Is It Time for an Intervention?

0:00:15 William Moyers
Hello! And welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues that matter to us and the issues that we know matter to you, too. Substance use prevention, research, treatment of addiction, recovery management, advocacy and education. I'm your host, William Moyers, and I'm here today to tell you that he is not Dr. Drew, but he is Drew Horowitz. An addiction and mental health consultant who specializes in clinical intervention.

0:00:47 Drew Horowitz
That's correct.

0:00:47 William Moyers
Drew, thanks for joining us today on Let's Talk. What does it mean to be a clinical interventionist?

0:00:53 Drew Horowitz
It's a good question. Essentially my role as a Clinical Interventionist means two things. One is it means that I am educated, licensed, and trained in both addiction and mental health. And overseen by the Board of Behavioral Health & Therapy in Minnesota. Two, it means that I have a—a strong understanding of what a family system looks like and how it acts and behaves when there's an active addict or alcoholic within that family system. And our training and experience allows us to come in, disrupt that system, and help the identified patient, being the addict or alcoholic, enter a treatment center.

0:01:29 William Moyers
In other words, you're doing "interventions" as they—

0:01:31 Drew Horowitz
Correct.

0:01:32 William Moyers
—Used to call them.

0:01:33 Drew Horowitz
I am doing them as they used to call them, but we're doing them much more strategically and measured and taking into a lot more factors and considerations.

0:01:43 William Moyers
But intervention used to come with that—it had a connotation of a negative experience or a confrontation or where there would be outright anger and all those other things.

0:01:53 Drew Horowitz
Absolutely. That's sort of the stigma I'm up against.

0:01:56 William Moyers
Ahhh. You have a stigma.

0:01:58 Drew Horowitz
Yeah. [chuckles] Very much so. And that is actually one of the biggest reasons I'm probably jumping ahead why people don't wanna do it because they have a misconception of what it is.

0:02:05 William Moyers
Yeah.

0:02:06 Drew Horowitz
It's none of those things. It's not a confrontation. It's not a fight. It's not an argument. It's a family meeting, facilitated by a professional who is educated and experienced in family systems. And how it operates. With a specialized understanding of what it takes to help motivate someone to enter treatment.  In using compassion, empathy, motivational interviewing and other evidence-based models that help motivate people. It's—it's none of the things you mentioned, William.

0:02:33 William Moyers
So at the end of the day, it is about motivating the person who is caught in the grips of the substance into going—recognizing they have a problem and then getting help.

0:02:43 Drew Horowitz
Correct.

0:02:43 William Moyers
How do you do that?

0:02:44 Drew Horowitz
Almost any person using a substance, where—who they meet criteria for, you know, a significant substance use disorder, they know internally that they have an addiction. So I don't really need to convince them so much that they have an addiction. I need to delicately help them understand that it's okay to get help for their addiction and that this isn't a bad thing, that we are gonna help you, we are gonna honor you, and we're gonna validate you, and we're gonna do it by appealing to their better nature, and helping find that person inside that really exists that's being essentially you know suffocated by the addiction. There's a good person in there. And part of the family meeting with myself there is to help bring on what we call moment of clarity.

0:03:28 William Moyers
Moment of clarity.

0:03:28 Drew Horowitz
We create it. Why wait for them to go near the brinks of death to see it when we can help artificially create it? And open a window of opportunity. And that's what I do. I help create that window of opportunity and pull them through.

0:03:42 William Moyers
And you often times utilize the family to do that?

0:03:46 Drew Horowitz
Absolutely. I mean, they don't know me, so—so it's not about me. It's about me teaching and coaching the family how to strategically utilize certain things that they could use and say and potentially help me find a way to motivate them. Absolutely. It's not about me. I am the director, but I'm certainly not the agent of change as part of this process.

0:04:10 William Moyers
Talking about agent of change this often times it's said that if a person doesn't wanna change, they can't be compelled to go to treatment. You know, that until somebody wants it, why bother?

0:04:25 Drew Horowitz
Yeah. I mean, I can speak you know to that very well. And speak personally to that.

0:04:30 William Moyers
Please.

0:04:31 Drew Horowitz
When I was 26 years old living in New York City active in a cocaine addiction, I didn't want it, but I knew I needed it. My family helped get me there. Hazelden Betty Ford helped me realize that I needed it. So to get to treatment, you don't have to want it. You just have to go. What happens there is magic. It's where treatment happens, it's where clarity happens, it's where your body heals. And you start to feel good. Then you develop a motivation to want it. So there's a misconception. You don't have to go to treatment—you don't have to wait till the person is—is surrendered and willing and wants it. You don't need that. A person needs to go to treatment with just a little bit of willingness. Once they're in treatment, that's where the recovery happens, that's where the brain opens up, that's where the clarity happens. That's where there's good clinicians that understand motivational interviewing and know how to motivate someone towards an acceptance, action stage of change. So, I would say William that that is an outdated concept around substance use disorder and mental illness that someone has to want it in order to do it. That's not—there's very little evidence that suggests that. I do believe that that's the case if they're gonna have ongoing and long-term sobriety. To some degree, they do have to want it. Otherwise—

0:05:46 William Moyers
You gotta be part of the solution? Yeah.

0:05:47 Drew Horowitz
They gotta be part of the solution. But the beginning stage to take that initial step, from Point A to Point B, the community to treatment, I see at least a hundred people myself a year take that step. With me—

0:05:59 William Moyers
Mmm-hmm.

0:06:00 Drew Horowitz
—That I'm pretty sure don't really quote "want" it. But, they certainly understand that it's something they need to do.

0:06:05 William Moyers
So they take that step—

0:06:07 Drew Horowitz
Correct.

0:06:07 William Moyers
And off they go to the treatment experience they're gonna have. Whether it's at Hazelden Betty Ford or somewhere else in the community.

0:06:11 Drew Horowitz
Correct.

0:06:13 William Moyers
They leave behind a lot of wreckage, a lot of damage, a lot of emotional raw wounds because the family is there. So your job is not done when the addict and the alcoholic, the focus is off in treatment. You have other things to do.

0:06:30 Drew Horowitz
Correct. The storm has stopped. For sure. The—the addict or alcoholic, the identified patient, is receiving life-saving care. Absolutely. The storm has stopped but there is significant wreckage that needs rebuilding. And that's recovery. It's family recovery. It's a family system. If the family recovers, research has shown that it's more likely that the individual is going to recover.

0:06:57 William Moyers
Mmm.

0:06:57 Drew Horowitz
Their recovery is actually partially contingent upon the family getting care. Because both individual—individual and the family need to proceed toward recovery. So my job now becomes how do I support the family in keeping up with the identified patient who just got care.

0:07:12 William Moyers
Mmm-hmm.

0:07:13 Drew Horowitz
So yeah, there—there comes a lot of work post-intervention. That's a great first step, but a lot of work to follow for sure.

0:07:19 William Moyers
What about do you do work with families once the afflicted person who has come back from treatment, do they come back to see you?

0:07:27 Drew Horowitz
Yeah, absolutely. I mean we have a lot of families—we've gotten to know them on a seriously intimate level.

0:07:32 William Moyers
Uh-huh. Yeah.

0:07:32 Drew Horowitz
We've been in their home, I've seen them cry, I've heard words that they haven't ever used before. I get to know them on a level that they—most people outside their family haven't seen. I'm privy to information very few people know about them or their family. So there's an immediate connection. There's a level of trust that they have to put in me and that just doesn't go away. You become a profound part of their family. And they really do depend on you, and trust you and value you.

0:07:59 William Moyers
Mmm-hmm.

0:07:59 Drew Horowitz
As—as a component of their family. They seek ongoing counsel, not just in the next thirty, forty, eighty days but years after. I talk to families.

0:08:09 William Moyers
So family members need to recover—

0:08:11 Drew Horowitz
A hundred percent.

0:08:11 William Moyers
—While their loved one is recovering or even if their loved one doesn't recover. Because it doesn't always work.

0:08:17 Drew Horowitz
It doesn't, no. And people discharge treatment AMA—

0:08:22 William Moyers
Against medical advice. Yes, yep.

0:08:22 Drew Horowitz
Against medical advice. People decline treatment and say they will do this without their family and figure out an alternative path. Here's—here's what intervention is. Intervention is a process. It's not an event. And that's where a lot of confusion is. Everybody puts a lot of pressure on the day of the meeting with the identified patient who's the addict or alcoholic. They're either goin' or they're not. And that's gonna determine everything. It's not. This is a process. Intervention is a process. People that don't go on the day of intervention almost always go to treatment within 7 to 21 days. Almost always. And that's just because the intervention process was very impactful. It was very hard, it was very crushing to the addiction. Because the disease of addiction doesn't like that. [Moyers chuckles softly] And this just really derailed their plans. And so what happens is they eventually come full circle, we get a call and they're ready to go.

0:09:16 William Moyers
They'll [sic] be a lot of people who listen or—or view this podcast who are interventionists or maybe wanna get into the field—

0:09:22 Drew Horowitz
Mmm-hmm.

0:09:23 William Moyers
Like you have as—as a consultant. But we know at the end of the day that a vast majority of the people who tune into these less—Let's Talk podcasts are people who are really looking for help. Either for themselves, for an employee or for a family member. What should family members look for before they pick up the phone or send you or somebody like you an email?

0:09:48 Drew Horowitz
The unfortunate reality is that I am the last call. Families believe that they should take all these other steps before they call me. They think the person needs to be arrested, they need to be hospitalized, they need to have lost their family, now they can call me. It's the exact opposite. This is a preventative method.

0:10:07 William Moyers
Hmm.

0:10:07 Drew Horowitz
They should call me first. Let's preserve that individual of all that suffering. Let's preserve that family of all the financial loss. Why do we need to go down that road? Why do we need to have legal barriers and medical issues and—and cirrhosis of the liver? We don't need any of those, we can motivate a person to seek treatment prior to having those consequences and outcomes are just as good. We should be the first call. A call or email doesn't cost any money. Our services start and we provide support because we like to help people.

0:10:34 William Moyers
Mmm-hmm.

0:10:34 Drew Horowitz
You know. There—there's a no-cost consultation, there's—there's opportunity, get to know us. If an individual is struggling in a relationship because of their substance use and they're not functioning at a level where they should be functioning or they're not happy in their life as a result of a substance, it's appropriate to call us. Those are the reasons. They don't need to be arrested. They don't need to have a long list of prior treatments or hospitalizations, that's not really necessary. Those—those individuals have already gone significantly down the road. Call and learn. Intervention is not a punishment. We're not going to leverage a person to do something that makes the family fearful.

0:11:14 William Moyers
Mmm-hmm.

0:11:14 Drew Horowitz
We're not gonna bully the family. We're here to help. And we do.

0:11:19 William Moyers
Point being that the family shouldn't wait for the loved one to hit bottom.

0:11:22 Drew Horowitz
Absolutely not. I mean let's—let's save them and the family. Bottom is a—is an old-fashioned term. It—there's no actual research or evidence that suggests they need to bottom out and be ready. People die every day from this illness. Where's their bottom? Six feet under.

0:11:41 William Moyers
Mmm-hmm.

0:11:41 Drew Horowitz
So, we don't wanna risk a person's life. We wanna take a—a model here that's evidence-based, that's strategic, that's done professionally and clinically, where we approach an individual and help them see an option of treatment. What they decide to do is going to be their decision. But it doesn't hurt to help direct 'em in the right place. And that's what we do.

0:12:05 William Moyers
Drew Horowitz, thank you for—

0:12:05 Drew Horowitz
You're very welcome.

0:12:07 William Moyers
—Directing our listeners and our viewers to that right place through your expertise as a clinical interventionist based in the Twin Cities of Minneapolis and St. Paul. [reaches across to shake hand] Appreciate your taking the time today.

0:12:15 Drew Horowitz
Thank you very much.

0:12:17 William Moyers
And on behalf of our Executive Producer Lisa Stangl, I'm your host, William Moyers. Thanks for tuning in for this Let's Talk podcast and we hope to see you again.