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The Week Before Treatment – After the Intervention

After a successful intervention, it is common for the identified loved one to delay the check-in process for a few days. Although work and family commitments are often cited, some people use seemingly trivial reasons, such as upcoming holidays and events, as a means of avoidance. Some one that agrees to goto treatment will change their mind the longer that they delay going to treatment. After an intervention, delaying treatment by a week is a long time.

Agency

Because interventions are organized by the support team, on the day and time chosen by the team, not the person of concern, compassion should be extended to the person of concern as they attempt to regain control of the situation. Their unwillingness to check into rehabilitation immediately is understandable; they were not prepared, mentally or physically, to attend treatment; and certainly they were not planning on going the day and time that the intervention team chose.

To help facilitate a successful outcome, the team may need to negotiate checking in after loose ends, such as child care and work commitments are figured out. By giving them a day or two to settle into the timeframe they might take more ownership of going to treatment.

Look for small ways that you can help them feel like they have control. Review the website of the treatment center, goto CVS and get toiletries, make plans for the pets.

Recommendation

In situations where there are safety concerns, such as violent behavior, unsafe driving, or reckless substance use, same day check-in might be required. If not, within the subsequent few days is acceptable.

If your loved one is in a facility, detox, or hospital, it is ideal to organize a facility to facility transfer. If your loved one returns home, they will return to use, setting the entire situation back to square one.

Is it safe for them to be alone? Will they hold to their commitment? Will they try to run? The safety of all parties, including family, friends, coworkers, and the individual themselves, needs to be considered.

Commit to a Date and Time

It is important that the family sets a firm deadline for treatment. If the person of concern is given a window of time to attend, they will always choose the furthest date out. This will only prolong their anxiety and give them opportunities to talk themselves, and their loved ones, out of going to rehab. If you need to give them a choice of dates, give a narrow window; the upcoming Friday or Saturday or today or tomorrow. not a week or a month from now. Nothing good every happens in the time that they delay going to treatment, and it often gets worse.

When planning your arrival keep in mind 9-5. While most centers accept late check-ins and weekend check-ins, they may be on reduced staff. It is best to check in during typical business hours. Always give the treatment center your planned arrival time and update them on the way to the facility.

Remove Roadblocks Before the Intervention

The most common barriers to immediate treatment include childcare, pet care, familial responsibilities, and work. To mitigate this, the support team should work together to ensure that these obstacles are taken care of before the intervention takes place.

Child and pet care can be organized through family and friends, as well as other personal responsibilities. Work concerns are more difficult to address, but since addiction is a protected medical class, it is likely that a leave of absence is possible and will be covered by FMLA.

By foreseeing the challenges, the support team can relieve some of the stress off the person of concern and give them the opportunity to organize themselves before attending treatment.

The “Last Hurrah” vs The “Cold Turkey” Method

If someone has a few days before they enter treatment, their use patterns tend to mirror one of two extremes: extremely heavy use (The “Last Hurrah”) or complete surrender of the substance (“Cold Turkey”).

Last Hurrah

If your loved one is taking this route, hold onto your seat – it might get bumpy. During the Last Hurrah, substance use tends to increase significantly, which is difficult to watch. They will receive negative or biased information about treatment from other users and begin to change their mind about attending the inpatient facility.

This stage can become very dangerous, very fast. As use increases, the risk of overdose or legal issues, such as a DUI charge, becomes greater. Thus, it is recommended that if the person of concern is showing signs of this behavior, the support team monitor them 24/7 with a chaperone.

At this time, safe use should be highlighted and in extreme cases, it may be necessary for the person to be checked into rehabilitation earlier than originally prescribed.

Cold Turkey

Although the effort is admirable, sudden stops in use can be medically dangerous. We have all seen movies where someone gets the “shakes”, sweating profusely and overwhelmed with nausea once they stop using their substance of choice.

These symptoms are serious and must be monitored by a doctor. During the first few days of treatment, patients undergo a medical detox, complete with 24/7 physician care, to ensure that they are safely weaned off drugs and/or alcohol.

Going Cold Turkey is the patient’s way of trying to avoid rehabilitation. Some try to use their short break from substances as evidence that they don’t need treatment and can achieve recovery on their own. However, the first few days are always the easiest to manage. The emotional and physical symptoms of detoxification can take up to a week to surface. The family needs to understand that a few days of sobriety, should not change the plan.

Family should not pressure their loved one to stay sober before treatment, families should focus on safe use, allowing the loved one to continue to use so that they don’t go into withdrawal or over indulge.

Insurance Paradox

Unfortunately, the Cold Turkey route can put someone at risk of not receiving insurance coverage. In a strange paradox, many insurance companies will not cover inpatient treatment if a person has maintained sobriety for five days or more.

To ensure insurance coverage, it is better that the POC use alcohol or drugs in the days before treatment. consumption before treatment may be the only way to ensure that insurance coverage is provided.

From Dream to Reality

Families have a pivotal role in making recovery a reality. Referencing the treatment center website, reviewing the packing list, and using active language (e.g., “when”, not “if” they recover) are useful tactics in placing rehabilitation at the forefront.

The intake call with the treatment center is the next step. Similar to the documentation you fill out during a preliminary visit to the doctor’s office, this call is filled with questions and lasts for roughly half an hour. Your loved one might find this process nerve-wracking, so sitting with them and keeping them on track would be helpful.

After the intake call, the facility will review “the case” with the medical team. Your loved one needs to be medically appropriate for the facility and they will call you back when they have accepted the condition of the patient. Treatment centers will consider factors such as heart conditions, significant medical issues, significant mental health concerns, or ambulatory issues when considering accepting a new patient. Understand that a treatment center is not a hospital, most have open campuses, stairs, and walks between buildings.

Red Coat / Blue Coat
Expect that your loved one will waiver, complain, change their mind, and threaten not to go, all in one day. I advise families to use the same techniques they would when dressing a young child. You would ask a 4 year old “Do you want to wear the red coat or the blue one?”, not “Do you want to wear a coat?”.

Using this method, you are helping for give your loved one a choice (agency), but the outcome is the same – they are wearing the coat. When approaching your loved one going to treatment, instead of asking what time they want to leave for treatment, you might ask “Do you want to leave at 10 a.m. or 11 a.m.?” or “Do you want me or your father to drive you?”, “Should we goto CVS this morning or afternoon?” This way, they can make decisions, but you are still leading them to their commitment to recovery.

The Power of Compromise Getting them there

Although I won’t allow anyone to use in my car, I have offered to stop at a convenience store to let them get a beer on the way, or an airport bar on a layover. It may seem counterproductive, but that promise might be the only thing that inspires them to get in a car to go to rehab.

They may fear going into withdrawal and having to combat the symptoms while on the road. Again, it is not the responsibility of the family to force them into sobriety, simplify the goal to just “getting them there”. They may need moderate use to avoid withdrawal, or deal with the anxiety and fear of going to treatment.

Understand Fear of Success and Fear of Failure

Most of your loved one’s reactions towards treatment stem from a place of fear. It’s a completely new environment, filled with unfamiliar faces, routines, and conditions – anyone would be scared!

Try to understand that they are afraid of success and failure, simultaneously. At the point of going to rehab, the thought of going a few days without using is unimaginable, thinking about a lifetime without drugs or alcohol is terrifying and beyond comprehension. After all, they’ve likely engaged in daily use for years and have never been able to stop using for more than a few days. They are also loosing a reliable friend, one that they turned to when they were happy and when they were sad. Success means giving up their entire way of life.

They are also afraid of failure, a return to use would feel like a failure, they want to get better, but the pressure is on to show the family that they can. Going back to old ways after all the time, effort, and resources that had been put in by their support team would be disappointing. They don’t want to let anyone down, including themselves.

Empathy is a key virtue during recovery. Be mindful of how their fears and anxieties, right now there doesn’t seem to be anyway out of this situation. Understand the AA adage, “one day at a time”. Right now, your loved one needs to take it one minute at a time and accomplish the next task required to get to treatment.

About Suntra

Adam Banks is a certified interventionist and recovery coach at Suntra Modern Recovery.  He received an MBA from the University of Chicago and built a company, which United Health Care acquired. He learned his rigor and attention to detail from his career as an airline pilot, holding an ATP, the FAA’s highest license.

Today Adam is dedicated to working with individuals that want to change their relationship to drinking.  Adam Banks is often called by families to help untangle crisis situations through a loving and inclusive approach to interventions.  Adam often engages in coaching executives, pilots, and physicians in recovery.

Suntra offers a free video course for families considering hosting an intervention for a family member.

Suntra Modern Recovery provides medical treatment for alcohol and opiate addictions via video visit with medical doctors. Suntra’s alcohol and drug intervention services are available locally in New York, Long Island, the Hamptons as well as nationally and internationally. Treatment for alcohol, opiate and heroin addiction, including Suboxone treatment, can start today.

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