What is intervention?
When is intervention over drug or alcohol use appropriate? One benefit of becoming knowledgeable about addictions is being able to spot, earlier and with more clarity, the signs and symptoms of developing substance abuse problems.
Here we offer some strategies to get help for people with substance misuse and abuse problems and their loved ones, and some options that are available specifically in the Capital Region to assist them.
SAIR believes that intervention is appropriate when someone has developed a pattern of drug or alcohol use that continues to progress despite negative consequences.
Intervention can take many forms. A parent confronting a teen-age child who comes home drunk or high on drugs after an evening out is intervening about their substance use. An employer who challenges a worker over showing up for work under the influence or over frequent absences from the job is also intervening.
Personal responsibility demands that people who see drug and alcohol problems developing in those they are close to not look the other way.
We offer detailed information about an informal intervention technique known as “FRAMES.” It has proven effective at making people think about the extent of their use of substances and the consequences, and about options for getting help. It requires no special training or expertise.
A pattern of alcohol or drug misuse has surfaced, indicating an opportunity for the use of “FRAMES.” SAIR believes “FRAMES” is an effective way of getting people who are misusing drugs and alcohol to start thinking about the consequences of their behavior and about seeking help.
“FRAMES” is an acronym referring to a positive, constructive way for people to express their concern about another’s substance use and to try to motivate them to do something about it. A “FRAMES” intervention is not a confrontational exchange where the user feels they are on trial for their behaviors and habits. Rather, it should be a conversation where a person expresses their concerns about another’s use of drugs or alcohol, discusses the approaches they can take to change and offers hope and encouragement to get help. It should be done with empathy and support. Professional expertise is not necessary for a “FRAMES” intervention.
The “FRAMES” components are:
- F is for feedback. Encourage individuals to discuss their substance use and problems that may have occurred.
- R is for responsibility. The responsibility lies with the individual to make appropriate, positive changes and choices.
- A is for advice. Recommend ways that individuals can get help.
- M is for a menu of options. Suggest specific actions individuals can take to address problems.
- E is for empathy. At all times, empathy should be shown toward the individual in need.
- S is for self-efficacy. Reinforce the point that the individual is capable of succeeding.
If successful, a “FRAMES” intervention will give its subject more awareness of the potential consequences of their alcohol or drug use, the options for getting help and the support that will be available to them if they do so.
An axiom in the recovery field is, “If nothing changes, nothing changes.” It is a way of saying that recovery is dependent on a person’s ability to change the behaviors and the attitudes that led to their misuse of drugs or alcohol in the first place. Another tenet of substance abuse professionals is, “Change is the foundation of recovery.”
Both expressions are based on the idea that in order to free themselves from dependence on drugs or alcohol, people must be motivated to change the way they think, act, feel and believe. The better a person understands and addresses the negative thoughts and behaviors that led to their misuse of substances, the better their chances for recovery.
The accepted stages of change progress from “precontemplation” (people are not even aware of their problem); to “contemplation” (they start to entertain the possibility or the need for change); to “preparation” (they have decided to make changes within the near future); to “action” (they actively begin to modify their behaviors) to “maintenance” (the replacement of old, destructive behaviors for new, positive ones). The final stage is “recurrence” or “relapse” (they resume their former, undesirable behaviors). Experts say that not everyone moves from one stage of change to the next in an orderly fashion, or that people are necessarily aware of the transitions as they are occurring. But they agree that behavioral changes need to occur if people are going to successfully overcome addictions.
The need for change also applies to those individuals who are attempting to help and support the abuser of drugs and alcohol.
A person has come forward on their own for drug or alcohol treatment. Or they have agreed to seek help during a “FRAMES” discussion or another form of intervention by others.
Where should they turn next?
Most people seek help through:
- Treatment providers licensed by the New York state Office of Alcoholism and Substance Abuse Services (both in-patient and out-patient facilities).
- Private treatment providers (psychiatrists, psychologists, counselors with master’s degrees in mental health and substance abuse and other state-certified professionals).
- 12-step programs for those in recovery (including Alcoholics Anonymous and Narcotics Anonymous).
- Faith-based support groups (including churches and synagogues).
- Communal support (associating with members of the community that can offer healthy support during the recovery process).
- 12-step programs for people supporting individuals in recovery (including Al-Anon and Nar-Anon).
The best options will vary according to the individual seeking help, their age, their families, their income levels, their access to private or public health insurance coverage, the depth of their drug or alcohol dependencies, and other factors.
Recovery plans may well entail being involved in two or more treatment options. It is common for people to need in-patient care at the detoxification stage of early treatment and to immediately explore a 12-step program such as Alcoholic Anonymous, so they will not be starting their journey to sobriety alone. Formal out-patient programs frequently offer basic information about substance abuse and the science of addiction while also urging participants to try 12-step programs to strengthen their sobriety. There are many paths on the journey to recovery. But isolation and a go-it-alone attitude are usually seen as major deterrents to achieving and maintaining sobriety.
SAIR urges people to beware of the recent proliferation of fraudulent, unregulated or ineffective treatment for alcohol and drug problems. Just as the misuse of alcohol and drugs has continued to grow, an increasing number of unscrupulous treatment vendors has surfaced to prey upon desperate individuals and families seeking help with their substance abuse problems.
When treatment is necessary for a drug or alcohol problem, resources are available to help sort out available options.
The Office of Addiction Services and Supports (OASAS) is the state of New York’s chief agency for alcohol and drug prevention and treatment. Its website explains when treatment may be necessary, how treatment options vary according to the different addicting substances and how to navigate the addictions care system in New York. It operates a round-the-clock helpline for people with alcohol, drug and gambling problems at 1-877-846-7369 (1-877-8-HOPENY). This site also allows visitors to search for state-licensed treatment providers in New York, the services they offer and contact information for each licensed facility. The office formally changed its name from the Office of Alcoholism and Substance Abuse Services in 2019, but the OASAS acronym remained the same.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a round-the-clock treatment referral and information service for individuals and families facing substance use and/or mental health disorders [1-800-662-HELP (4357)]. Among the useful guides produced by SAMHSA about finding effective treatment for addictions is "Resources for Families Coping with Mental and Substance Use Disorders" and "Know the Risks of Marijuana."
SAMHSA’s Treatment Improvement Protocol (TIP) Series provide best-practice guidelines for professionals in the alcohol and drug treatment field. TIP 35 includes an in-depth description of the “FRAMES” intervention approach along with motivations behind the process of change. The Treatment Improvement Protocols series describes standards for treatment of addictions in the United States.
The National Institute on Drug Abuse maintains a website with information about finding treatment for alcohol and drug addictions.
SAIR believes that isolation is one of the most dangerous threats for people with alcohol and substance abuse problems. Since 1935, the 12-step concept originating with Alcoholics Anonymous has helped millions of people “solve their common problem” through a message of “experience, strength and hope.” More than 100,000 AA chapters hold regular meetings around the world, including those offered by the dozens of active groups in the Albany region. The Albany region AA maintains a hotline to help people struggling with alcohol at 518-463-0906.
A number of videos document the history of AA, including the filmed first-person recollections of Bill Wilson, the group’s co-founder. Father Joseph Martin provides good background on AA and the effectiveness of the 12-step approach.
Does a 12-step program like AA work? Nothing is guaranteed in the treatment of substance use disorders, but the AA approach has been effective for many people for many years. In this recent update of a 2006 study, the independent Cochrane scientific and medical research foundation reported that Alcoholics Anonymous appeared to have as good, or better, long-term results at promoting sobriety than any other accepted treatment method. The authors of the study wrote that the fact the AA program is available for nothing or at the cost of nominal meeting donations is an added plus.
Since 1951, Al-Anon has provided support to the families and friends of problem drinkers recover from the impacts of a loved one’s drinking. Members help each other by practicing the 12 steps of AA, by welcoming and comforting the families of alcoholics and by giving understanding and encouragement to the alcoholic. Its local meetings are listed online. This video presents a good idea of what Al-Anon has to offer.
Adult Children of Alcoholics/Dysfunctional Families takes a 12-step approach to helping people cope with problems as adults that they trace to growing up in alcoholic homes.
“Counselor Carl” Benedict focuses on one of the most difficult concepts for those who try to help people struggling with alcohol or drug problems – “detaching with love”.
Claudia Black is a highly respected addictions treatment and education professional whose presentations provide excellent guidance on reaching out and supporting those struggling with alcohol or drug misuse. This presentation on the “domino effect” of addictions also discusses how people seeking to help substance abusers must safeguard their own health and emotional well-being.
An informative report by U.S. News & World Report offers numerous links to articles relating to addiction treatment and recovery. Included are tips on avoiding the potential pitfalls posed by the emergence of costly treatment facilities in the addictions care industry.
A word of caution to keep in mind about treatment. Addictions experts and government agencies have increasingly warned about the rise of treatment fraud and of the brokering-for-a-profit of patient referrals. The New York State Office of Addiction Services and Supports (OASAS) warned early in 2018 about the potential for fraud in the addictions care industry and emphasized that OASAS-certified and credentialed professionals are prohibited from receiving patient referral fees. The state has created a hotline (1-800-553-5790) to report addiction treatment fraud.