ARISE – Intervention by Invitation
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ARISE – Intervention by Invitation
“Often it is a crisis or last straw that motivates someone to seek help for their loved one. A Relational Intervention Sequence for Engagement (ARISE) has been developed by Judith Landau et al. (48). This approach is used when someone requests help engaging a person who suffers from an addiction disorder but who is resistant to admitting it is a problem or to getting help. Evolved from the Johnson Institute Intervention (49-52) with the addition of a family systems focus, this approach involves a series of visits with the family (and significant others) including the addicted person if he or she is willing to accept the invitation to attend. Level 1 begins with the first caller over the telephone or at a face-to-face visit at the office or hospital. The approach instills confidence in the first caller that something can be done. On the phone, the family members and, if possible, the addicted person can generate a list of who should be invited to participate in the first group meeting, develop a strategy to engage these supporters in this task, facilitate an optimal invitation to the addicted person to attend, craft a recovery message, and elicit a commitment from the invitees to attend the first meeting whether or not the addicted person attends; 55% of the time this level of effort is sufficient to engage the addicted person in treatment (53).
If treatment does not begin, level 2 offers a series of group meetings of the support network with or without the addicted person in attendance. Each member of the group is a "significant other" of the patient, and is coached to describe an iconic experience in which the patient's drinking, drug use, or process addiction adversely affected that person. Team members are coached to present the feedback in a non-accusing manner, focusing mostly on how it made him or her feel. They are not to engage in arguing, blaming, name calling, or other disrespectful behavior. If the addicted person is present, he or she is asked (and reminded if necessary) to listen to all the feedback before responding. Examples of phrases that can be uttered by the team members include: "It's not you, it's the drinking," "It hurts me too much to see you continue in this painful disease,” "You did not develop this on purpose, but you've got it," "We care about you, but hate your drinking," "I will not argue; this is what you did, this is when you did it, and this is how it made me feel." There are several common threads in these phrases: exhibiting positive regard toward the individual but negative attitudes toward the addiction behavior; providing data about specific events rather than generalities; validating the disease through statements about the obvious pain of this progressive illness—which destroys families, jobs, finances, legal standing, spirituality, and physical health—thus giving the patient permission to become less defensive; and relieving guilt and reducing defensiveness by acknowledging that patients with addiction disorders did not intend to "catch it," but insisting that they need treatment nonetheless. With the weight of all of this evidence, presented by mutually supportive friends and family members, the "wall of denial" for many patients breaks down sufficiently to encourage the patient to enter a treatment program. By this level, 81% have entered treatment (53).
Even if it is not successful in engaging the index patient in treatment, a family intervention usually alters the family system surrounding the index patient in a positive way by helping family members free themselves from the secrets, isolation, guilt, and fear engendered by the index patient's addiction.
Level 3 involves meetings at which contingencies are crafted by the support group team that will be executed if the addicted person continues to resist treatment and recovery; 2% of additional cases entered treatment during this level, making A Relational Intervention Sequence for Engagement procedure effective for 83% (53). This approach engages the supporters of the addicted person in resisting further enlistment as enablers and builds a confident, cohesive team to put a firm, healing structure into the life of the addicted person. This team must withstand pleading, lying, threats, empty promises, rationalizations, minimization, tricks, and subterfuge to stand firm with its contingencies. Through thick and thin, the team must sustain its commitment to hold the addicted person responsible for his or her behavior, for completing needed treatment and for sustaining recovery.” Principles of Addiction Medicine, Fourth Edition (2009 American Society of Addiction Medicine), page 862-863 (numbers in parentheses are the footnote numbers).
If treatment does not begin, level 2 offers a series of group meetings of the support network with or without the addicted person in attendance. Each member of the group is a "significant other" of the patient, and is coached to describe an iconic experience in which the patient's drinking, drug use, or process addiction adversely affected that person. Team members are coached to present the feedback in a non-accusing manner, focusing mostly on how it made him or her feel. They are not to engage in arguing, blaming, name calling, or other disrespectful behavior. If the addicted person is present, he or she is asked (and reminded if necessary) to listen to all the feedback before responding. Examples of phrases that can be uttered by the team members include: "It's not you, it's the drinking," "It hurts me too much to see you continue in this painful disease,” "You did not develop this on purpose, but you've got it," "We care about you, but hate your drinking," "I will not argue; this is what you did, this is when you did it, and this is how it made me feel." There are several common threads in these phrases: exhibiting positive regard toward the individual but negative attitudes toward the addiction behavior; providing data about specific events rather than generalities; validating the disease through statements about the obvious pain of this progressive illness—which destroys families, jobs, finances, legal standing, spirituality, and physical health—thus giving the patient permission to become less defensive; and relieving guilt and reducing defensiveness by acknowledging that patients with addiction disorders did not intend to "catch it," but insisting that they need treatment nonetheless. With the weight of all of this evidence, presented by mutually supportive friends and family members, the "wall of denial" for many patients breaks down sufficiently to encourage the patient to enter a treatment program. By this level, 81% have entered treatment (53).
Even if it is not successful in engaging the index patient in treatment, a family intervention usually alters the family system surrounding the index patient in a positive way by helping family members free themselves from the secrets, isolation, guilt, and fear engendered by the index patient's addiction.
Level 3 involves meetings at which contingencies are crafted by the support group team that will be executed if the addicted person continues to resist treatment and recovery; 2% of additional cases entered treatment during this level, making A Relational Intervention Sequence for Engagement procedure effective for 83% (53). This approach engages the supporters of the addicted person in resisting further enlistment as enablers and builds a confident, cohesive team to put a firm, healing structure into the life of the addicted person. This team must withstand pleading, lying, threats, empty promises, rationalizations, minimization, tricks, and subterfuge to stand firm with its contingencies. Through thick and thin, the team must sustain its commitment to hold the addicted person responsible for his or her behavior, for completing needed treatment and for sustaining recovery.” Principles of Addiction Medicine, Fourth Edition (2009 American Society of Addiction Medicine), page 862-863 (numbers in parentheses are the footnote numbers).
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Join Date: Jun 2012
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Titanic, what is the research that verifies these statistics?
If it is true, it is impressive. It is counter-intuitive, however, to what I would expect most active alcoholics/addicts to do.
I can see how it would help the family. That part of it is like creating an "Alanon type community" specifically for the people affected by the addicted person.
ShootingStar1
If it is true, it is impressive. It is counter-intuitive, however, to what I would expect most active alcoholics/addicts to do.
I can see how it would help the family. That part of it is like creating an "Alanon type community" specifically for the people affected by the addicted person.
ShootingStar1
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