Is addiction a habit or a disease? Intervention specialists who believe that addiction is a disease will encourage family members to approach the addict with a gentle, compassionate approach that stresses love, acceptance and solidarity. The addict is encouraged to seek help, and the family provides support to help the addict overcome the disease. Intervention specialists who believe that addiction is a habit will encourage family members to use an aggressive approach, designed to make the addict see the behavior in a clear and harsh light, feel a certain amount of humiliation and resolve to change in any way they’re asked to change. This latter description forms the basis for the confrontational model of intervention.
The confrontational model of intervention has been in use since the 1940s, and some form of confrontation is used in most forms of intervention. Any time a family talks directly to an addict and points out the pain that person is causing by his or her addiction, this can be considered a form of confrontation. For some addicts, this confrontation provides an impetus to change, and many counselors use some form of confrontation in therapy. A 2001 study, for example, found that 46 percent of addiction professionals felt that confrontation should be used more frequently in treatment programs.
All forms of confrontation aren’t created equal, however, and the confrontations of the 1950s might seem quite harsh to modern families. In fact, some severe forms of confrontation that were in use during this time can be downright destructive.
In the 1940s, people generally believed that addicts developed through no real fault of their own. They were upstanding citizens one moment, and then they became hooked on a vicious substance that robbed them of their ability to make good decisions and care for themselves. The goal of therapy was to eliminate this substance and restore the person to their former good health. This thinking began to shift in the 1950s, when psychiatrists such as Lawrence Kolb suggested that addicts had a sort of mental illness and a deficit of character that made them addicts. In order to truly heal, these people needed to be removed from society and forced to change, therapists thought.
One psychiatrist, Harry Tiebout, contended that an addict had four major personality flaws that needed to be amended before therapies would work. Those flaws were:
An inflated ego and feeling of self-importance
A disconnection from other people
Anger and hostility
Confrontation intervention has its roots in this thinking of the 1950s. If intervention specialists and families believe that the addict has a personality disorder that must be resolved, the confrontation is designed to strip away those barriers, peel off the self-protection scab and reduce the addict to a child-like state so the therapy can rebuild the person. The therapists believed that addicts were simply immune to statements of caring and support. They had to be broken down and reduced to a child-like state of abject humility before they could truly learn.
Confrontation Techniques of the 1950s
In a traditional confrontational intervention, the intervention specialist worked as a sort of parental figure, in a leadership position. The family met with the intervention specialist to discuss the addiction, and the intervention specialist helped the family come up with a sort of script to use during the intervention. The addict was invited to a neutral location under a veil of secrecy, and the intervention began before the addict was even sure what was happening.
During the intervention, the family and the intervention specialist worked to point out the addict’s behavior in clear and concrete terms. The addict was not allowed to defend the behavior in any way, and was encouraged to listen. Addicts are often told they must “hit rock bottom” before they can get better. In a confrontational intervention, rock bottom may come up to hit the addict. The addict was called names, stripped of responsibility and presented with a long list of character flaws. The addict was encouraged to seek help through therapy, and some addicts were taken to facilities directly after the intervention.
In extreme cases, addicts were told they were “stupid” or “weak.” Some addicts were forced to shave their heads, sit on stools in the middle of the room while their families hurled insults at them, or they were stripped of all rights and responsibilities within the household until they could demonstrate that they were in control of the addiction. These interventions were likely quite difficult for the addicts to bear, although many addicts did go through these treatments and some did recover as a result of these methods.
Confrontation on the Decline
In the 1970s and 1980s, this harsh form of confrontation had fallen out of favor. Modern thinkers emphasized that people should gain control of their impulses and know themselves. Breaking down someone in order to build them up again was no longer a popular option. In addition, some studies suggested that this form of direct confrontation could do harm instead of helping the addict improve. Some addicts simply stopped talking to their family members altogether when they were attacked in this way, and they went on with their addiction alone. Some other addicts entered treatment facilities after the confrontation, but if they had a relapse, they didn’t feel comfortable seeing their family members for support.
Modern confrontation techniques rarely involve direct humiliation, but they may still require the addict to listen to a list of grievances, and some counselors do encourage family members to be completely honest about their feelings, even if they are unpleasant for the addict to hear. In these confrontational interventions, the addict may still feel attacked on an emotional level. Even though the technique is a bit softer, it is still a confrontation. Modern research suggests that this sort confrontational therapy is no better and might be worse than more supportive methods. In a 1992 study, patients were placed into two groups for addiction interventions and therapies. The group that received supportive measures remained sober twice as long as the group that received confrontational therapies.
Direct forms of confrontation, where the addict is blamed and reprimanded for negative behavior, aren’t the only forms of confrontation available. In fact, making a few small adjustments to a standard confrontational intervention could make the confrontation positive and helpful for the addict and the family. For example, the intervention could:
Avoid placing blame. The speakers can point out the addict’s behavior using only “I” statements (for example, “I feel unsafe when you drink and drive me home.”). This can be much more constructive than antagonistic statements like, “”People like you who drink and drive are weak.”
Emphasize therapy. If the intervention specialist and the family point out that addiction is a disease that can be treated with therapy, this can serve as a sort of life-preserver to the addict. The focus moves from curing a moral failing to curing a disease.
Keep anger at bay. While yelling at the addict might provide an emotional release for the family, it doesn’t help the family heal and it may not prove constructive help to the addict. Family members can speak with intervention specialists about their feelings in private sessions, if needed, to blow off steam so they can keep it out of the intervention.
Focus on consequences. A confrontational approach that focuses on consequences (“If you’re drinking, I won’t get into the car with you.”) provides the addict with control and a choice.
The steps above are often used as part of the Johnson model of intervention. This confrontational approach is focused on caring and healing, rather than blaming and degrading, and it’s often used in modern interventions. Even though this may be a soft form of confrontation, this type of therapy is still considered controversial and some intervention specialists feel no form of confrontation should be used in an intervention. Others believe a soft confrontation, as used in the Johnson model, can be considered effective. A study published in the journal Addictive Behaviors found that confrontations were effective if addicts felt that the confronters were being supportive and helpful. In other words, the confrontations worked if the addicts didn’t feel like they were being blamed, humiliated or punished for their actions, even when they were being confronted with the realities of their addiction.
Admittedly, this can be hard to accomplish for many families, especially if the addictive behavior has gone on for years and the family has developed a lengthy backlog of minor slights and hostilities. It can seem much easier to simply sit the addict down and yell for a time, to encourage the addict to “snap out of it” and contribute to the family once more. This is when an intervention specialist can help. Some families need their own interventions, so they can process those feelings separately and move forward from them, long before the intervention takes place. The goal of an intervention, after all, is to help the addict get better, not to settle family scores or make the addict pay for past bad behavior. By focusing on this goal, and getting help to perform an intervention in a humane and caring way, the families can get the results they want without causing more pain to the addict or to themselves.