A Case Example of Intervention in Alcohol Use Disorder

A Case Example of Intervention in Alcohol Use Disorder

By Rickard Elmore 07/30/15

How an experienced interventionist can jump start a successful treatment episode.

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Although there is some controversy about the effectiveness of interventions, there are undoubtedly situations where, lacking intervention, an individual’s downward spiral would likely continue. In these situations, a skilled interventionist can prove the catalyst that begins the journey to lasting recovery for the patient while also uniting family and friends behind a chosen treatment plan. Rickard Elmore, an experienced addiction and mental health interventionist, recalls a case in which multiple challenging variables were overcome in order to help a man begin treatment and attain early recovery...Richard Juman.

Intervention is a craft. It calls for a well-trained clinician with real-life experience to identify the various components of a situation and then direct it into complete solution. Inviting an unqualified interventionist into a volatile situation could potentially exacerbate the problem. But an interventionist who incorporates strategy, patience, and compassion can help someone to begin the journey of recovery and alter the whole direction of their lives. As an experienced interventionist, I’ve found that a lot of the work I do is more about treatment strategy than anything else. Not everyone is going to make a lifetime commitment to abstinence in the beginning. Even so, we have successfully entered people into long-term recovery by allowing them the opportunity to get some help before making such a daunting decision. 

Most of the time it just makes sense to start off with abstinence. If a person has been consumed with toxins and their behavioral patterns or emotional condition have caused them to continue to make decisions that create great conflict and turmoil in their lives, they will often admit that they need to take some time to get better. Eventually, they gain insight, as do their treatment providers, about what might be the best lifetime solution for them. Although intervention techniques can be taught, not everyone has the experience and diversity to be able to handle the complex situations that often occur without warning. 

“Dan” was a retired 53-year old professional man who had been consuming 20 to 30 ounces of vodka a day for the last five years. His significant other had finally convinced him to seek treatment. During his intake assessment at the treatment center, he said he thought of killing himself every day and that he slept with a gun beneath his pillow. The treatment facility followed protocol and dialed 911. The client was arrested as a possible danger to himself and others, and transferred to a hospital for a 72-hour evaluation. 

That is when I received the call. 

At this point, he had begun to exhibit signs of delirium. The hospital staff diagnosed him and proceeded to give him medication (not for detox of alcohol). You see, detox from alcohol can cause a person to be in a great state of confusion about time and place and have a decrease in short memory recall as well as disorganized thinking. These same symptoms exist in many other mental health disorders. Even for trained professionals (in this case, the staff members of a hospital), it can be difficult to discern what is really going on.

An experienced interventionist will be able to ascertain a potential client’s level of substance misuse and to determine the extent to which a psychiatric disorder is impacting the presenting problems. It is critical to recognize a traumatic behavioral episode in the client’s history and understand the underlying issues being presented. Those issues need to be assessed before further diagnosis can commence.

Now, what happened next may seem shocking but it is not an isolated incident in the world of addiction treatment and behavioral healthcare. While the client was sleeping, the nurse decided to wash his body. When she got too close to his private areas, he reached out and attacked her. He was then restrained to the bed and charged with assault. Fourteen hours later, he was discharged to police custody. Not a good place for him to be in his condition; or at all for that matter! 

I’ve found that it takes a great capacity for patience to help people find their road to recovery. All too often, medical professionals and treatment providers alike try to determine the cause and the nature of a person’s problem without the knowledge or expertise that’s necessary, and long before a diagnosis can be considered conclusive. This has unfortunately led to many faulty diagnoses.

If a person who has a true mental health condition is consuming a substance to “self-medicate,” does that mean that they have the “disease of addiction”? An accurate diagnosis can not be determined until further analysis has been completed. True diagnosis can only be determined over time. To facilitate emotional, psychological, biological and behavioral stability in a patient, one must allow the journey to unfold.

Unfortunately for Dan, he was looking for help but instead of being admitted into a treatment facility, he found himself in police custody. His road was turning out to be rougher than anyone expected. 

After hiring a bail bondsman and getting an attorney on retainer, I found out that my client had been transferred downtown under a false name that he had given to the authorities in his continued delirium after his questionable release from the hospital into police custody. We were told that, once cleared, he would be transferred back to the main jail and released. Instead, they discharged him on his own with someone else’s clothes on! 

After a full-on manhunt with family, investigators, and a contracted security team, we found Dan. By this point, I was in communication with a number of different friends and family members. Each one had a different account of what was going on and what needed to be done, but they all hoped that I would be able to help their father, brother, son, ex-husband, father-in-law, son-in-law, or boyfriend. I explained to his family that I could orchestrate things such that Dan would agree to go to treatment as long as we all agreed to be on the same team. They agreed, reluctantly. You see they, too, felt betrayed by the system. 

Clearly, an interventionist must hold space not only for the individual in treatment, but also for the family and friends of that individual. An experienced interventionist will be able to educate and support the families and loved ones of those who are suffering. That education will, in turn, allow them to support their loved one without sacrificing their own peace of mind. 

Once we were all on the same page and the family understood that I was there for them as well as for their loved one, we began the intervention. The tension in the room was palpable. My client was in the middle of negotiating another drink before going to treatment when I asked his daughter to get the soda I had in the refrigerator. I told my client that for the last 36 hours I’d been riding around with this in my car, and I held up his favorite non-alcoholic drink: a can of Orange Crush. 

With a sparkle in his eye, he thanked me and took the soda. After another 10 minutes of negotiation I said, “Hold on.”

All eyes were on me. But my eyes were on him and there was a big smile on my face. I said, “It seems to me that you have a heart that flows with love and compassion. It’s gotta be hard to hear everyone offering their love and support for you. Not only that—I’m over here watching you drink that soda, and I’m drooling after two days of not cracking the top off that drink myself. Aren’t you even gonna offer me some?!”

The tension in the room deflated. He smiled as he handed me the Orange Crush. “Of course my friend, sorry about that.” 

I took a drink, smiled, and handed it back. “No worries, thank you for allowing me to be here.”

With that, I could feel his daughter come around, the one that had the least confidence in me, who reluctantly allowed me to proceed with the intervention and whom I purposefully sat next to me. In that moment, the entire room united in support of Dan’s recovery. Of course, there is more to the story, but my hope is that what I’ve described highlights one of the key elements involved in intervention work. It’s about having the ability to work with what is in front of you without allowing unexpected roadblocks or tension to break your resolve. And it’s about compassion. 

We have found that the only true healing for a person’s wounded sense of self comes from love and understanding. If you can start a person on the road of recovery, it can alter the whole direction of their life. It’s a magical opportunity to open the doors of recovery and fulfillment to someone who has been suffering from a seemingly hopeless condition. 

The craft of intervention is needed to truly move people from their troubled condition into a place of recovery with kindness and compassion, the same compassion anyone would give to someone who they could see was suffering from a life-threatening condition. The right interventionist will approach your loved one with an abundance of compassion as opposed to bullying them: this is an intrinsic value to having a successful treatment episode. 

Dan went to treatment the next morning. The treatment team found out why he attacked the nurse, something that had been causing him harm since childhood. Today, nearly one year later, he is sober. 

As an interventionist, I have to say it’s quite a blessing to facilitate sustainable recovery for so many people in need. Times have changed, but life in recovery without shame or regret is the clear winner. As a lifetime participant in recovery myself, I have found that there is no need to rest on yesterday’s accomplishments. There are constantly new developments in treatment and recovery that a well-versed interventionist will be informed about. In case you haven’t noticed, tomorrow is the place where hope lives. 

Rickard Elmore has been in the field addiction and mental health for over 20 years, and is one of the few interventionists who specializes in mental health interventions. He is the founder of Rickard Elmore Intervention. 

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Rickard Elmore has been in the field addiction and mental health for over 20 years, and is one of the few interventionists who specializes in mental health interventions. He is the founder of Rickard Elmore Intervention.  You can find Rickard on Linkedin or follow him on Twitter.

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