By Dr. Greg Skipper, MD When a doctor or other professional shows signs of a problem with drugs or alcohol, an intervention is the next step. I’ve led many of these addiction interventions, sometimes speaking to the struggling professional one-on-one and sometimes joined by family members and others who can lend their influence and encouragement. Over the years, I’ve learned that there’s no single right way to conduct an intervention, but how it’s handled can set the stage for success or failure. In particular, five actions have the potential to derail an intervention for a professional such as a doctor — or for anyone, for that matter — before it has a chance to get off the ground.
- Making a diagnosis before an evaluation.
When a person’s drug or alcohol use is challenged, their first response is almost always to deny there is a problem. They may truly believe they have the situation under control or they may be panicked at the thought of being exposed and having to give up a substance that has come to seem essential. Either way, your attempt to get them to accept help is more likely to backfire if you label them as being an alcoholic or addict right off the bat. The reality is, you really can’t know for sure how severe the problem is in advance of an evaluation, no matter how plugged in you feel you are. But more important, you are much more likely to get the reaction you’re hoping for if you simply state that you are concerned and encourage them to be evaluated by a professional team to figure out what, if anything, is going on. Once an evaluation is completed, an addiction specialist can then make a dispassionate diagnosis and steer the person toward the help they need. This approach is less threatening, not to mention less embarrassing, and it’s much more likely to make the person open to complying with the recommended course of treatment.
- Not understanding where your power and responsibility begin and end.
It can be important to communicate the potential consequences that await if the subject of your intervention refuses help. But these consequences shouldn’t be posed as threats, and they certainly shouldn’t be empty threats. Everyone involved must decide in advance how much leverage you have and how much you’re willing to use. For example, a spouse might be ready to serve divorce papers or a business partner might move on if the person won’t commit to the evaluation. It may be tempting to threaten to take a doctor’s medical license, but only their professional board has that power. You can, however, remind them that because of the existing concerns it is likely that someone will soon report them to the licensing board, and it is much better to proactively get evaluated to see if treatment is needed. Along with knowing how much power you have, you also have to understand your responsibilities. Could they be endangering themselves or the public? Are you required to report them? To call police? Can you have them committed for a mental health evaluation? The laws vary by state. Know yours. In short, before you try to help, know what you can do, what you are willing to do, and what you should do as you work to ensure the most positive outcome.
- Waiting too long to stage the intervention.
It’s natural to hope that you are overreacting to what you’re seeing and you won’t be forced to intervene, but that’s too big a risk to take where substance use is involved. For one thing, there’s the very real possibility the person could be harmed or hurt others or perhaps even die while you delay. If something happens to make you think they need help, strike while the iron is hot. This is particularly true in the aftermath of a crisis. Say, for example, that the person is jailed after driving drunk. Intervening immediately after their release, while the incident is still fresh, can be a great motivator toward change. Wait a couple of weeks, however, and the person’s defenses will kick in and you’ll likely hear, “Things aren’t that bad.” And, of course, the sooner the person is helped into treatment, the greater the chances of their recovery.
- Involving those who will sabotage the process.
Before the intervention begins, make sure everyone who plans to participate understands that this may be a blunt and emotional process, and ask if they are confident that they can follow through. Nothing is more counterproductive than one person in the party starting to speak for the subject of the intervention and questioning whether the situation is really as dire as it seems. As an example: During one intervention I led on behalf of a doctor struggling with substances, a family priest began to suggest that perhaps a little more church attendance could set things right. Needless to say, this “out” allowed the doctor to put off treatment, and his substance use became even more entrenched and tougher to overcome.
- Not knowing when to stop.
I’ve seen the subjects of interventions agree to go to treatment in the first two minutes, yet the interventions continue. In some cases, there’s a sense that because the process is underway, it must be seen through. Or maybe you came prepared, perhaps eager, to add your encouragement or even to let off a little steam. But this isn’t your moment. The focus has to remain firmly on the goal — to get the person to accept help. The second that happens, stop the intervention, or you may risk making the individual increasingly resentful, embarrassed or harassed, none of which will help in the recovery process.
Optimistic Recovery Odds
An intervention isn’t an easy process for anyone involved, but there is good news to share with the person you are attempting to help — addiction treatment does work, and those in professions such as medicine have among the highest recovery rates. In fact, before I joined Promises Treatment Centers as the director of its Professional Health Services, I served as principal investigator in a national study of addiction treatment programs for physicians. We discovered a relapse rate of less than 21% over more than seven years. That translates to about a 3% relapse rate per year. If you are considering an intervention, those should be highly encouraging numbers. By convincing the professional you care about to aim for sobriety and a better future, odds are good that they’ll get there. Dr. Greg Skipper is the director of Professional Health Services at Promises. Dr. Skipper has worked in professional health, impairment and occupational and addiction medicine for over 30 years. He is certified by the American Society of Addiction Medicine and the American Board of Addiction Medicine, and is a diplomat of the American Board of Internal Medicine. Dr. Skipper is also an educator, author and a sought-after speaker who has been interviewed by leading national television and radio shows.