Wednesday, April 11, 2007

Your Health Matters - Crisis intervention in

RECURRENT crisis is a common event in the natural history of an addict's life. Inevitably there will arise situations of confrontation between him and his family, concerned friends and even the law. If unresolved professionally, each crisis
escalates from one to another, sometimes with tragic results.

The drug addict is often totally unable to see the severity of his addiction and how this has led to the crisis.

The development of a crisis can be looked upon as a golden opportunity to reconnect and intervene in the addict's life
in a positive way. Crisis intervention is an act of love, it is gentle and supportive but firm in its ultimate goal, ie. to move the addict physically and mentally to the next step for professional help.

It is important that families and friends help plan and strategise in advance how they would approach the problem when
the opportunity arises.

It would be most useful to recruit the help of professionals in the field. The occurrence of the crisis is sometimes unpre-
dictable; but sometimes they can be craftily engineered to create a window of opportunity for intervention.

The need for crisis intervention

There are a number of factors that can
cause a crisis in the addict's life:

  • Being found out by the family
  • Running out of finances
  • Police investigations
  • Ultimatum from the employer
  • Health reasons
  • Time to quit - a rare occurrence

Addicts in crisis do show some form of reactive behaviour. Common reactions will include:

1. Shock, whereby the addict is stunned or numbed and feels helpless.
2. Anxiety due to being overwhelmed with a sense of failing apart.
3. Depression as when the addict feels immobilised and helpless in his predicament -time to quit but how!
4. Rage as the addict feels cornered and not able to worm/wrangle his way out.
5. Intellectualisation is used to rationalise the crisis so as to cut offthe pain.

Case history
Sara L is 18 years old and currently studying in a local college and on a twinning programme with a university in Australia.

She comes from a middle class family of five, Sara being the youngest of her siblings.

Over the last few months her parents have noticed a drastic change in Sara that has got them very worried. Upon checking
with the college, they were told that Sara had been cutting classes, her assignments were always late and her grades had plunged. Her friend disclosed that Sara had been borrowing money and was often in a daze.

They decided to confront her, but getting Sara to open up was no easy task, Sara went ballistic when her parents queried
about her performance at school. It was at this point that they noticed that Sara's eyes were glazed, there were scratch marks on her face and hands and she had developed a natural way of lying.

After almost an hour of screaming and arguing, Sara blurted out... "Okay I am a junkie but I can take care of myself as my
habit is under control!"

The above is a typical scenario when it comes to individuals whose addiction is discovered by their loved ones. There is
much denial coupled with resistance and reluctance to seek treatment. This is further compounded with the misperception that
unless you hit rock bottom, or as recovery groups say "bottomed out", the addict is not ready for help or treatment.

"... all the lies, all the rationalisations, all the illusions fall away as we stand face-to-face with what our lives have become.., the truth is we must pass through this place before we can embark upon the journey of recovery."

There is some truth in the above statement, but let us also be clear that it is not an absolute truth, simply because we also acknowledge that "not every act of growth is motivated by pain". This simply means that learning does not have to come from a painful or negative experience.., it can come from cognitive reframing, using proven recovery approaches and also learning from others who have been down the
same path!

Do we have to wait for Sara to become a full blown junkie.., from chasing the drag-on to shooting up the "highway"? Does she need to see her veins collapse.., her face crumble with premature ageing.., get into crime and eventually become involved in the flesh trader to feed her ever increasing habit.., or be infected with

STD's/HepC/HIV and die a miserable death?

Dealing with denial
When One confronts the addict with his problem, the first defence mechanism that one may encounter is denial. Denial is afatal aspect of addiction because it impairs the judgment of the affected individual, thus keeping them locked in ever destruc-tive patterns. This defensive manoeuvre distorts reality and will appear in various forms. Some of the commonest are:

Simple denial - Maintaining that something is not what it is, for example, insisting that substance dependency is not a problem despite obvious evidence that it is a problem and is perceived to be a problem by significant others.

Minimising- Admitting to some degree to a problem with chemical usage but in such a way that it appears less serious than
is actually the case.

Blaming - Denying responsibility for addictive behaviour and maintaining that the responsibility lies with someone or
something else.

Rationalisation - Offering excuses and justifications for addictive behaviour. The behaviou is not denied but an inaccurate explanation of its cause is given.

Intellectualisation - Avoiding emotional and personal awareness of the problem of addiction by dealing with it on a level of intellectual analysis or theorising.

Diversion - Changing the subject to avoid a topic that is threatening, for example, cracking a joke and making light of the situation.

Hostility - Becoming angry and irritable when reference is made to drug use and related behaviour, Anger works as it causes people to back off!

Those seeking to help the addict must be aware of which aspect of denial is being used by the addict. No matter how con-
vincing the addict can sound, they must maintain focus and not be influenced otherwise.

Beware that the addict always has another trick up his sleeve; he will take you into orbit and leave you there, probably even manage to get a few ringgit from you and is gone! The bottom line here is "one is too many and a thousand never enough" (12 Steps NA).

The goals of intervention
From the onset, the first step of intervention is to break down the denial strategies so that reality can shine through long enough for the addict to accept his predicament. Note that this is not a time for confrontation or an interrogation, rather "a care-frontation". Attack the denial and the defence wall


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