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Preparing an Intervention for Adolescent Addicts
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In the last section, we discussed learning the three essential confrontation skills. These are monitoring skills, giving feedback, and consequating.
In this section, we will discuss the professional’s role in an intervention with a chemically addicted teenager, as well as the six steps to preparing for an intervention. These are, choosing a group leader, going over the data on the teen’s behavior gathered by the intervention group, deciding speaking order and seating arrangements, decide on a location for the intervention, choose a person to act as the teen during the rehearsal, and the rehearsal itself.
As you know, teenagers who have broken a bottom line contract often require a structured family intervention that is very similar to the form of structured intervention used with a chemically addicted adult. I find that the primary responsibility of the professional in such an intervention is to guide the key people involved in the intervention through a rehearsal of the intervention process. In my experience, the first step in this process takes place during the initial meeting of everyone involved in the intervention process.
Six Steps to Preparing for an Intervention
♦ #1 - Choosing a Group Leader
The first step is to choose a group leader. As you are aware, this person will direct the intervention and speak for the group. As you are well aware, someone other than the teenager’s parent should be chosen, because the parents usually have too many conflicting emotions concerning the addicted teen.
In my experience, it is also important to avoid having the teenager feel as though the intervention is being done solely at the urging of the parents. I also find that although a professional can lead the intervention, it is more effective if someone else the teenager already knows and respects assumes this role. When assisting at an intervention, I usually introduce myself to the teenager, explain that these people have gathered out of concern for him or her, and then allow the elected group leader to take over guiding the process.
♦ #2 - Reviewing the Data on the Teen’s Behavior Gathered
In my experience, the second step is to go over the information about the teenager’s addictive behavior collected by the members of the group. As you may have experienced, interventions for teenage addict usually focus on the Bottom Line Contract, which we discussed in Section 10. According to the contract, the teenager agreed to the consequences for breaking the contract.
During the intervention, the group will restate the consequences, give the teenager feedback according to their observations, and let the teenager know how and when the consequences will be enforced. I usually practice making statements from the recorded information with my clients. Anne, whose daughter Elize was addicted to crack cocaine, stated, "Elize, when you came home high last night at 4 am and shouted and broke the dishes, I felt sad because you seem to be so unhappy with your life."
♦ #3 - Deciding Speaking Order & Seating Arrangement
I find that the third step in preparing for a structured intervention for a chemically addicted teen is to decide on the order group members should speak, as well as on a seating arrangement for the intervention. In my experience, it is usually best for group members outside the immediate family to speak first. I find that these people help to break down the teen’s resistance to listening to the data, so that when the family members speak, and present the most powerful and convincing data, the teen is more prepared to hear it.
When deciding the seating arrangement, I find that it is important to avoid having the teen sit near the door, as this makes it easy for the teen to leave impulsively. Putting others in front of the door presents a psychological barrier. It is also important not to seat the teen next to his or her parents, as sitting near the parents will cause the teen to focus their anger and fear on the parents and disregard the group. I usually have the objective leader of the group, or a trusted role model such as a coach, sit next to the teen.
♦ #4 - Decide on a Location for the Intervention
As you know, the fourth step is to decide on a location for the intervention. I find that it is important not to have the intervention in the teenager’s home. In my experience, the best locations are my own office, a school counselor’s office, or a classroom in which the teenager participated in intervention group settings. As you are well aware, the location should be neutral ground for the teen.
♦ #5 - Choose a Person to Act as the Teen During the Rehearsal
In my experience, the fifth step is to choose a person to act as the teen during the rehearsal. As you are aware, it is important to choose someone who will respond as the teen is likely to. I find that it is important to watch the group for signs of anger, resentment, opinions, and judgments during the rehearsal. As you know, the rehearsal is a good opportunity to identify and work through these feelings. I find that it is a good idea to remind group members that they need to stay on task, especially when the teen is desperately trying to push their buttons.
♦ #6 - Rehearsal
In addition to choosing a group leader, going over documented information on the teen’s behavior, deciding order of speaking and seating arrangements, choosing a location, and choosing a group member to act as the teen during rehearsal, the sixth step is the rehearsal itself.
I usually break the rehearsal into five steps:
(1) First, I the group start by summarizing to the teen why everyone is at the meeting. For example, Elize’s field hockey coach, Beth. acting as group leader, stated in rehearsal, "Elize, we are here because we care about you, and we are concerned about what you are doing to yourself. We all know you have not been able to follow the terms of the Bottom-Line Contract. By breaking the contract, you’ve let us know you cannot control your drug use, and that you need our help. We’re here to share our concerns about your behavior and to tell you about the consequences of breaking the contract."
(2) The second step in the rehearsal is to set the ground rules. As you know, the most important point is to get the teen to agree not to respond until everyone else has spoken. I usually also take this opportunity to remind group members that if the teen tries to interrupt someone who is sharing a concern, the group member should calmly restate their point.
(3) The third step in my experience is to have the group rehearse presenting their concerns, as mentioned earlier, in the speaking order you will use at the interventions.
(4) Fourth, I have the group leader review the choices and consequences given in the Bottom-Line contract, and list the two pre-selected treatment centers that the teenager may choose.
(5) Finally, I have the leader practicing closing by summarizing the concerns of the group, and restating the choices the teenager can make. As you may have experienced, this rehearsal process is vital, so that when the day of the intervention arrives, everyone is reasonably well prepared. In my experience, my role is to make sure the group does what they have prepared themselves to do- in other words, my role is to help the group stay on track.
I find that on the day of the intervention, the group should arrive at least an hour ahead of time, and double check that arrangements with the two treatment centers are finalized. As you are aware, at the end of the session, the teenager may not accept the choices offered. After Beth told Elize which two treatment centers she could choose, Elize stated, "What if I don’t choose either, huh?"
As we rehearsed, Beth responded, "Then you have just made a choice to be turned over to the court. They will send you to the treatment center that they choose." Elize responded angrily, stating "Well what the hell kind of choice is that?" Beth calmly stated, "It is your choice." Elize chose on of the two centers offered to her, and Beth and Anne drove her to the center that afternoon to begin treatment.
As you are well aware, it is important that the teenager go in to treatment as early as possible. I usually recommend that arrangements are made with the centers so that the teen can be taken there immediately following the intervention.
In this section, we have discussed the professional’s role in an intervention with a chemically addicted teenager, as well as the six steps to preparing for an intervention. These are, choosing a group leader, going over the data on the teen’s behavior gathered by the intervention group, deciding speaking order and seating arrangements, decide on a location for the intervention, choose a person to act as the teen during the rehearsal, and the rehearsal itself.
In the next section, we will discuss reintegration into a non-using lifestyle after an intervention with a chemically addicted teen.
Peer-Reviewed Journal Article References:
Baer, J. S., Beadnell, B., Garrett, S. B., Hartzler, B., Wells, E. A., & Peterson, P. L. (2008). Adolescent change language within a brief motivational intervention and substance use outcomes. Psychology of Addictive Behaviors, 22(4), 570–575.
O'Leary-Barrett, M., Castellanos-Ryan, N., Pihl, R. O., & Conrod, P. J. (2016). Mechanisms of personality-targeted intervention effects on adolescent alcohol misuse, internalizing and externalizing symptoms. Journal of Consulting and Clinical Psychology, 84(5), 438–452.
Spoth, R., Trudeau, L., Guyll, M., Shin, C., & Redmond, C. (2009). Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation. Journal of Consulting and Clinical Psychology, 77(4), 620–632.
What are the six steps in preparing an intervention for a chemically addicted teenager?
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