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Interventions for Opioid Use Disorder: A Guide for Family and Friends

April 20, 2022

Table of Contents

Broadly speaking, the term “intervention” refers to anything that can be done to beneficially alter the course of an illness. However, we will be using this term to refer to the process by which friends and family can confront a loved one about an opioid use problem in an attempt to engage them in treatment. 

This article will provide a general overview of this kind of intervention and explain how well it works. We will also give tips on how to make these interventions most effective.

What Is an Intervention?

People who struggle with opioid use disorder (OUD) often lack awareness that they have a problem. One study concluded that 95 percent of people with a substance use problem do not realize they have a problem. 

Therefore, one of the primary goals of an intervention is to help the person recognize that they no longer have control of their drug use and may have an OUD. The second goal is to provide information on available evidence-based treatment options and convince them to engage in effective care. 

When confronting someone with an OUD, the tone should be positive and focus on solutions, not shaming or blaming. 

There are several specific types of interventions for substance use problems. One example is the Johnson Institute Model that started in the late ‘90s. This model emphasizes educating family and friends on how to confront someone who has an OUD and convince them to seek help. 

Similarly, the ARISE intervention involves intervening with other members of the person’s family and support network to change their enabling behavior.[1] 

There are several things to consider related to interventions, particularly in terms of OUD:

  1. If prescription pain medication is involved, it is good to rope in the prescribing physician at this early stage. 
  1. Recovery outcomes are best when people are treated with medications, such as buprenorphine, methadone, and naltrexone. This type of treatment is also known as Medication for Addiction Treatment or MAT.
  1. Inpatient and residential stays, outpatient treatment with individual or group psychotherapy, and/or attendance at Narcotics Anonymous meetings are helpful. While these are also important components of recovery, MAT is the cornerstone of treatment for OUD. Linking people to MAT should be the focus of the intervention.

Do Interventions Work?

Even though there are few studies on interventions in any substance-using population, the data from available research is promising

  • The ARISE strategy led to 83 percent of people with a substance use disorder agreeing to receive treatment.[1] 
  • Family involvement in OUD treatment improves chances of successful treatment outcomes.[2] 
  • The National Council on Alcoholism and Drug Dependence (NCADD) reports that more than 90 percent of people with a substance problem who undergo an intervention involving a trained professional agree to seek treatment.

Although the efficacy of professionally-mediated or family-led interventions for OUD is largely unknown, we do know that people who struggled with OUD do best with MAT. 

Compared to counseling-based treatments without medication, data shows that MAT decreases overdose death rates by more than 50%. In addition to that, it reduces craving, prevents relapse, improves productivity, and promotes long-term recovery.[3] 

Of the three available medications, buprenorphine is recommended as the treatment of choice for moderate to severe forms of OUD. Compared to methadone, buprenorphine carries a lower risk of overdose. It is also easier to initiate than naltrexone.[4] 

Therefore, the primary goal of an intervention for someone with an OUD should be to link them with MAT resources, and ideally one that provides buprenorphine-based medications, like Bicycle Health.

Can Interventions Turn Dangerous?

An intervention can be a emotionally charged situation. It may trigger anger, resentment, and a sense of betrayal in the person with a substance use disorder. 

However, remember that misusing opioids is also highly dangerous, carrying with it a heightened risk of overdose and death if left untreated. If done well, many of the risks of an intervention can be mitigated. 

How to Organize an Intervention

An intervention can be stressful for the family and friends of the person with an OUD, and triggering for the person being confronted. In some cases, it may even lead to violence or relapse. Carefully thinking through the who, what, when, where and how of the intervention can make all the difference.

1. Form an Intervention Team

The intervention team should consist of a small group of people. This will usually involve close friends and family members who the person loves, respects, and trusts. A qualified interventionist, often an addiction professional, can also help organize an effective intervention. 

Professional support should seriously be considered if the person has a serious mental illness, a history of violence or has shown suicidal behavior, or recently talked about suicide.

2. Choose an Appropriate Setting

The intervention should be staged in a private, neutral, and non-triggering environment.

3. Pick the Right Time

The date and time should be selected carefully, and everyone on the team should be present. The intervention should be done when the person with the disorder is not under the influence of opioids.

If the person agrees to engage, treatment should be made available immediately after the intervention. 

4. Prepare Strong Statements

Everyone on the team should present an honestly prepared statement in which they tell their loved one what specific behaviors they have observed. They should also talk about how their behavior related to opioid use affects them personally and what they feel are some of the negative consequences of their use. 

Example statements: 

  • “When you use opioids, I feel very scared.”
  • “Your use has drained the family finances and has negatively affected the emotional state of our children.”

The group should focus on solutions while also reminding their loved one of numerous detoxification and treatment options. They should also offer the person with an opioid problem a few evidence-based prearranged treatment ideas. 

In addition, firm boundaries should be set. Each member of the intervention group should communicate what the consequences will be if the person with an OUD refuses to accept treatment. All participants should prepare themselves emotionally for the possibility that the person being confronted may not agree to accept treatment. 

If that happens, they should be ready to calmly follow through with the stated consequences of refusal. In case the situation becomes destructive, the team members should remove any vulnerable loved ones (e.g. children) from the situation and leave immediately.

5. Show Love and Support

Carefully plan ahead of time, minimize spontaneity at the event, and stay on topic. Avoid sounding accusatory or saying counterproductive and hurtful things. 

Concise personal impact statements can be written and practiced ahead of time. The overall message should be rooted in love, honesty, and support, emphasizing that the person with the use disorder is not alone. 

Keep in mind that a message of blame can push the person into shame or guilt that could cause them to retreat further into drug use or a self-destructive spiral. Avoiding terms like addict and junkie will minimize negative responses to an intervention.

Creating space for a person to talk about something that's bothering them can lead to a real productive conversation that may result in a shared decision to take a step toward addressing an OUD problem.

Brian Clear, MD, FASAM, Medical Director at Bicycle Health

Learn About Bicycle Health's Treatments for OUD

Bicycle Health uses Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.

Photo by Rosie Sun on Unsplash

Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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Citations

1. Landau J, Stanton D, Brinkman-Sull D, Ikle D, McCormick D, Garrett J, Baciewicz G, Shea RR, Browning A, Wamboldt F. Outcomes with the ARISE approach to engaging reluctant drug- and alcohol-dependent individuals in treatment. Am J Drug Alcohol Abuse. 2004 Nov;30(4):711-48. doi: 10.1081/ada-200037533.

2. Nattala P, Leung KS, Nagarajaiah PM. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic.Family member involvement in relapse prevention improves alcohol dependence outcomes: a prospective study at an addiction treatment facility in India. J Stud Alcohol Drugs. 2010 Jul;71(4):581-7. doi: 10.15288/jsad.2010.71.581.

3. Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. N Engl J Med 2014; 370:2063-2066 doi: 10.1056/NEJMp1402780

4. Saxon AJ, Strain E, Peavy M. Editors: Saitz R, Friedman M. Approach to treating opioid use disorder. In: UpToDate. Wolters Kluwer. Literature review current through: Sep 2021. Topic last updated: May 05, 2021. Accessed October 21, 2021.

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