An Interview with Board Certified Interventionist Roger Canevari

By Meghan Vivo

If someone doesn’t want help for their addiction, there’s nothing anyone can do. This is a myth that has been debunked by decades of successful interventions. A group of caring friends and family can “raise the bottom,” helping an addict recognize the seriousness of their drug problem and find the strength to recover – even if they don’t fully buy into the process at first.

Addiction interventions have saved millions of lives in the past 50 years, and they are becoming even more effective as our knowledge of addiction grows. Roger Canevari, a board certified interventionist with more than 25 years of experience in the field of addiction and owner of Recovery Found, notes a few key ways the modern addiction intervention differs from interventions of the past.

A Loving, Respectful Approach

Early on, interventions were viewed as opportunities to vent long-held resentments and to blame and shame an addict into getting help. In the past two decades, addiction interventions have evolved into a respectful expression of love and concern, explains Canevari. Rather than condemning the addict, family, friends and co-workers respond with compassion and an understanding of the impact addiction has had on the individual’s ability to make healthy decisions.

“Our role as professional interventionists is to guide the intervention on a loving and respectful course,” says Canevari. “We encourage the family to make decisions based on what they are emotionally and physically capable of following through on, and then express themselves in a healthy way.”

Not Just About Drugs

In the past, experts assessed the need for an intervention based on the type of drug being used and the extent of abuse. Now, it is just as important, if not more so, to evaluate how the addictive behaviors have impacted the individual’s quality of life.

“Drug use is a symptom of an underlying problem,” Canevari explains. “If we focus on the drug, the individual comes out of rehab and uses a different drug or a compulsive behavior like gambling or sex. The intervention has to delve beneath the drug use into the real issues.”

Entering drug rehab is not something that is forced upon the addict, but rather a decision they are actively involved in. If the addict is reluctant to get treatment, Canevari presents more than one drug rehab center to choose from and asks that the addict at least tour the facility to see what they’re saying no to.

One Size Doesn’t Fit All

After decades of research, we know that addiction treatment is most effective when it is tailored to the needs of each individual. The same is true for addiction interventions. While the structure of interventions has largely remained the same over the past 20 years, according to Canevari, the modern approach is flexible enough to meet clients wherever they are.

Canevari doesn’t routinely recommend a particular drug rehabilitation center for every client, but rather works with the family to understand the type of care that would be most effective for the individual. The intervention participants and the individual struggling with addiction then make the final decisions.

“Intervention should be a very individualized and creative process,” says Canevari. “We do not use generic models or a cookie cutter mold; we design a specific plan to meet each patient and family’s needs.”

A Long-Term Process

Despite becoming more widely available, most people’s knowledge of addiction interventions is limited to television portrayals on shows like A&E’s Intervention.

“Television shows highlight one moment in time, but an intervention is so much more than that,” explains Canevari.

The intervention is only the first step. Addiction recovery is a lifelong process, which is why interventionists like Canevari are focused on the long-term success of their clients.

In addition to guiding the intervention, Canevari educates his patients about relapse prevention and remains involved throughout the treatment process. He serves as a liaison between the drug rehab center and the family to help facilitate a smooth transition from treatment to daily life back at home.

The Critical Role of Family

Traditionally, interventions have been designed with one purpose in mind: getting the addict into treatment. For Canevari, the primary goal is making changes within the family system, which typically has the effect of convincing the addict to enter drug rehab.

“What we’re really doing is teaching the family how to do an intervention,” Canevari explains. “It is critical that the message comes not just from a professional but also from the people the addict cares about most.”

Canevari recommends that the family stay involved throughout the process, from beginning to end. When the intervention ends, the family doesn’t put their loved one on a plane and go back to life as usual. Instead, Canevari recommends that they accompany the interventionist and the addict during the admissions process, spend the first few nights in a hotel near the drug rehab, and actively participate in the center’s family program. Not only does family involvement increase the likelihood that the addict will complete treatment, but it also helps the entire family begin to heal.

“It is very helpful for the family to physically see the facility and make a connection with the staff for a smooth admission and treatment stay,” says Canevari, who was rescued from addiction by a life-saving family intervention in 1983. “In the most successful addiction interventions, the addict doesn’t feel like they’re being tossed away. The family’s message is, ‘It’s not just about you, it’s about all of us.’”

A Growing Field

When Canevari first started conducting addiction interventions nearly 20 years ago, he was part of small group of specialists doing this work. Since then, thousands of interventionists have joined the ranks.

When choosing a professional interventionist, Canevari advises families to find someone who is board certified and highly experienced, and to interview more than one to determine if their philosophy is a match. A professional intervention is one of the most effective ways for addicts and their loved ones to begin the healing process, but it requires experience and know-how to ensure that it is done right.

Since 1995, Canevari has conducted interventions throughout the U.S. and South America with a 97% success rate of getting addicts into treatment. He has more than 25 years of experience as a nationally certified alcohol and drug counselor and board certified family interventionist. Although he is not affiliated with any particular drug treatment center, Canevari works closely with some of the best drug rehab centers in the world, including Promises in Malibu, California.

“I consider it a privilege to guide others into recovery just as I was guided over 25 years ago,” says Canevari. “For me, an addiction intervention is not a confrontation but a celebration of life in recovery. By taking away some of the shame, fear and denial surrounding addiction, we can create a window of opportunity where one may never have existed.”

Most people at some point in their lives discover someone they love or work with has a problem with alcohol or drugs. Public health experts estimate 1 in 10 people has a substance abuse problem, so it is unlikely you will never meet someone who needs addiction treatment. And chances are some of those people need an intervention. How do you know if an addiction intervention is the right next step for your family?

The biggest obstacle to addiction treatment is denial. Any attempt to address substance abuse behavior is often met with outright hostility – how dare you suggest such a thing. This attitude is encouraged by a number of factors: as a society we still incorrectly look at addiction as a moral failing and the addict who is confronted about their problem feels threatened. What would they do if they didn’t have their drink or drug of choice? How could they handle life? You are, in effect, threatening their very ability to survive in their eyes.

The point is you can rarely just ask someone if they have a problem with alcohol or drugs and get a straight answer. Most likely, you will have to do a little detective work and figure out on your own if that person needs an addiction intervention.

Here are 10 tell-tale signs that someone you know needs an alcohol intervention or a drug intervention.

1. Tolerance

They need a lot more alcohol or prescription pain medication, whatever their substance of choice, to get the effect they are seeking. You might notice they are filling a prescription more often, or buying an extra case of beer more often. This is because as an addiction escalates, tolerance develops, and the body requires more of the drug just to feel “normal.” If you see tolerance increasing to risky levels, an intervention is a good idea.

2. Deceptive Behavior

The addict will try to disguise their behavior. They might do this by hiding bottles of alcohol, showing up at events already intoxicated so they don’t appear to drink too much in public, or hiding opiate prescription medications in unmarked bottles so you can’t identify them as addictive substances.  In an intervention you can address the deception and move the addict toward treatment.

3. From Clean and Sharp to Just-Rolled-Out-of-Bed

The addict’s appearance deteriorates. An addict has one goal each day: get the alcohol or drug they need. As this need becomes more pressing, other needs get left by the wayside. Their clothes may appear disheveled or they may shave less often; they might appear tired and haggard much of the time. Women will often try to disguise this with more makeup. Remember, however, an alcoholic or addict will put enormous effort into hiding their problem, so a decline in appearance may not occur until the later stages of addiction.  By pointing this aspect out in an intervention, you begin to break through the addict’s denial.

4. Forgetting What They Did or Said

It is common for heavy substance abusers to experience black outs or brown outs. These are periods of time that the alcoholic or addict cannot recall. They might have hazy recall or no recall at all of events that occurred when they were intoxicated. You might remark on something they said or did at a party, and they look utterly baffled. This is a sign of serious substance abuse, especially if it occurs more than once or twice.  Reminding the person about each of these episodes can be a very powerful part of the intervention.

5. Financial Woes

They are having money problems that can’t be explained. Addicts can be pretty adept at manipulating others to feed their addiction, but eventually the cost of substance abuse catches up to them and they can no longer hide dire financial straits. If someone is wealthy, this sign can take a lot time to show up, which may mean their addiction can progress to a much more serious stage before they feel financial pressure to find a solution.  If you have been enabling the addict with money, the intervention is a good time to let them know that money will only be put toward treatment from here forward.

6. Risky Behavior or Just Clumsy

They experience an unusual number of accidents and injuries. Or they may miss the accident, but end up with a DUI. If your friend gets one DUI, that’s a problem; two DUIs indicates a much bigger problem. Generally, normal drinkers get the message with one mistake. Those who get repeated DUIs get them because they cannot stop themselves from drinking; once they have that first drink, they lose the ability to control their intake. For prescription drug addicts, they may have real injuries, or they may begin to “manufacture” pain to get more medication. As addiction progresses, the addict has less regard for their physical health. They may become more accident prone and show signs such as bruises or unexplained injuries.

7. Moody and Unpredictable

They exhibit irrational behavior and mood swings. Being around an addict can be like riding a roller coaster. They will often overreact, particularly to even the slightest mention of their drinking or drug use. You never know if they will be angry, depressed, happy, elated, miserable, hostile…the list goes on. Often their mood is determined by when they last used, how much they used, if they are in withdrawal, or if they are nursing a hangover. Once the addiction has a total grip on a person, their mood is determined by the availability of their drug of choice, sufficient opportunities to use it, and how adeptly they maintain sufficient intoxication to avoid withdrawal symptoms – it becomes a tougher game to play as time goes on.

8. From Responsible to Just Getting By

Previously responsible people are now late to work, sleeping too much, or grades are slipping. Usually if you have known a person for a while, you will recognize certain baseline behaviors. This person is very responsible, rarely calls in sick to work, or always does pretty well in school. If you do know this baseline, changes in behavior can be pretty striking. Someone who prides himself on never calling in sick to work, starts calling in on a regular basis, or worse, goes to work anyway and gets sent home. The young adult who was always a straight-A student has now dropped one class and barely passed two others. Your spouse falls asleep at 9 pm and it would take an atom bomb to wake him – he never used to sleep so heavily.

9. Isolating Themselves

They start to isolate, preferring to be alone at home. Does your friend or loved one avoid doing things they used to love, particularly things that involve other people? Isolating is a common behavior as addiction progresses. They may only want to be around others who drink the way they do, so they narrow their social circle to other substance abusers, or they may have found it’s just easier to get the level of intoxication they want by staying home and taking care of business. Other people just get in the way.  The intervention may be the first time the addict has been in the same room with all their loved ones at the same time. Breaking through that isolation is a powerful part of the intervention process.

10. Worsening Mental Health Problems

Mental health issues that were once mild are getting much worse. Maybe they always got a little down, or had some mild anxiety, but as the addiction progresses, mental health issues often get magnified. Depression may deepen dramatically, or the anxious person might start having panic attacks or develop phobias or paranoid behavior. Alcohol and drugs are often ways of self-medicating for real emotional or psychological issues, but they are a poor solution and usually serve only to exacerbate underlying mental health issues.

We suggest you first read “How to Recognize a High-Functioning Alcoholic” to help you eliminate any denial or soft-pedaling by family members. The high-functioning alcoholic can be one of the most difficult to do an intervention on because denial is so strong.

Families often proceed with an alcohol intervention when the alcoholic has really done significant damage, such as been arrest for DUIs, ended up in the hospital, been in a car wreck, or has completely ruined their financial, professional, and family lives.

It’s different with the high-functioning alcoholic.

This person is often at the top of their profession, making good money, and managing to keep all those balls in the air despite their heavy drinking. They can be some of the toughest interventions because they will challenge you thus: If I’m such an alcoholic, why am I so successful at work?

A professional alcohol intervention is absolutely critical in getting any high-functioning alcoholic to see that he or she needs help. The professional interventionist will be very experienced in getting past this powerful denial. They will know exactly how to best get across the point that just because you’ve been getting away with it, doesn’t mean it’s not a problem.

An alcohol intervention is essential if the high-functioning alcohol you love is in a profession where impaired judgment can truly harm others – such as a doctor who could harm a patient, an attorney who could seriously undermine a legal case for a client, or a high-level executive who could make decisions that threaten jobs and livelihoods.

The high-functioning alcoholic is not as invulnerable to criticism as you might think at first glance. The professional interventionist will do a thorough pre-intervention and will likely come up with many ways to overcome denial. Certainly if you see a problem that is big enough to warrant looking into an intervention, it has more than likely been a problem for a while. Consequences might not be devastating yet, because the HFA often has the money and the power to hide behavior or make the consequences “go away.” But consequences do eventually pile up for everyone.

Typically the cracks in the armor begin appearing when the alcoholic begins to harm family members. Maybe he gets arrested for drunk driver or embarrasses himself at a work event; maybe she makes poor choices while intoxicated, such as an affair; maybe he develops some health problems such as stomach or liver problems. While the HFA can hide the problem at work, the spouse usually gets the brunt of the bad behavior, and divorce is often one of the signs that the behavior is out of control.

The best way to do an alcohol intervention on a high-functioning alcoholic is to hire a very successful interventionist who has a long history of doing difficult or high-end (such as celebrity) interventions. They will understand the denial, the ego, and the obstacles that can undermine an intervention.

The Drug Abuse Resistance Program or DARE with its slogan "Dare to keep kids off drugs" remains widely popular with parents, even though it is gradually disappearing from many schools. Developed in 1983 when First Lady Nancy Reagan was telling children to "just say no to drugs," DARE was offered in schools all over the United States, and drug education grew into a $2 billion business.

Today, however, the program is being discontinued, partly because of a 2009 study by Dr. Dennis Rosenbaum, a professor of criminal justice and psychology at the University of Illinois in Chicago. He found that children in Illinois who took part in the DARE program actually had higher rates of drug abuse than students who did not.

Organizations that are working toward the legalization of marijuana and other drug reforms have criticized schools for giving children too much misinformation. For example, an educator may equate heroin abuse with cigarette abuse. There is also some evidence that DARE programs do not work for teenagers who are already substance abusers.

During difficult economic times, police departments do not have the money to spare for a DARE officer, or to pay for its supplies and T-shirts, and that is having an impact on the DARE programs.

"I wish I could wave a magic wand to end the funding mess and bring the DARE program back," said Susan Mochen, a Palm County school district education director for the DARE Officers’ Association of Florida. "It is really concerning because in certain communities there is really a high use of drugs and alcohol."

In south Florida, 6,318 students participated in DARE in 2008, but today, that number is down to 2,430. Similar declines in participation may be seen all over the United States.

While research focused on the genetic factors involved in addiction points to connections between the ways addiction can travel through families, experts also remind people that this isn’t an affirmation that they’ll have a substance abuse problem, nor anyone else in their family.

A recent article in Addiction Treatment Magazine addresses this issue, stating that there’s still much to be learned about the ways genetics impacts a person’s likelihood or vulnerability related to substance abuse. While some people may have a genetic likelihood of carrying specific traits related to a higher addiction risk, many live a completely addiction free life even when exposed to addiction triggers.

Research continues to explore the ways genetics are related to a person developing an addiction to alcohol or drugs. Although some studies suggest a person’s genetic makeup may include genes that are connected to cravings and abuse for alcohol or drugs, and that they may be able to pass these genes forward to their children, experts note that a person’s environment, attitudes and the presence of any co-occurring illnesses, like depression or anxiety disorders, all have a role to play.

The reality of genetics and addiction can be stated in these terms: While research indicates genetic tendencies that may influence some people’s risk for addiction, these genetic combinations don’t mean addiction is imminent. By identifying and addressing the stressors and triggers ahead of time that may make them more susceptible to addiction, many people lead a life without addiction, despite their genetic wiring.

There are many suspected side effects to an all work and no play lifestyle. The stereotypical workaholic has tattered family relationships, a nonexistent exercise regimen and lives on fast-food meals. While this lifestyle is often portrayed in the media, researchers are exploring whether there are connections between work hours and health issues.

A new study published in the January 2012 issue of the journal Addiction explores the connection between work hours and alcohol related problems during the early years of adulthood. The study was conducted by Sheree J. Gibb, David M. Fergusson and Jon Horwood at the University of Otago in New Zealand.

To examine the association between work hours and alcohol use, the researchers conducted a longitudinal analysis of a birth cohort from Christchurch, New Zealand. The participants were all born in 1977 and were followed to the age of 30.

The sample included a total of 1,919 participants. The data included information about working hours and alcohol-related problems collected at the age of 25 or 30.

The researchers measured data relating to frequent alcohol use, the number of symptoms identified as criteria for alcohol abuse or dependence, a diagnosis of alcohol abuse or dependence and the number of weekly hours spent working in paid employment.

The team also adjusted associations identified between alcohol-related problems and work hours using measures of personality and behavior, academic achievement and IQ, mental health problems, recent life events, parental and family background, and current partner and family situations.

The researchers discovered that longer work hours showed a significant association with more frequent alcohol use. Longer work hours were also associated with higher rates of alcohol abuse and dependence and a greater number of symptoms of alcohol abuse or dependence.

The associations were adjusted with several different confounding factors. Even with accounting for these factors there was a significant connection between working hours and alcohol-related problems. Those who worked more than 50 hours a week were 1.8 to 3.3 times more likely to have an alcohol-related problem than those who did not work. The results did not differ when gender was considered.

While the study does not seek to establish a causal relationship between working hours and increased alcohol use, the results call for further study. Additional research may provide evidence that there is a connection that indicates that increasing work hours is a risk factor for the development of alcohol-related problems. Additional research may also help to identify whether certain types of employment are connected with increased alcohol use when compared with others.

Prescription drug abuse, regardless of the brand, has reached epidemic heights. There are an estimated 1.5 billion people who suffer the effects of chronic pain worldwide. For individuals in this predicament, care is required 24 hours a day, seven days a week. This need requires a longer-lasting prescription. Opioids answer that demand with its extended-release formula. The number will continue to climb as shifts in the population age and become afflicted with osteoarthritis and other conditions.

Pharmaceutical companies are then faced with the continual increase of prescription pain medication demands. In an effort to improve safety and the efficiency of pain medication, drug companies have focused on the reformulation of current therapy. There are many different modes of delivering the drugs including opioids and NSAIDs.

Patent protection for these drugs will also soon be gone and big name drug manufacturers will see a larger market in competition from generic drugs. This will ultimately create a decline in price for prescription drugs. The lower cost of these meds could see many different reactions. Drug addicts will now have the means to afford their habit or the violent crime associated with obtaining the once expensive drugs will decrease. Only time will tell the effect this will have on the abuse of opiods.

Dr. Bonnie Nagel, a professor of psychiatry and behavioral neuroscience, led the research in which 31 young people ages 13 to 15 years old were hooked up to brain scanning technology (magnetic resonance imaging) while they played "Wheel of Fortune." None of the participants drank alcohol themselves, but 18 were from families with histories of alcoholism. The game they played involved either taking risks or playing it safe to win money. While both the children with family histories of alcoholism, and those with no such histories played the game about the same way, there were differences in their brain scans.

"While our study found that adolescents (with family histories of alcoholism) did not perform significantly different on the Wheel of Fortune task compared to the other adolescents, we found two areas of their brains that responded differently, "said Dr. Nagel. "These areas were in the prefrontal cortex and cerebellum, both of which are important for higher-order day-to-day functioning, such as decision-making. In these brain regions, adolescents (with family histories of alcoholism) showed weaker brain responses during risky decision-making compared to their peers."

Previous studies involved young adults who had already started drinking. This study involved participants who did not drink alcohol, and yet it indicated that certain genetic factors could already be at work and causing differences in the way adolescents with family histories of alcoholism make decisions.

"Taken together with other studies on youth (with family histories of alcoholism), these results suggest that atypical brain structure and function exist prior to any substance use, and may contribute to an increased vulnerability for alcoholism in these individuals," Dr. Nagel said.

"While having a family history of alcoholism may put one at greater risk for alcohol abuse, personality and behavioral risk factors are also important to consider. A combination of genetic and environmental factors is very different for everyone, so some individuals may be at higher risk than others, and certainly there are genetic and environmental factors that can also protect against alcohol abuse. Future research will need to determine the relative influence of these traits on alcohol abuse risk to be able to define specific prevention strategies for different high risk populations."

The study appears in the journal Alcoholism: Clinical and Experimental Research.

The Alcoholic Beverage Control Commission is initiating early warning campaigns in hopes to alert the public about the issues of drinking and substance abuse with this population. Jena Burkhart, a geriatric clinical pharmacist at UNC believes there will be a rapidly increasing problem and that those in the health care field need to stay alert and aware of how to handle these growing concerns.

So far, research into these types of substance abuse issues among this group of baby boomers yields several dismal statistics. Baby boomers are categorized as the generation born after WWII and typically were born between the years 1946 to 1964. These statistics have sparked initiatives by those in the medical community to give better information regarding this subject. Keith Kimbro, a 60 year old recovering addict of alcohol and drugs, says he sees an abundance of evidence of this trend at his job in Durham, NC with the Alcohol and Drug Council. Kimbro says usually these folks have dealt with some serious issues such as death of a spouse, a car accident or a disability of some kind. Until now, they typically have not had issues with their addiction and suddenly at 55-60 their tolerance decreases.

Suddenly, as this group reaches their senior years, they are having issues handling their tolerance of drinking and become visibly disabled by it or are noticeably drunk.

The use of a B-12 supplement during treatment was discussed in a recent health article. During detox, it is crucial to be under the care of a medical physician. Those who proceed to detox can hurt themselves even if they use dietary supplements or B-12.

Alcoholism takes a toll on the gastro intestines and prevents the body from absorbing B-12 and other B-vitamins properly. This B-12 deficiency and even anemia is directly caused by alcohol abuse. Alcoholics that are substituting food with alcohol may be doing damage in other areas, too. Not giving the body what it needs can lead to serious nerve damage and other diseases like peripheral neuropathy.

B-12 supplements and other B vitamins could have an impact on the mental state of the alcoholic as well. During detox, adding this benefit can greatly reduce a relapse and other mental health problems like hallucinations and depression. Detox is difficult enough, so patients need all the help they can get and B-12 can help with the withdrawal process.

Several studies in recent years show positive results from patients administered B-12 during their detox. In a 2007 Japanese medical study, alcoholics with both anemia and neurological symptoms vastly improved after B vitamin treatments. Another similar study using animals just last year proved B-12 therapy reduced liver disease in alcoholics. In rats, the B-12 supplements elevated specific homocysteine levels commonly related to liver disease.