This is the sixth installment in a continuing look at opiate abuse and its effect on the Island community. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard,” and on June 5 “Section 35—when addiction calls for drastic action.”
Addiction doesn’t just take over an addict’s life. It also takes over the lives of their loved ones. As their world becomes more cluttered with the wreckage that the addict leaves behind, anger and resentment builds, along with the constant worry that every time the phone rings, it’s bad news. When the promises of sobriety have been broken so often they’ve lost all meaning, a planned intervention provides a way for friends and family to tackle the addiction head on.
On Island help
There is a dearth of on-Island professionals who are qualified to lead interventions. Dr. Charles Silberstein, resident psychiatrist and addiction specialist at Martha’s Vineyard Hospital is one of the few.
“Intervention is a very powerful way to break through an addict’s denial,” he said.
Dr. Silberstein meets with the friends and family before the intervention and advises them on the combustible encounter that lies ahead. “I ask that they don’t tell the addict what’s best for him or her because it comes across as controlling,” he said. Saying, ‘’I love you so much, I’m angry with you all the time. If you can’t go into treatment I can’t live in the same house,’ is much different than saying, ‘You need help.’ When you communicate from a place of anger it never works.”
Dr. Silberstein sometimes recommends a planned intervention, where the element of surprise is eliminated and the addict actually helps to organize the event. “The problem with surprise interventions is it can leave people traumatized,” he said. “The nice thing about a planned intervention it that it can feel empowering and it doesn’t feel like an attack. With any intervention, the goal is the same — to intervene on the destructive behavior and to design solutions to the problem. People go through stages of readiness for change. Once you have a dialogue you can bolster the addict to make the change they want to make. There’s a part of every addict that doesn’t want to be an addict. It’s not a pleasant life.”
Dr. Silberstein added that if someone is in imminent risk to themselves or to others, the best course of action is to call 911.
Deborah Pigeon, a licensed mental health counselor (LMHC) and licensed marriage and family therapist (LMFT) based in Vineyard Haven, can also supervise an on-Island intervention. Before going into private practice on the Island, Ms. Pigeon worked at Gosnold addiction treatment center and a satellite facility, Emerson House for Women in West Falmouth.
“Interventions now are approached a different way,” she said. “They’re not as much about the shock value as they used to be.”
Since there are no inpatient facilities on the Island, Ms. Pigeon and Dr. Silberstein arrange for a bed in an off-Island facility and a friend or family member to accompany the person before the intervention. Although Ms. Pigeon is no longer solely dedicated to treating substance abuse, she estimates that at least 75 percent of her patients are directly or indirectly affected by it.
Holly Carroll, an intervention coordinator at Gosnold addiction treatment center, has supervised interventions on the Cape and Islands for the past seven years. As is usually the case with recovery, it all begins when someone picks up the phone.
“It starts with a call to my cell phone — 774-313-0662 — from a friend or family member and I listen to their concerns,” Ms. Carroll said in a phone interview with the Times. “I tell them about the services we provide and we discuss things like family history. After the initial interview we schedule a time to meet. In most cases this involves immediate family, but I urge people to think outside the family system. It can help to hear from a wider spectrum of people, like a high school friend or neighbor or athletic coach.”
She said. “My job to be flexible and work within their time frame because crisis can’t be planned.”
Once Ms. Carroll is enlisted, the process moves quickly. “I like to meet with family and friends the day before and have the intervention the next morning,” she said. “In the planning session we discuss the who, what, when, where, and why of how the day’s going to work. Some families are not as cohesive as they need to be, and I need to educate them on addiction. Without a cohesive group, intervention is not a good idea. You can end up dividing the family rather than uniting them.”
Ms. Carroll asks everyone in the group to write letters to the addict, which are read aloud at the intervention. “We also talk about what’s going to stand in the way of the person accepting help, and we address it,” she said. “People often say they can’t go to rehab because they’re afraid of losing their job, but you can’t lose your job based on getting help. It’s the law. If they have a dog or a child that needs looking after, that’s where family and friends step in.”
The actual intervention usually doesn’t last more than an hour. The vast majority of the time, the next step for an Islander will be the trek to an off-Island inpatient facility.
“99 percent of the time, that person needs inpatient help.” Ms. Carroll said. “I encourage families to follow up quickly. Change is not easy. Sometimes people change their minds if you wait. I don’t feel comfortable leaving the family unless I know that patient is on the way to an inpatient facility.”
Ms. Carroll estimated that 75 to 80 percent of the patients are also are battling clinical depression or bipolar disorder, which makes professional inpatient care even more essential to their recovery.
Ms. Carroll usually arranges inpatient care at Gosnold. “I can ordinarily get a bed within 24 hours,” she said. “Not only am I part of the admissions process, but I follow the family and the case throughout the system. That’s a significant advantage when you work under the same umbrella.”
The cost of an intervention is another hurdle Ms. Carroll can help families overcome. “It’s $250 an hour for my face-to-face time, $50 an hour for travel time,” she said. “Ordinarily the cost is not more than $1,000. $3,500 is the industry standard.”
Ms. Carroll stressed that no one is turned away if they don’t have the financial means. “Many of our patients have state insurance [Mass Health]. We can also work with sliding scale when necessary.”
Dr. Charles Silberstein, Martha’s Vineyard hospital resident psychiatrist and substance abuse specialist 508-696-1990
Deborah Pigeon LMHC, LMFT, 508-693-7435
Holly Carroll, Gosnold Intervention coordinator, 774-313-0662 Sunday through Thursday.