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Could 'Intervention' Have Helped a Star?

by Sarah Kershaw | The New York Times, August 6, 2009

IN the days following Michael Jackson’s death, people close to him said they had warned his family and pleaded with him to get help for drug problems, angrily decrying a coterie of enablers surrounding the star.

Authorities looking into his death now say they believe Mr. Jackson, who in 1993 was treated for a painkiller addiction, had prescriptions written under more than a dozen assumed names.

“He was surrounded by enablers, including a shameful plethora of M.D.’s in Los Angeles and elsewhere who supplied him with prescription drugs,” Deepak Chopra, the high-profile spiritual guru and a friend of Mr. Jackson’s, wrote on the Huffington Post Web site on June 26, shortly after the singer’s death. “As many times as he would candidly confess that he had a problem” to Dr. Chopra, he wrote, “the conversation always ended with a deflection and denial.”

Specialists in drug interventions — a rapidly growing field since the concept was developed in the late 1960s — have watched the Jackson case closely, viewing it as a classic example of lost opportunity. Denial is at the core of addiction, and breaking through it, many experts say, can require extreme measures, particularly with celebrities, who can procure an endless supply of drugs and are cocooned by people with an interest in keeping the star’s earnings flowing.

Whether Mr. Jackson was addicted has not been established, but investigators are proceeding under the assumption that drug abuse was involved. They are pursuing a homicide case against his personal physician, who reportedly administered a dose of a powerful anesthetic, propofol, before he died. The drug is sometimes used for sleep by painkiller addicts, experts say.

Mr. Jackson’s biographer, J. Randy Taraborelli, who knew him for 40 years, said in an interview that family members had made attempts at interventions in recent years. Another source close to the family confirmed there were two attempts.

The most common form of intervention, known colloquially as a “living room ambush,” relies on surprise and an ultimatum. The addict is lured to a meeting with a promise like “Grandma has a check to give you this Sunday.” Bags are packed for a stay in a treatment center, and the family is encouraged to draw the line in unison: get clean and sober, or get out.

This approach is also called the Johnson method, named for an Episcopal priest, Vernon E. Johnson, whose seminal book, “I’ll Quit Tomorrow,” gave rise to the belief that family and friends, aided by a professional interventionist, could break through the alcoholic or addict’s denial. It was intended to avert disaster before an addict hit rock bottom or died, although it has drawn criticism for doing more harm than good, and since the early 1990s, less draconian methods have arisen.

Some experts now caustically refer to traditional intervention as the “A&E model,” a reference to the popular reality show “Intervention,” which profiles families and addicts and which always ends with a surprise confrontation.

But critics say such a showdown can add more trauma to already devastated families and addicts, and deter an addict from getting help.

Just as Mr. Jackson’s death has highlighted the difficulty of trying to help a chronic drug abuser, it was the death of another celebrity, Kurt Cobain in 1994, that added momentum to an alternative philosophy of intervention known as “motivational interviewing” or “invitational” intervention.

Mr. Cobain, a heroin addict, committed suicide days after disappearing from a rehab center he had agreed to enter after a classic tough-love intervention staged by his wife, Courtney Love, and his Nirvana bandmates, according to news accounts at the time.

It prompted concerns about all-or-nothing interventions among psychologists and addiction experts, according to G. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington. Dr. Marlatt said he spoke with a record label executive who was present at Mr. Cobain’s intervention, who recounted that the musician asked friends and family if he could meet them “half way” and cut down on his heroin use, rather than stopping entirely. The answer was no.

It is unlikely there was a single cause for Mr. Cobain’s suicide. But it has spurred Dr. Marlatt and others to speak out in support of nonconfrontational approaches. “Many people are unwilling to maintain abstinence, but what are you going to do, wait until they hit bottom, if they even survive?” he said. “Everything is all or none, you’re either using or not using, there’s no safe middle way from that perspective.”

“Motivational interviewing” and other less confrontational approaches involve asking an addict to join family members, who may attend lengthy counseling before and after the encounter with the addict. The family does not necessarily demand that an addict or alcoholic quit using or drinking; they may be asked to cut down their use — part of a treatment known as “harm reduction,” which is itself controversial.

“I guess motivational interviewing is not going to be the next reality TV show because it’s so boring,” said Jeffrey Foote, a founder and the executive director of the Center for Motivation and Change, a treatment and research center in New York. “It’s nuanced, it’s gentler, it’s working with people in a slower way, and it’s effective. But that’s not good TV. What’s good TV is taking drug addicts, harnessing the anger people feel toward addiction and drug addicts, and smashing them in the face.”

To traditional interventionists and critics of harm reduction — including 12-step programs, which call for total abstinence — many addicts are both unable to control their intake and stubbornly resistant to getting help unless the consequences are incredibly dire, such as being cut off financially, divorced or faced with jail.

“I have never had anyone call me or e-mail me to say they wished they wouldn’t have given someone an ultimatum,” said Jeff VanVonderen, one of the three interventionists on the A&E show, who has worked in the field for 25 years and is certified by the state of Illinois to work as an interventionist. “But I have a couple of dozen times had some contact me to tell me that they wish they wouldn’t have backed down or waited, because now the person is dead.”

Mr. VanVonderen said that of the 137 interventions filmed for the show so far, 135 of the subjects agreed to go to treatment, and 111 are currently sober.

He and other interventionists agree that Al-Anon, the popular 12-step program for the families of alcoholics and addicts, which holds that relatives should “detach with love” because an addict will only seek help at rock bottom, is a powerful support but that waiting for that bottom risks lives.

Research about the success of competing approaches to intervention is not definitive, in part because the data on recovery is unreliable: why an addict stays sober or relapses is hard to measure. But some studies on the nonconfrontational approaches, described by independent researchers not doing the interventions themselves as statistically sound, have shown the Johnson model to be both less effective in getting an addict into treatment and linked to higher relapse rates, compared with softer approaches, including one called “carefrontation.”

Interventions of any kind can be costly, ranging from $1,500 to $15,000, depending on the interventionist and whether travel is involved, said Corinne Butler-Williams, president of the National Association of Drug and Alcohol Interventionists, which she founded in 1985. She could not estimate the number of working interventionists because they do not need to be certified by state boards or her own association to practice. But her group is certifying a growing number, she said, and interest in the field has exploded because of the A&E show.

Most interventionists agree that no matter the approach, an addict has to be made aware of the enormous consequences of his addiction and behavior. Drug courts, which give nonviolent substance abusers the option of undergoing treatment rather than going to jail, have spread across the country in the last two decades — and they certainly espouse a philosophy of tough love.

R. Gil Kerlikowske, who in May was sworn in as the Obama administration’s director of the Office of National Drug Control Policy, is a supporter of drug courts as an alternative to mandatory drug sentencing. The new drug czar and the man nominated as his deputy, A. Thomas McLellan, are viewed by many addiction experts as representative of a sea change in thinking about treatment: away from the punitive, toward more acceptance of nuances and complications of addiction.

“Ten years ago, if you would have asked me this question about addiction, I would have said it’s obviously a moral failure and I don’t know why people can’t pull themselves up from their bootstraps and handle this and get themselves totally clean,” Mr. Kerlikowske, a former police chief in Seattle, said in an interview. “But we can be going in a different direction. We can look at this from different viewpoints now.”

One of the newest alternatives to the Johnson model, developed by Brad Lamm, a New York City interventionist, relies heavily on technology like Skype, podcasts and Internet chatting to connect families with addicts in an effort to include as many significant friends and relatives as possible, far flung as they may be.

Ideally, he said, the families continue to “meet” as a group weekly while the addict is in treatment and for up to six months after that. He makes podcasts of the meetings so both family members and addicts can revisit the meetings, as a reminder that they are all in it together, he said.

“The thinking was that the addict needs to be captured, then once captured needs to be treated,” Mr. Lamm said. “But what I know from working with families is that we can use the family strength to get us where we want to go, to healthier relationships, even in the face of crushing addiction.”

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