CHAPTER 29
Intervention
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
29.1: Understand the concept of intervention
•
29.3: Understand the characteristics of the intervention process
•
29.5: Describe ethical considerations in relation to interventions
•
29.6: Review some common forms of intervention
CHAPTER OUTLINE
A Definition of Intervention
A Brief History of Intervention
Characteristics of the Intervention Process
Physician-Based Brief Intervention
Informal Interventions
The Mechanics of Intervention
The Ethics of Intervention
Some Common Forms of Intervention
Family Intervention Projects
Intervention by the Legal System
Drug Court
Court-Mandated Involuntary Treatment
Other Forms of Intervention
Employer-Mandated Treatment
Reactions Against the Concept of Intervention
CHAPTER OVERVIEW
The purpose of this chapter is to help the student understand the concept of intervention. While
a form of intervention is the subject of many “reality” television programs and is occasionally
portrayed in the movies, the actual process is much more complicated than what is seen on the
television or in the media. There are also multiple forms of intervention that are often not
viewed as “intervention” because they do not fit with the traditional connotations of the word.
A wife confronting her partner with the observation, “I do not like how you behaved at the party
last night” could be viewed as using a mild form of intervention, especially in cases where the
spouse did not have an established substance use disorder (SUD) but simply misused alcohol on
the particular occasion.
DISCUSSION QUESTIONS
Break-Out Discussion number one is focused on the “traditional” form of intervention. The
questions that follow address other forms of intervention that the student might not view as
such and might need to learn how they are forms of intervention even if they are not as dramatic
as the media’s portrayals of intervention projects.
Break-Out Discussion #1:
Intervention: As was stated in your text, the purpose of the intervention project is to break
through the individual’s denial and obtain a commitment to immediately enter treatment. This
may require some degree of confrontation from those who participate in the intervention
project, which raises the question of when and whether coercion into treatment becomes an
appropriate and acceptable treatment tool.
Bentall (2009) discussed cases in which patients had been coerced into psychiatric
hospitalization in past eras. Their outgoing mail was routinely intercepted, read, and placed into
their files if the patient claimed that the treatment was cruel and harsh. Since it was assumed
Questions
1. Is the woman’s decision to enter this profession justification for the “intervention” project?
Why or why not?
2. Is her behavior harming herself (or somebody else)? What are the reasons that might be used
to justify the “intervention” project based on? What might her family members be afraid of or
angry about? How can you measure whether her behavior is harming her, and on what
standards can you base whether the intervention project is justified?
Break-Out Discussion #2:
Imagine a person who has a severe alcohol-induced liver disease, but who continues to drink.
The person’s family coordinates an intervention project. One evening, the person arrives home
after stopping off at a local bar to have a few beers with coworkers, to find eight of his family
The hypothetical intervention project outlined above might not be appropriate, as it might be
overwhelming for both the individual and the family. To help avoid this risk, individual family
members should affirm their concern for the drinker. “You’re my brother,” the sister might
begin, “you stood up for me and fought for me when those guys bothered me in the third grade.
I will always love you for that. We have laughed together and cried together. You are a great
guy, and I was always proud to say that you were my brother. But I am concerned, and that is
why I am here, today.” A supervisor might say, “Joe, you have really been an asset to this
company, and some of your suggestions as to how we might improve the production line have
In your text, a hypothetical situation in which a physician was discussing a client’s drinking with
him was introduced. The physician might calmly begin the discussion with the observation that
“Joe, we have your blood tests back from the lab, and I think that we need to talk about them.”
There is no harsh confrontation, just a quiet discussion about how Joe’s liver function tests are
dangerously high, and that he is in very real danger of going into liver failure, following which he
would very likely die. Further, the physician might point out that Joe had been hospitalized three
Notice that the physician’s confrontation is delivered in a gentle, professional tone of voice. He
calmly presents the facts to Joe. Then, if Joe refuses to enter into a substance treatment facility,
his physician might conclude, “Well, Joe, that is your choice. But as your physician I cannot in
good conscience continue to prescribe the benzodiazepines that you say that you need to help
Again, in this hypothetical example the confrontation is provided in a gentle manner, with the
facts supporting the doctor’s concern(s) being expressed in a calm, logical manner. Joe might be
invited to sit in the examination room for a few minutes to think about what his doctor just told
him before they select a plan of action. “But, you need to have a plan of action before you leave
Questions
1. Imagine the family intervention session introduced earlier, where the sister was screaming at
her brother about how he needed to listen and go to treatment. How many of us really listen
when somebody is yelling at us? Re-imagine this scenario in a way that would be calm, coherent,
and supportive. How might Joe’s family members confront him? What behaviors and tactics
might be used to induce Joe to behave in a more positive manner?
2. Do you know anybody who was the subject of an intervention project? How did he or she feel
about this experience? Was the project harmful or helpful, in your opinion? Why?
Break-Out Discussion #3:
Drug Courts: Rempel (2005) suggested that such programs reduce recidivism by only 13%, which
raises the question of whether Drug Court programs are really effective.
Another question that arises is whether you measure “success” in the short term, or, in terms of
the individual’s lifetime. A 13% reduction in recidivism in one year may not be cost-effective for
that community. Over the course of 10 years, a reduction in recidivism by 13% might be quite
cost-effective. But what we mean by “recidivism” can also vary. Does that mean any offenses,
or, just drug-related offenses? If a person is arrested for burglary two years after completing the
Drug Court program, but has not used alcohol or illicit drugs in that time, is this a success for the
Drug Court, or a failure?
Imagine a hypothetical case in which a person was charged with and convicted for trafficking in
cocaine. This is the person’s first criminal offense. When considering whether this person would
Questions
1. Should the above individual be referred to a Drug Court? Why or why not?
2. If, in this case, the individual was carrying 6 grams of cocaine, would this be different than if
he or she were to be found to have 60 grams of cocaine? Cocaine wrecks terrible havoc on the
3. Does the situation change if the person were also to have been found to have a 9 mm semi–
automatic pistol at the time of the arrest? This is a deadly weapon. Drug dealers are often shot
by their rivals. Would carrying a firearm for self-defense be sufficient to exclude the individual
from Drug Court? Remember that the suspect has not been convicted of any violent crimes. But
4. Drug Court programs are both labor- and time-intensive. Is this 13% reduction sufficient to
warrant the expense of setting up a Drug Court program for that community?
Break-Out Discussion #4:
Celebrity status: A famous movie actor, actress, or sports figure is arrested for driving a motor
Questions
1. Should such an individual be allowed to enter a rehabilitation program before the case is
brought before the judge? Is there any way that an assessor can determine whether this person
2. While in “rehabilitation” our celebrity demands special privileges, such as his or her own chef,
3. In a slightly different scenario, a member of the entourage of a famous movie actor, actress,
or sports figure is arrested for possession of a controlled substance. His defense is that his
employer sent him out to buy the substance for the employer’s own use. Should the police then
be permitted to search the home of the famous movie actor, actress, or sports figure to
4. The central issue in both scenarios is whether the rich and/or famous should be held to the
same legal standards and treatment standards that apply to the rest of us. What do you think?
Might there be exceptions?
References
Bentall, R. P. (2009). Doctoring the Mind. New York: New York University Press.
Rempel, M. (2005). Recidivism 101: Evaluating the Impact of Your Drug Court. New York: Center
for Court Innovation.
KEY CONCEPTS AND TERMS
Intervention: An organized effort by a person or persons who are part of the individual with an
SUD’s environment, to break through the walls of denial and rationalizations that surround the
Detachment: The process by which the person determines and begins the process through
which he or she will no longer support another individual’s addiction
Contingency management: Process through which a person with an SUD is trained to identify
high-risk situations in advance, and then practices coping mechanisms to avoid relapsing
Autonomous motivation: When an individual requests treatment solely on his or her own
motivation
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
A Definition of
Intervention
29.1: Understand the
concept of
intervention
1a: history and philosophy of the
counseling profession and its specialty
areas
A Brief History of
Intervention
29.2: Review
the history of
the
intervention
movement
1a: history and philosophy of the
counseling profession and its specialty
areas
Characteristics of the
Intervention Process
29.3:
Understand
the
characteristics
of the
intervention
process
1a: history and philosophy of the
counseling profession and its specialty
areas
The Mechanics of
Intervention
29.4: Describe
the mechanics
of
intervention
1a: history and philosophy of the
counseling profession and its specialty
areas
The Ethics of Intervention
29.5: Describe
ethical
considerations
in relation to
interventions
1a: history and philosophy of the
counseling profession and its specialty
areas
Some Common Forms of
Intervention
29.6: Review
some
common
forms of
intervention
1a: history and philosophy of the
counseling profession and its specialty
areas