An intervention is a method of confrontation that attempts to present reality to the chemically dependent person who is unable, due to the disease process, to recognize the seriousness of the problem. The goal of intervention is to get the employee to submit to an evaluation and treatment, not to get the employee to admit the degree of the problem.

The confrontation is caring in that the individuals involved maintain a firm stance regarding the disease and the need for treatment, while simultaneously emphasizing their concern for the nurse's well-being.

An intervention should be done as soon as possible so that the chemically dependent employee's harmful behaviors can be stopped. The manager or staff member should confront a chemically dependent employee as soon as appropriate information has been gathered. Obvious signs, such as catching an employee in the act of diverting or stealing controlled drugs or observing an employee who is overtly under the influence of alcohol or drugs, indicates that the disease is in an advanced stage. Chemical dependency is a progressive disease. By learning to recognize its signs and symptoms and intervening as early as possible, nurse managers increase the odds that the employee will recover successfully.

Interventions are never conducted on a one to one basis. This type of confrontation is just not powerful enough to deal with the disease of chemical dependency. At least two people are required for an intervention team. The maximum effective number is generally considered to be no more than five. However, what is really important is who should be on the intervention team.

The following individuals are essential to an effective team: the manager, another authority figure (nurse executive, another nurse administrator or nurse manager, etc.), coworkers who have a close relationship with the employee, a recovering employee, and other persons who have knowledge of the employee's problems by virtue of their personal or professional relationship with that person (Catanzarite, 1992).

The following actions need to be done prior to the intervention (Catanzarite, 1992):

• The documentation (see Signs and Symptoms) needs to be gathered and reviewed. The results of urine and/or blood drug screening tests also need to be reviewed, if available.
• Financial resources for this employee need to be identified to the extent possible. These include paid time off, medical leave, insurance benefits, disability benefits, etc.
• Possible treatment programs need to be identified which consider the employee's health insurance coverage. Another consideration is the location of treatment programs as related to accessibility and protection of confidentiality.
• The team needs to meet to develop their intervention plan. Key roles and tasks need to be assigned. Rehearsal of the intervention session is often helpful, stressing the use of therapeutic interview and good communication techniques. A time, date, and place needs to be set.
• Identification of other resources should also be done. These might include a peer assistance or an employee assistance program, KY Board of Nursing, KY Nurses Association, KY State Association of Licensed Practical Nurses, local Alcoholics Anonymous or Narcotics Anonymous groups.
• Each team member should prepare a written script from which to read during the confrontation. The script should be factual, objective and nonjudgmental.

The initial step of the intervention is to present to the employee information and facts related to the employee's chemical use. Each person presents the facts and observations as planned. When presenting these facts to the chemically dependent employee, the intervention team must not debate the issues with the employee but rather should focus on the objective material.

The next step is the presentation of alternatives. Treatment alternatives should be presented which are accessible, compatible with the employee's insurance coverage, and allow for protection of confidentiality. Do not present alternatives for treatment or agree to treatment programs which are not acceptable to the employer or are clinically inappropriate for the employee. For example, do not agree to outpatient therapy rather than inpatient if you feel that an inpatient program is necessary.

Sometimes it is difficult for the intervention team to know exactly what type of treatment program is best for the employee. In these cases, recommendations should only be general with specific recommendations to follow the chemical dependency assessment.

The team should also prepare for possible reactions by the employee during the intervention. Catanzarite (1992) has described several situations that may occur. They include the following examples.

The employee becomes angry and leaves the room during the intervention. When this happens, one or two team members should follow the employee. The team members who have this role should be assigned in the team planning meeting prior to the intervention. They should request that the employee return and listen to what the team has to say. If the employee refuses to return, he/she should be contacted and another meeting date established.

The employee does not attend the meeting. When this happens, the team should immediately contact the employee and set another meeting date. It should be clear to the employee that failure to attend the second meeting will mean that disciplinary action will be taken.

The employee refuses to undergo evaluation and treatment. In this case, the team should explain the consequences of the refusal. These consequences should have been previously determined and should be based on facility policy. Termination may be an appropriate consequence. If this action is taken, the facility's normal procedure needs to be followed.

The employee threatens to sue the team or facility. This is not an unusual reaction because the employee may become angry and defensive and try to diffuse the discussion regarding the need for treatment. The team should feel confident that the processes they used were sound and protected the individual's rights and confidentiality, and the information gathered was objective and based on poor performance. Sometimes this type of response can be countered by demonstrating an obvious concern for the employee's well being and being supportive of the internal difficulties the employee is feeling at the time.

The employee wants to postpone the date for an evaluation or wants to choose the counselor. This is often done to avoid the issues or to take control of the situation. It is important that the evaluation be done immediately (within 24-72 hours). It is also important that the team make the decision about who is to do the evaluation and what qualifications this person should possess.

The employee denies that he/she is chemically dependent. The team does not accuse the employee of being chemically dependent, but rather is concerned because a problem has been identified. The team's goal is to have the employee get the help that is needed to solve the problem. It is not necessary for the employee to admit to any aspect of the disease, but it is necessary that he/she submit to a full evaluation and the recommended treatment.

Another area to discuss, prior to the intervention, is the possibility of attempted suicide. This possibility must never be overlooked for the potential always exists that the employee is experiencing suicidal ideation or could become suicidal. Suicide attempts and completions occur more frequently among chemical abusers. Indications of possible suicidal risk include:

• feeling guilty, hopeless or worthless
• restlessness or decreased activity noticed by others
• feelings of sadness or irritability
• complaints of physical aches or pains for which no medical causes can be found
• thoughts of suicide or death
• withdrawal and social isolation
• giving away of personal possessions
• lack of support systems
• continued excessive use of alcohol or drugs
• stressful life events and/or losses
• previous attempts or gestures
• impulsiveness
• seeing the current situation as desperate or hopeless

The team should be prepared to initiate procedures to admit the employee involuntarily to a psychiatric facility for his/her own protection if the employee demonstrates suicidal behavior or threatens suicide and refuses voluntary admission. One of the team members should gather the necessary information on this process from the facility's social work department, or a mental health clinic prior to the intervention meeting.

It is helpful to assure that the employee will not be alone from the time of the intervention to the time of the evaluation. This is especially critical for employees who are felt to be at risk for suicide but is also desirable for all employees. This can be accomplished by asking the employee, at the end of the intervention session, to contact a family member or friend who will provide the transportation home and then arrange constant presence and support until the evaluation session occurs.

Careful attention to the planning of the intervention will promote a successful entry into treatment for the impaired employee. In addition, with thought given to contingency planning, the team is also prepared for potential difficulties that may occur. Once the intervention has occurred, specific steps should be taken to assist the employee with a successful treatment program and successful reentry into the workplace.