The Week Before Treatment
The week before treatment is a critical time in the recovery process. After a successful intervention, it is common for the identified loved one to delay the check-in process for a few days. Often a person of concern will use trivial reasons like holidays to avoid going to treatment. After an intervention, the addicted person will spend time look for reason to change their mind. Do not let the timeframe exceed a week.
How interventions work
Interventions are organized by the support team, on the day and time chosen by the team, not the person of concern, compassion should be extended to the person of concern as they attempt to regain control of the situation. Their unwillingness to check into rehabilitation immediately is understandable; they were not prepared, mentally or physically, to attend treatment. Certainly, they were not planning on going the day and time that the intervention team chose.
To help facilitate a successful outcome, the team may need to negotiate checking in after loose ends, such as child care and work commitments are figured out. By giving them a day or two to settle into the timeframe they might take more ownership of going to treatment.
Look for small ways that you can help them feel like they have control. Review the website of the treatment center, goto CVS and get toiletries, make plans for the pets.
Organizing a facility transfer
In situations where there are safety concerns, such as violent behavior, unsafe driving, or reckless substance use, same day check-in might be required. If not, within the subsequent few days is acceptable.
If your loved one is in a facility, detox, or hospital, it is ideal to organize a facility to facility transfer. When your loved one returns home, they will return to use, setting the entire situation back to square one.
Is it safe for them to be alone? Will they hold to their commitment? Will they try to run? The safety of all parties, including family, friends, coworkers, and the individual themselves, needs to be considered.
Drawing enemy lines
The addict will try to find an enemy that he can rally a family member around. The most obvious enemy is the interventionist (or member of the family that was outspoken during the intervention). The addict will try to peel a soft member, probably the person that was uncomfortable with the idea of an intervention from the beginning, out of the group and align them against the new enemy.
Once the suffering individual has someone else on their side, you will hear things like, “Dad doesn’t think I need to go,” or “My wife says that I need to stay home and watch the kids.” The worst case scenario is that the cosigner joins with the suffering person and turns against the interventionist. This can be a powerful alliance that becomes unbreakable. The co-signer needs to be back on board with the recovery plan, and then go back to the suffering person.
Sometimes this isn’t possible. This alliance can completely erase any progress the family has made. It could be a long time until another opportunity arises for recovery.
If there’s a plan in place for that person to go to treatment in a few days, loved ones must be ready for the calls, the manipulation, the attempts at alliances, the excuses.
Commit to a Date and Time
It is important that the family sets a firm deadline for treatment. If the person of concern is given a window of time to attend, they will always choose the furthest date out. This will only prolong their anxiety and give them opportunities to talk themselves, and their loved ones, out of going to rehab. If you need to give them a choice of dates, give a narrow window; the upcoming Friday or Saturday or today or tomorrow. not a week or a month from now. Nothing good every happens in the time that they delay going to treatment, and it often gets worse.
When planning your arrival keep in mind 9-5. While most centers accept late check-ins and weekend check-ins, they may be on reduced staff. It is best to check in during typical business hours. Always give the treatment center your planned arrival time and update them on the way to the facility.
Remove Roadblocks Before the Intervention
The most common barriers to immediate treatment include childcare, pet care, familial responsibilities, and work. To mitigate this, the support team should work together to ensure that these obstacles are taken care of before the intervention takes place.
Child and pet care can be organized through family and friends, as well as other personal responsibilities. Work concerns are more difficult to address, but since addiction is a protected medical class, it is likely that a leave of absence is possible and will be covered by FMLA.
By foreseeing the challenges, the support team can relieve some of the stress off the person of concern and give them the opportunity to organize themselves before attending treatment.
No Rogue Decisions
The intervention team must make a commitment that they will not make any decisions without consent of at least one other person on the team. The addict is an expert at peeling people off, once someone peeled off the group, the addict will be able to manipulate that one person. Every decision, no matter how small, should be made with another team member. Two people will see and overcome the manipulation; alone the addict will always win. Well laid plans can be destroyed by one well intentioned family member. Lending money, going to the store, choosing a flight, choosing a connection, date and time of departure – at every corner the addict might be trying to find a way out.
The “Last Hurrah” vs The “Cold Turkey” Method
If someone has a few days before they enter treatment, their use patterns tend to mirror one of two extremes: extremely heavy use (The “Last Hurrah”) or complete surrender of the substance (“Cold Turkey”).
If your loved one is taking this route, hold onto your seat – it might get bumpy. During the Last Hurrah, substance use tends to increase significantly, which is difficult to watch. They will receive negative or biased information about treatment from other users and begin to change their mind about attending the inpatient facility.
This stage can become very dangerous, very fast. As use increases, the risk of overdose or legal issues, such as a DUI charge, becomes greater. Thus, it is recommended that if the person of concern is showing signs of this behavior, the support team monitor them 24/7 with a chaperone.
Although the effort is admirable, sudden stops in use can be medically dangerous. We have all seen movies where someone gets the “shakes”, sweating profusely and overwhelmed with nausea once they stop using their substance of choice.
These symptoms are serious and must be monitored by a doctor. During the first few days of treatment, patients undergo a medical detox, complete with 24/7 physician care, to ensure that they are safely weaned off drugs and/or alcohol.
Going Cold Turkey is the patient’s way of trying to avoid rehabilitation. Some try to use their short break from substances as evidence that they don’t need treatment and can achieve recovery on their own. However, the first few days are always the easiest to manage. The emotional and physical symptoms of detoxification can take up to a week to surface. The family needs to understand that a few days of sobriety, should not change the plan.
Family should not pressure their loved one to stay sober before treatment, families should focus on safe use, allowing the loved one to continue to use so that they don’t go into withdrawal or over indulge.
The Insurance Paradox
Unfortunately, the Cold Turkey route can put someone at risk of not receiving insurance coverage. In a strange paradox, many insurance companies will not cover inpatient treatment if a person has maintained sobriety for five days or more.
To ensure insurance coverage, it is better that the POC use alcohol or drugs in the days before treatment. consumption before treatment may be the only way to ensure that insurance coverage is provided.
As time passes after an intervention, denial will likely return to your loved one. The intervention was successful at breaking through this denial, the addicted person agreed to treatment. The longer that goes between intervention and checking in, the commitment by the addicted person will change, they will wax and wane between commitment and a return to denial. You will hear, “I don’t think I am that bad, I can do this on my own, This is an overreaction” or “I will try a moderation program.”
When denial starts to creep back in, remind your loved one of their commitment. This is a time to use love and support. “We know you can do this, we know that it is scary, but we will be there with you.” Remind them of the specific commitment that they made, remind them of some of the things that loved ones said during the intervention. Keep bringing them back to their commitment.
Commitments made during an intervention don’t last forever, and as time passes denial will get stronger and stronger. After an intervention, move fast to get your loved one into the facility.
That Place Sucks
The addicted person will read the reviews of the treatment center you selected on-line. They will latch on-to a bad review and try to get the family to turn on the plan. “This place has bad reviews!” they exclaim, the family will read the reviews and doubts will creep in.
Understand that on-line reviews of treatment centers are often very skewed, drug addicts don’t give high praise to places that try to take their drugs away from them. People that get through treatment successfully are unlikely to leave a review of their rehab center. Read the reviews with a grain of salt.
Another version of this objection is, “my friend went there and said it sucks.” Similar to online reviews, we should not take advice from un successful people who look for reasons to complain.
You did your research before the intervention, go back to the reasons that you chose the treatment center, don’t derail the plan over your addicted person’s attempt at using the reviews to blow up the plan.
From Dream to Reality
Families have a pivotal role in making recovery a reality. Referencing the treatment center website, reviewing the packing list, and using active language (e.g., “when”, not “if” they recover) are useful tactics in placing rehabilitation at the forefront.
The intake call with the treatment center is the next step. Similar to the documentation you fill out during a preliminary visit to the doctor’s office, this call is filled with questions and lasts for roughly half an hour. Your loved one might find this process nerve-wracking, so sitting with them and keeping them on track would be helpful.
After the intake call, the facility will review “the case” with the medical team. Your loved one needs to be medically appropriate for the facility and they will call you back when they have accepted the condition of the patient. Treatment centers will consider factors such as heart conditions, significant medical issues, significant mental health concerns, or ambulatory issues when considering accepting a new patient. Understand that a treatment center is not a hospital, most have open campuses, stairs, and walks between buildings.
Red Coat / Blue Coat
Expect that your loved one will waiver, complain, change their mind, and threaten not to go, all in one day. I advise families to use the same techniques they would when dressing a young child. You would ask a 4 year old “Do you want to wear the red coat or the blue one?” not “Do you want to wear a coat?”
Using this method, you are helping for give your loved one a choice (agency), but the outcome is the same. They are wearing the coat. Give options that lead them into a decision. You can ask “Do you want me or your father to drive you?” You could also mention, ” This allows you to lead them to recovery while still making it their decision.
Leave the Day Before
Your loved one is going to try to delay leaving on the day of admission. If the treatment center is a long drive, it is better to leave the day before and get a hotel room near the treatment center. A few delays close to the treatment center can be manageable. Delays before leaving home can cause the need to roll over into the next day.
The Power of Compromise
I have offered to stop at a convenience store to let them get a beer on the way, or an airport bar on a layover. It may seem counterproductive, but that promise might be the only thing that inspires them to get in a car to go to rehab.
They may fear going into withdrawal and having to combat the symptoms while on the road. Again, it is not the responsibility of the family to force them into sobriety, simplify the goal to just “getting them there.” They may need moderate use to avoid withdrawal, or deal with the anxiety and fear of going to treatment.
AA Doesn’t Work, It’s a Religious Program
“Contempt prior to investigation is what enslaves a mind to Ignorance.” – Albert Einstein.
Another version of “this place sucks” is “it’s a religious program” or “Its AA, and that doesn’t work for me.”
The addicted person won’t spend a lot of time researching the treatment center’s website, but they will grab onto what ever they disagree with and run with it.
Love it or hate it, AA is the most successful long term recovery program that there is. Any treatment center would be remiss to not include these learnings in their programming. AA doesn’t make up for the entirety of the treatment centers program, typically there is an AA meeting in the evening. AA is a separate program and it not affiliated with any outside organizations. Many people change their views on AA while in treatment, after they actually learn about the program.
Addiction is said to be a “spiritual malady.” All treatment programs explore spirituality, but it’s not their entire programming. Addiction is the opposite of living a spiritual life, I encourage people to open up to the great journey that everyone is on, trying to make sense of our lives.
Spirituality is explored in many ways including yoga, mediation, nature walks. Modern programs do not push a specific religious agenda. Most treatment centers do a fantastic job of working with people from all religious backgrounds in one milieu.
Again, in the days before treatment, you AP is grasping at straws to blow this up. Keep them on track and keep pushing them forward.
Understand Fear of Success and Fear of Failure
Most of your loved one’s reactions towards treatment stem from a place of fear. It’s a completely new environment, filled with unfamiliar faces, routines, and conditions, anyone would be scared!
Try to understand that they are afraid of success and failure, simultaneously. At the point of going to rehab, the thought of going a few days without using is unimaginable. After all, they’ve likely engaged in daily use for years and have never been able to stop using for more than a few days. They are also loosing a reliable friend, one that they turned to when they were happy and when they were sad. Success means giving up their entire way of life.
They are also afraid of failure, a return to use would feel like a failure, they want to get better, but the pressure is on to show the family that they can. Going back to old ways after all the time, effort, and resources that had been put in by their support team would be disappointing. They don’t want to let anyone down, including themselves.
Empathy is a key virtue during recovery. Be mindful of how their fears and anxieties, right now there doesn’t seem to be anyway out of this situation. Understand the AA adage, “one day at a time.” Right now, your loved one needs to take it one minute at a time.
About Adam Banks
Adam Banks is a certified interventionist and the owner of Adam Banks Recovery. After receiving an MBA from the University of Chicago, Adam built a company acquired by United Health Care. His discipline and attention to detail comes from his former career as an airline pilot, holding an ATP, the FAA’s highest license.
Today, Adam is dedicated to helping others achieve long-term sobriety. His work has guided executives, pilots, and physicians on paths to recovery. Adam brings families together through a loving and inclusive approach.
Adam has authored four books on addiction. His recent work, Navigating Recovery Ground School: 12 Lessons to Help Families Navigate Recovery, educates families on the entire intervention process. He also offers a free video course for families considering an intervention for a loved one.
Adam is available for alcohol and drug intervention services in New York, Long Island, the Hamptons as well as nationally and internationally.