1. Invitational Intervention:The ARISE ModelGetting Resistant Substance Abusers into Treatment Char Scott Maloney Passages Counseling Center, Inc. www.passagescounseling.net www.ARISEInterventionNow.com Office: 630.848.0445 charlcswcadc@sbcglobal.net

2. Today’s Agenda Scope of addiction and current challenges Psychosocial Aspects The role of families and support systems in treatment engagement Impact of stressors Treatment engagement, treatment and long-term recovery How families can bring about healing

3. DEFINITION OF ADDICTION LOSS OF CONTROL PROBLEMS IN ONE OR MORE OF THE FOLLOWING HEALTH HOME LEGAL WORK FINANCIAL EMOTIONAL CONTINUED USE IN SPITE OF PROBLEMS

4. ADDICTION STEREOTYPES & MYTHS Myth 1: “You are powerless to help until the substance abuser is ready” Myth 2: “Putting pressure on the substance abuser will push him/her over the edge” Myth 3: Secrets are really secret Myth 4: “The substance abuser must ‘hit bottom’ before getting help” Myth 5: Substance Abusers are disconnected from their families Myth 6: “Tough consequences will chase the substance abuser away forever”

5. TREATMENT ENGAGEMENT A very small proportion of people with drug dependency or abuse are engaged in treatment or self-help NATHAN (1990) ESTIMATED 5% FRANCES ET AL. (1989) ESTIMATED 10% KESSLER ET AL. (1994) ESTIMATED 8%

6. Psychosocial Aspects of Addiction

12. 70% 64% 60% 51% 50% 40% 30% 20% 9% 10% 0% Non-Addicts Heroin Polydrug Percentage of Subjects in Daily Telephone Contact With One or More Parent Addicts Heroin Addicts Polydrug Non- addictss (Purzel and Lamon, 79)

13. IS THERE A STRANGER LIVING IN YOUR HOME? Nature of calls that come in from family regarding getting a resistant loved one started in treatment

15. impulse control

17. organization

18. learning from experience

19. empathy

21. poor judgment

22. inability to learn from experience

23. decreased attention span

24. becoming easily bored

25. argumentative

26. thin skinned

27. Self-centered

29. Easy Does It (But Do It)

30. Insanity: Doing the Same Thing Over and Over Again and Expecting a Different Outcome

33. People and environments are constantly in transition

34. Individuals, families and communities will find and utilize their competence

35. Competence is unavailable when individuals and families are cut off from their extended families and natural support systems

36. To access competence, mobilize and extend natural support system

39. Despite prevailing beliefs, a well-guided Intervention with no secrecy or ambush will not chase a resistant substance abuser away, but can motivate him/her to enter and maintain treatment and long-term recovery

40. Intergenerational Transitional Checkerboard I MGF MGM PGF PGM Wife Husband Mother Father Sibling 1 Sibling 2 Sibling 3

41. Intergenerational Transitional Checkerboard I MGF MGM PGF PGM Wife Husband Husband Husband Mother Father Father Sibling 3 Sibling 1 Sibling 2

42. Intergenerational Transitional Checkerboard II MGF MGM PGF PGM Wife Husband Husband Husband Mother Father Father Sibling 3 Sibling 2 Sibling 1

43. Family Resilience

44. Family Motivation to Change is the combined forces operating within a family guiding it toward maintaining survival and healthy functioning in the face of serious threat, and toward healing when that threat is removed.

45. FAMILY MOTIVATION TO CHANGE: THE PROCESS IN ACTION First Protecting and then Healing the Family Completing the Transitional Task for “Peace of Mind.” Getting a Loved One Back Preventing Further Loss

47. Principle: Stop at the first level that works

49. Responds to the love, fear, worry, and guilt of those living with the addiction

52. Someone calls or contacts an agency concerned about a substance abuser

53. The call is used to “coach” the caller on getting the substance abuser into treatment

54. The First Caller (Concerned Other) is coached to mobilize members of the support system to get the substance abuser into treatment

55. Level II: Strength in Numbers

56. Family, friends, and Concerned Others meet to plan bringing the substance abuser into treatment if substance abuser is not engaged after Level I

57. Level III: The Formal ARISE Intervention

60. Of 110 cases, 82.7% (n = 91) became engaged in treatment (n = 86) or self-help (n = 5)

61. Over half (55%) became engaged during Level I (First Call and First Meeting)

62. Mean amount of time required (telephone and face-to-face) per case was 88 minutes (median = 75 minutes)

64. Less time spent by clinician on phone, or fewer calls, predicted better outcome

65. Parental involvement significantly enhanced rate of success, regardless of age of parent or substance abuser

67. RELATIONSHIP OF CONCERNED OTHERTO THE Addicted Individual 94.7% OF ALL CONCERNED OTHERS WERE FAMILY MEMBERS PARENTS 38 40.3% SPOUSES/PARTNERS 29 30.9% OFFSPRING 4 4.3% OTHER RELATIVES 18 19.2% NON-RELATIVES 5 5.3% The majority was female: 68.8% Their mean age was 46.6 (range 15-78)

68. Outcome By Level Of Care 60.00% 52.70% 50.00% Inpatient Intensive OPD 40.00% 27.50% SA OPD 30.00% Self-Help 20.00% 13.20% 10.00% 5.50% 0.00%

69. Invitational Intervention: The ARISE Model(Relational Intervention Sequence for Engagement) Results of Real World Replication of ARISE at SSTAR (Stanley Street Treatment & Resources)

70. Real World Data from SSTAR cont. 17%