Data On “Intervention” Methods
Success Rates for Three Intervention Models to Motivate People to Enter Treatment
OK, readers, time for an update on the daunting topic of how to motivate our substance-abusing loved ones (LOs) to agree to seek help, BASED ON RESEARCH.
So what does the research show regarding various approaches to encouraging alcohols and addicts to agree to enter treatment?[1]
Three Different Common Models
- CRAFT MODEL 64% Success Rate
- JOHNSON MODEL 22% Success Rate
- Al-ANON MODEL 14% Success Rate
This study randomly assigned 130 families to the three different models, with the success being defined as the addict entering treatment. What are the models?
Craft Model
The CRAFT (Community Reinforcement Approach to Family Training) model is described as collaborative, practical and respectful approach based on teaching families a set of positive strategies to interact with their LO with the problem.
Johnson Model
The Johnson Model is described in the book, I’ll Quit Tomorrow and popularized by the show Intervention. This model usually involves an early-morning visit to the LO’s residence by family members, under the guidance of an interventionist, who then read letters telling the target how much his/her addiction has hurt them, hope for the future and consequences if s/he does not immediately agree to go to treatment. This is the model that many interventionists (a.k.a. patient brokers) try to sell to families, with the goal of sending paying clients into treatment centers.
Al-Anon
Al-Anon recommends doing nothing and waiting for your LO to seek help when s/he decides to quit. I call this the “waiting for the light bulb to screw itself” model. This approach is one reason for the high death rates among addicts. Family members are often referred to Al-Anon by therapists, treatment centers or other professionals. I consider this malpractice.
Vital Information
The success rates for these models is vital information for family’s seeking help because they can overestimate (hope) for positive outcomes using these methods. Also, treatment centers and interventionists will oversell success rates to families to gain their business. The intervention game is an unregulated, anything-goes, buyer-beware sales market. (Note that there are better interventional models described further on [i.e., contingency management], but the emphasis in this first part is on research on the probabilities of success for these three common approaches.)
RECOVERY RATES
20% or Less at One Year
As I discuss many times elsewhere, recovery rates from treatment are low, less than 20 percent at one year, according to reliable studies. As with interventionists, any representations or reports about success rates for treatment are unreliable because the industry is unregulated.
So even when your LO does agree to go to treatment, the expected outcome is relapse.
Which is why, my goal is to educate concerned family members and friends about data-driven models that improve the odds of sustained recovery, compared to the above models. The reader will see that by combining success rates for getting people into treatment and success rates for sustaining recovery after treatment, the likelihood of success is low.
Example: 22 percent under the Johnson model go to treatment. Of that 22 percent, 20 percent will be abstinent at one year. QED: The likelihood of recovery is 4.4 percent (22 percent x 20 percent) for those intervened on using the Johnson model. Even if off by 500 percent, these are poor odds. Keep in mind that the treatment center/interventionist cohort is a business, with substantial income generated by former patients who relapse. There is scant economic incentive to adopt highly effective recovery models.
War Between Old Ways and Evidence Based Practices
Right now, there is an active war going on in the addiction treatment field between the old ways practiced by treatment centers and AA sponsors and evidence-based practices based on research.
Example: A family business member returns from treatment. A member of a family business, Bob, is in treatment for the second time and the family is concerned about his return to his job in marketing involving entertaining, where alcohol is present.
Treatment Center/AA Sponsor: Bob is responsible for his own recovery and the business should make no changes or require any oversight measures. If Bob fails, he suffers the consequences until he gets the miracle of recovery.
Family Business Position: Business leadership wants Bob to sign a Return to Work Agreement, similar to agreements for pilots and doctors resuming work activities. These agreements provide for regular drug testing, changes in the work environment to reduce the risk of relapse, counseling requirements and similar accountability measures. From the family business perspective, they can’t afford Bob to relapse and harm the business and they are concerned about maximizing Bob’s opportunity to become sober.
Ongoing Warfare: This dispute is common and reflects what I call the treatment center/AA “mafia” hold on advice to addicts and family members that so often leads to relapse, versus the much higher, evidenced-based recovery outcomes of the pilot/doctor programs. This war between the two dramatically different approaches is ongoing for over 20 years, with no end in sight.
Going to Treatment is NOT the Same as Deciding to Recover
The kicker here, of course, is just because your LO agrees to GO to treatment does not mean s/he will WANT to recover or be able to SUSTAIN recovery.
- Got it? The decision to seek help is only the beginning.
Many people decide in treatment they do not want to quit, do not want to do what is necessary to maintain abstinence, or – even if they want to be abstinent – are provided an inadequate post-treatment program and relapse. Therefore, in the next section, I will review more successful intervention models using some form of contingency management or leverage.
Leverage – Pressure – Incentives – To Seek and Sustain Recovery
Other, more successful motivational models: Treatment Courts, Incentives, Doctor/Pilot Leverage Concepts
CRIMINAL JUSTICE SYSTEM – TREATMENT COURTS
From the National Drug Court Website (NADCP.org):
Treatment courts are the single most successful intervention in our nation’s history for leading people living with substance use and mental health disorders out of the justice system and into lives of recovery and stability. Instead of viewing addiction as a moral failing, they view it as a disease. Instead of punishment, they offer treatment. Instead of indifference, they show compassion.
Treatment court judges are said to have higher success rates than treatment centers!
Treatment courts are both a model to encourage people to seek help and to keep the pressure on until the addict can sustain recovery on their own. In the context of our work with families, a criminal incident can be used as leverage to encourage a loved one to seek help. However, most often families marshal their resources to make incidents go away. Not only is a treatment opportunity lost, but the addict learns the family will come to his rescue, no matter his/her behavior.
Example: A young adult steals money/objects from parents’ home. In this situation, we commonly suggest that the parents ask their lawyer to find a criminal defense lawyer to represent their child with the goal of a plea agreement requiring successful completion of treatment in exchange for dropping the charges. It is most successful when the prosecution is informed of the desired result before the parents bring the charges. One common problem occurs when a parent or other family member subverts the system when the young adult is noncompliant with the plea agreement.
INCENTIVE-BASED SYSTEMS – ASAM – CONTINGENCY MANAGEMENT
As reported previously, the American Society of Addiction Medicine (ASAM) states[2]:
Contingency management has been studied and shown to be effective in the treatment of many substance use disorders, including opioid use disorders, cannabis use disorders, and stimulant use disorders. Importantly, it is the only evidenced-based treatment for stimulant use disorders. …… The National Institute on Drug Abuse (NIDA) also promotes contingency management as a highly effective approach to increase treatment retention and promote abstinence from drugs.
I recall reading several studies that indicate using contingency management in combination with community-based support services can double recovery rates for the chronic low-income using population – perhaps up to 40 percent.
DOCTOR/PILOT PROGRAM – CONTINGENCY MANAGEMENT
Programs run by airlines and medical boards for substance dependent pilot and doctors, respectively, have the following recovery rates:
- Pilots: 92% continuous abstinence at two years
- Doctors: 84% continuous abstinence at five years[3]
The pilot success rate was first reported in the Hazelden Treatment Center Newsletter, Voice, in 1998. Pilots, like doctors, are offered a special treatment program unavailable to the general public. The contingency management component of the program is simple: You comply with all treatment recommendations and you can fly or practice medicine again. Very effective. We find using access to money and other family resources is often a very compelling tool in encouraging family to seek help and stay focused on recovery.
Closing Comment
Let’s use research and data to make treatment decisions concerning our loved ones. Most readers are likely in high states of anxiety – looking for help and worried sick about their son, daughter, sibling or parent with a serious using disorder. But keep in mind the data. Don’t settle quickly for a solution with a low chance of success. This is not like horseshoes. Close is not good enough, and you may not get another turn to pitch that shoe.
In the next several blogs, more information on leverage.
[1] Miller, Meyers and Tonigan, 1999 Study,
[2] Letter to HHS Secretary Azar, July 6, 2020 from ASAM, by WF Haning, MD
[3] The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment A Report of the John P. McGovern Symposium Hosted by the Institute for Behavior and Health, Inc. November 18, 2013, Washington, DC