Information for Individuals

Structured Intervention - Interfering Can Save Lives

Addicts are rarely able to help themselves, so it's up to family and counsellors, finds Sacha Vaughan Structured Intervention - the six-step plan

SARAH Soames was in despair as she watched her 29-year-old daughter, Rose, change from an articulate, attractive woman into a frighteningly angry figure dependent on heroin.

Rose had a good job in a big investment trust, but spent all her earnings on heroin; when her salary wasn't enough, she sold everything she could - engagement ring, all her electrical goods - to feed her addiction.
Sarah longed to be able to say or do something, but felt powerless to do so because she was terrified of driving her daughter - and her small grandson, Ben - out of her life. Her fear that Rose might kill herself, or, unwittingly, endanger Ben, finally drove her into a tough confrontation with her daughter. But she did not do this alone. Supporting Anna and her husband was Roger Green, a Chemical Dependency Counsellor, who was pioneering personal "Structured Intervention Therapy" in this country (Jersey Chanell Islands)

Popular in America, this sensitively structured, six-step programme is designed to shorten the gap between a family recognising that they are living with someone who is chemically dependent (alcohol or other drug addicted) and that person realising they need help. Whatever the dependency - drugs or alcohol - the problems are similar.

And, tragically, if nothing is done, the outcome can be death through accidental overdosing. "Structured Intervention" is tailored to help those closest to addicts bring them to the point of seeking help and treatment. One prevailing idea is that those who are addicted to drugs or alcohol have to "reach the bottom" before they will realise that they can fall no further and must do something. Structured Intervention challenges that view; it is an approach that is increasingly attracting the attention of psychiatrists, drug dependency counsellors and psychologists.

"It is cruel and unnecessary to leave a chemically dependent person until they hit rock bottom," says Mr Green. "Family and friends, with the guidance of a therapist, need to raise that person's 'bottom' by creating a situation that will persuade them to seek help."

Mr Green trained as a dependency counsellor at the Hazleden Clinic in Minnesota, which is renowned for setting the highest standards for dependency treatment in America. Betty Ford went there when she wanted to set up a clinic, and many of her clinicians were trained there. Mr Green then studied Structured Intervention therapy at the Johnson Institute in Minneapolis, which pioneered the technique. After helping to set up treatment programmes in London and Jersey, he branched out on his own in London in 1995.

"I discovered that, although there are huge numbers of people battling with drug dependency, the British are reluctant to meddle in another person's business. But the point is that addiction is a disease; the person is ill, not bad, as the British often fear. One should intervene." Rose, who lives in Jersey, had been addicted to heroin for four years when her mother heard about Mr Green. "Roger and my parents came to see me," she says. "I had no idea they were coming and I remember being shocked by what my mother told me about my behaviour.

The worst was hearing about times when I had stormed out of the house, taking Ben with me in the car, and he would look back at my mother through the window, terrified. Each time, she was convinced I would crash. She would cry for hours, terrified to pick up the telephone. I could remember none of it - that I was completely neglecting my son and even putting him in danger.

"I had never seen it like that before. I thought my behaviour was quite normal. Seeing my mother so desperate that she had to look for help herself made me realise I had to do something. I don't think she would have told me the things she did without Roger's help." Within days, Rose was in a rehabilitation centre.

While the concept of intervening in an addict's self-destruction is part of a rehabilitation centre's treatment programme, its introduction here as a specific and vital step towards treatment is relatively recent. Roger Green explains its impact: "Even if that person does not seek help immediately, they will never again have a drink or take a drug without a feeling of discomfort. That alone can trigger the decision. Sometimes it takes a week, sometimes years."

Structured Intervention has been so successful in America that the services of a trained counsellor are available free in almost every state. The six steps in the Structured Intervention process apply in every case. Diana Wells, chief executive of Broadway Lodge, a rehabilitation centre in Weston-super-Mare, feels that Structured Intervention is greatly undervalued in Britain. "It can be a hugely positive springboard in breaking through denial by the addict and their family."

Mark Bennett, at Alcohol Concern, says that part of the problem in helping addicts is the lack of comprehensive services. "We get a huge number of calls from families asking: 'What can we do? We don't know where to go.'" Dr Massimo Riccio, medical director of The Priory clinic, Roehampton, also recognises the benefits of Structured Intervention.

"Although it has formed part of many treatment programmes for quite some time, there is a need for it to be more widely recognised as an invaluable part of the process. Professional guidance in approaching the addict is essential and often a great comfort." There are an estimated four million people who are chemically dependent in Britain - and with each report on the problem, the figure continues to rise.

In every case, up to 10 people can be directly or indirectly affected. Mr Green is only too aware of this. "Structured intervention must become available on the NHS. With statistics like these, taking that significant first step is crucial."

Assessment & Diagnosis

Recovery Resources offers a full assessment/diagnostic impression service for people suspected of chemical, food, gambling, and computer addiction. Families and Individuals Procedures used are psychometric testing egg: the SASSI-3-UK (Substance Abuse Subtle Screening Inventory), the TAAD (Triage Assessment of Addictive Disorders) to determine such disorders of either abuse or dependence on drugs/alcohol according to the DSM-IV (the American Psychiatric Association's diagnostic definitions) and the British diagnostic definitions; the Jellinek Chart of symptoms and phases of drug and alcohol dependence through symptomatic use of chemicals in the Prodromal, Crucial, Basic, and Chronic phases; and counselor interviewing skills. The results of these tests are fully documented in the form of a clinical formulation with an initial diagnostic impression.

Qualified recommendations for management of the condition of drug or alcohol addiction are then given. If referral to treatment is necessary, Recovery Resources clinicians will refer to appropriate treatment settings for immediate admission. Recovery Resources has links to treatment in the USA, UK, Australia and New Zealand. If in-patient treatment is not required, a day care plan will be drawn up for the client who can either be referred on or who can work with Recovery Resources clinicians on an out-patient basis.

If you are suspicious of your own use of chemicals or if you can persuade another person where there is a suspicion of dependency or abuse, call Recovery Resources on 027 5462 247 for an appointment.