY (Caller): Yes, I'm here.
CONAN: Go ahead, you're on the air.
JERRY: Yes, sir. I was just calling in about this intervention stuff and specifically to AA.
JERRY: I'd been an alcoholic for 30-some years. And I've been in and out of AA. And I think AA is the worst thing for any alcoholic in the country because it doesn't have a person take the responsibility of his actions and it indicates that it's all a religious problem. You have a spiritual problem someplace. And if you don't get into that realm, if you don't get into that mindset, you're not going to have a chance in Hades. As simple as that.
CONAN: AA has been successful with many alcoholics, Jerry.
JERRY: Well, I know that. But by the same token, it's been unsuccessful for a majority of them as well. And I don't understand where these treatment centers - most of the treatment centers in this country are AA-oriented.
CONAN: Lisa Najavits, is that accurate?
Prof. NAJAVITS: It is accurate. And I would say that AA is helpful to quite a number of people and also not helpful to quite a number of people. And I think the caller is bringing up an excellent point, which is it's not just about getting the person into treatment but what is the quality of that care once they're in. And you see huge variation in the addiction field in terms of level of quality, of the treaters themselves, of the types of programs, the variety of orientations that are offered.
CONAN: Jerry, thanks very much.
JERRY: Yes, sir. Thank you.
CONAN: And good luck to you.
JERRY: Thank you. Bye-bye.
And let's see if we can talk now with - this is Damian(ph). Damian with us from Syracuse in New York.
DAMIAN (Caller): Yes. I was just calling to comment on the earlier comments about hitting bottom being a myth. And I'm an addict, I personally have experience with a lot of addicts in recovery, and most of them have to hit a bottom in order for them to make the choice that they want to do something, you know? I had an intervention by my mom, which I had to, you know, boundaries were put up and I was put out on the streets and it was through that that I was able to come to a choice and a decision on my own. So I don't really think it's like a myth.
I think it's more like - I mean, it's a reality. It doesn't has to be that way but the way an addict mentality is or just the way, you know, addiction is, it tricks you into believing that, you know, nobody's out there to help you and you're all alone and it isn't until you're desperate that you seek the help that you need, whether it be through intervention, recovery, or anything like that.
CONAN: Well, Bob Poznanovich, as a former addict yourself, I think you have some insight here?
Mr. POZNANOVICH: Well, I think, the majority of people who enter treatment do so off of an intervention. Now, whether it's a formal intervention or not, it is about pain and consequences that are motivators. And if our life was going great, we wouldn't be looking for treatment. It is the external stimuli that sometimes has to force us into treatment.
I defined my bottom as jail. I didn't hit that but that was, you know, one of the obvious next steps for me. And I think that, that what we tried to do through the intervention process is to bring consequences and some discomfort and maybe some pain to the addict to make them and force them to make a decision. But that those consequences are consequences that we control - we control as a family - a family system, so that we're not susceptible to the consequences that we don't control, which are usually legal or medical.
CONAN: Damian, thanks for the call and we wish you good luck.
DAMIAN: Thank you.
CONAN: Appreciate it.
And I'd like to thank our guests. You just heard from Bob Poznanovich, CEO of Addiction Intervention Resources. He joined us today from Minnesota Public Radio studios in Saint Paul.
Thanks very much for your time today.
Mr. POZNANOVICH: Thank you.
CONAN: And Lisa Najavits, clinical psychologist with the VA Boston Health Care System, with us today from our member station in Boston, WBUR.
We appreciate your time.
Prof. NAJAVITS: Thank you.
CONAN: We'll just end with this e-mail that we got from Lisa(ph).
My - 25 years ago, some college friends and I planned and executed an intervention on my roommate. She was the most successful person I'd ever met: 4.0 student, national team athlete, etcetera and a functioning alcoholic. We were in our 20s and did the best we could and tried to become educated before the event. Needless to say, she blew us off and three years later died from a fall during an alcoholic stupor. She was not saved - but I was. I would have been devastated with guilt and regret if I had not spoken and followed through. We couldn't force her but we did try. All we succeeded in doing is moving her addiction on to the next level: honesty.
Thank you for that e-mail.
And stay with us. When we come back, we'll talk about the war of words in South America. It's the TALK OF THE NATION from NPR News.
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