ARISE Intervention Model

In any given year only 5% to 8% of people who experience substance use disorders enter treatment. (Kessler et al, 1994; Nathan, 1990). Studies have shown that about 50% of people with mental illness don’t believe that they are ill nor are they willing to take medication. Mental Illness and Substance Use Disorders are brain diseases that by their nature impair an individual’s judgment, reasoning and cognition. This is often characterized as denial; however it can also be attributed it to Anosognosia. Anosognosia, meaning "unawareness of illness," is a syndrome commonly seen in people with serious mental illness and some neurological disorders, according to Xavier Amador, Ph.D., author of the book “I Am not Sick I Don’t Need Help!.” (Vida Press, New York; 2007)

Engaging people in treatment when they do not believe they need it is our biggest challenge as we know that early intervention and treatment of dual disorders results in better outcomes. At WestBridge Community Services, we describe this stage of change as Precontemplation. Often times, family members, concerned friends and treatment providers resort to coercion, rejection or threats to motivate people to enter treatment. This leads to high drop out rates and to not following treatment recommendations. Sometimes families are not willing to risk alienating their loved one nor are they willing to put them at risk with no support. Research also shows that when the family is involved in the treatment of people who experience dual disorders, the individuals have better treatment outcomes.

At WestBridge Community Services, we have searched for an intervention method that is respectful, inclusive and transparent and have found the ARISE model which we have implemented and is successful. ARISE stands for A Relational Intervention Sequence of Engagement and it is a process rather than an event. An intervention meeting is designed with the extended family and support system and the individual; the process is transparent with no surprises. The basic goal is to help the family reorganize toward getting the problem behavior stopped and to motivate the person to enter treatment. By adapting the invitational intervention model, WestBridge Community Services offers families another tool and opportunity to heal and regain

ARISE Principles and Techniques:

• Cooperating and Engaging people Across Systems to Build Social Networks and Community Partnerships. Creating bridges and collaborative relationships among the people who are involved on a day-to-day basis with the person who is experiencing mental illness and substance misuse and their family is a powerful motivator for engaging the person into treatment.
  
  
  
• Owning a Sense of Competence that Relieves Guilt and Blame. Believing that current problem patterns result from adaptive and effective solutions from the past, enabling positive problem solving in the here and now. This allows sustained focus to reach the goal of getting the person into treatment. Once blame and guilt are removed, family and friends are united towards a single goal - getting the person to engage in treatment.
  
  
  
• Acknowledging, Building and Shifting Accountability. Recognizing the fact that family members remain family members, regardless of whether they’re talking to each other or not. They remain each other’s primary relationships across time, and have a responsibility and accountability for each other that is greater than that of other members of their network, particularly the assisting professionals.
  
  
  
• Recognizing the Tension and Timing of Protectiveness versus Autonomy. Learning how to choose when and how much to help each other through difficulties. The ARISE model allows for negotiations with the prospective participant because of built-in long-term accountability that the family and social network bring. No longer is the person “calling the shots” and manipulating the individual family and social network members in his/her life. The larger group is in charge and sets the rules for negotiations and monitoring regarding such areas of level of care, when to start treatment, involvement in self-help, when to take medication and when to stop using alcohol and drugs.

ARISE Philosophy:

• Individuals, families and communities are in constant transition - the more transitions they experience at any one time, the more likely they are to develop a problem.
  
  
  
• Individuals, families and communities are intrinsically competent.
  
  
  
• Professionals, on their own, lack the resources, impetus and time to effect prevention and intervention across families and communities.
  
  
  
• Families are more powerful in effecting change than are treating professionals.
  
  
  
• “Family Links” (persons who play a key, connecting role across the family network) have a powerful stake in resolving identified problems. With minimal coaching, they are capable of mobilizing the extended family and social support networks for problem solving.
  
  
  
• Expanding the network by helping members to be in touch with each other (helping them to reconnect, if necessary) at the earliest possible time, accesses their competence and minimizes guilt and shame.
  
  
  
• The model encourages family members to stay connected across time, being available to resolve problems as they arise.
  
  
  
• “Less is more.” Applying the minimum amount of effort, expense, and professional time enables families to demonstrate that they are capable of doing much of the work on their own.
  
  
  
• Given the opportunity, individuals, families and communities will find and utilize their competence.
  
  
  
• Attending to issues of culture, gender and spirituality enhances the individual and family’s chance of long-term recovery.