It’s become a staple phrase in addiction medicine, “The addict must ‘hit bottom’ before he or she can be encouraged to change.” As long as the addict has a job, a family, a home and friends, the thinking goes, the addict can be convinced that the problem is manageable and not serious enough to merit a change. When the benefits of a healthy life are stripped away, the addict is forced to face the addiction head on and make the needed adjustments.
There’s one major problem with this theory; for many addicts, the bottom means death. For example, in 1987, 46,386 people died in car accidents. Half of these crashes involved alcohol. Family members may resist the idea that they must wait for their loved one to be in a fatal accident before they can help. In other words, they’re looking for a way to make the bottom visible, long before the addict’s life is actually hanging in the balance.
These families may benefit from the Johnson model of intervention. In this intervention, the family confronts the addict directly, and speaks in clear terms about what the addiction is doing to the family and what the addiction is destined to lead to. The addict may hear, for the first time, that addiction can lead to death or long-term disease, and the addict may hear that the family will no longer look away from addicted behavior. The family, in turn, learns more about addiction and may acquire tools that allow them to help the addict deal with the problem and truly heal.
Meet Dr. Johnson
Vernon Johnson, founder of the Johnson model of intervention, was an Episcopal priest who devoted his life to the study of addiction and methods that could be used to stop addiction before death occurred. In the 1960s, Dr. Johnson studied 200 recovered alcoholics and attempted to determine why they chose to quit. He found that most of these addicts chose to quit when they had small disruptions in multiple areas of their lives. Instead of having one defining event, such as a car crash or the loss of a job, the addicts had several small events, such as a fight with a spouse, a ticket and an addiction-related illness.
As Dr. Johnson wrote in his landmark 1973 book, I’ll Quit Tomorrow, “It is a myth that alcoholics have some spontaneous insight and then seek treatment. Victims of this disease do not submit to treatment out of spontaneous insight – typically, in our experience they come to their recognition scenes through a buildup of crises that crash through their almost impenetrable defense systems. They are forced to seek help; and when they don’t, they perish miserably.” He set out to define a system that could make the consequences of addiction clear, without allowing the addict to feel harm first.
The method Dr. Johnson developed was in line with other confrontational interventions in use in the 1960s and 1970s. The addict was surprised by a group meeting and forced to listen to unpleasant information concerning the addiction. The addict was asked to listen to the information, without providing any excuses or justification for the behavior. Unlike other confrontational intervention techniques, however, Dr. Johnson encouraged family members to focus on caring for the addict and helping the addict, rather than blaming or hurting the addict. Where a traditional confrontational method might strive to hurt the addict’s feelings in order to force the addict to submit, the Johnson method focused on reminding the addict that the consequences are serious and the family wanted the addict to avoid those consequences. It’s a simple tweak; instead of blaming and breaking down an addict, the Johnson method strives to educate and motivate the addict to change. Dr. Johnson felt that the addict simply couldn’t hear the information without some sort of confrontation, but that confrontation had to be presented in a caring manner that allowed the addict to lower defenses and listen.
A Johnson Intervention
A traditional intervention in the Johnson style has seven components:
A team is pulled together to help the addict, made up of family members, friends and coworkers. An intervention specialist heads up the team.
In a planning session, the team determines exactly what they want to tell the addict about the addiction and they’re encouraged to use specific terms. They might describe how the addiction hurts the heart or lungs, or how the addiction is impacting the children in the family.
All information should focus on concern and caring, not blame and anger. Families may remind the addict that they love the addict but hate the disease. The addict isn’t asked to do penance for past crimes.
All information presented should be tied to the addiction, not other problems that may be occurring.
Statements should be backed up by evidence, and that evidence should be specific. Statistics are ideal but relating stories in a factual manner is also allowed.
The team must agree that the goal of the intervention is to lead the addict to treatment. The goal is not to punish but to help.
The team pulls together at least three treatment options and agrees to let the addict decide.
This planning can take quite a long time to complete, and the family is encouraged to learn quite a bit about addiction and how the disease progresses. Some families can become a bit discouraged and despondent during these planning sessions, and they may choose to cancel the intervention before it moves forward. In a study published in 1989 in the American Journal of Drug and Alcohol Abuse, 70 percent of groups cancelled the intervention during the planning stages. Families must be prepared to hear difficult statistics and plan for confrontation before they agree to a Johnson intervention.
The intervention itself is quite straightforward. The team agrees to a time and place for the meeting, and the addict is lured to the location on some other pretense. Then, the addict is confronted with the statements the team has prepared. The team sticks closely to the script, and the intervention specialist steps in if the family veers off the script. The family may provide a list of consequences that will befall the addict if the behavior doesn’t change, such as the loss of parental rights or the loss of a home, but that isn’t always required in the Johnson model. Some families focus only on the health impacts of the addiction. At the end of the intervention, the addict is presented with the list of treatment options and chooses one option to enter. If the addict chooses not to enter a program, the family can put the consequences in place right away, or the family can continue to hold smaller interventions in the hopes of convincing the addict to change with repeated exposure to the information.
Performing an intervention in the Johnson model can be effective, if a few basic steps are followed:
Hire an intervention specialist. The Johnson model relies on the family members to be informed about addiction and learn how the disease process works. It can be difficult to learn this information without the help of a licensed, trained professional. In addition, an intervention specialist can provide the sort of follow-up care the addict needs.
Stay positive. Family members simply must avoid attacking the addict during this meeting. This may mean that family members need their own counseling sessions to resolve feelings before the therapy begins. The intervention specialist can also assist and cut off any comments that seem destructive, angry or combative.
Provide choices. The Johnson model requires families to present treatment options, so the addict has a chance to make an informed decision. Presenting an ultimatum (“Enter this program or else!”) is not a part of the Johnson model.
Prepare for setbacks. Addiction can be considered a life-long disease, and it’s likely that the addict will have at least one setback and relapse in the years to come. Families can expect to hold more than one intervention, but the lessons they learn in the planning stages may make subsequent interventions easier to stage.
Most families want reassurance that a Johnson-style intervention will work before they commit to the time, effort and emotional strain of holding these meetings. It’s normal to expect results, and families are often desperate for a magic bullet that will cure the disease. One study published in the American Journal of Drug and Alcohol Abuse suggested that alcoholics who were confronted by family members and friends were significantly more likely to stay sober than people who were not confronted in a similar manner. However, it bears repeating that not all addicts and not all addictions are alike. Some people may truly need to be confronted with the problem and shown the benefits of sobriety while others may find a confrontation to be isolating and difficult to recover from. A qualified intervention specialist can help a family choose the right method to confront the addict, and then provide assistance to make sure the intervention progresses as planned.