Dennis Hoffacker reached down and shook his son John's shoulder. "Wake up," he said. "We need to talk to you." It was 7 a.m. on Thanksgiving day, 1988. A day earlier he and his wife Sue, who live in Gaithersburg, had flown to Phoenix where their 19-year-old son was attending technical college.
"Please don't say one word until we're finished," Hoffacker told his son. "Then you can say anything you want."
Sue Hoffacker read from a prepared statement she had rehearsed. "John, I love you very much," she began, "but I can no longer tolerate the pain your alcohol and drug abuse has caused me.
"I was so proud to tell people my son was going to Georgetown Prep. I know in my heart that . . . you were selling drugs, but I denied it, thinking I was helping you by protecting you from suffering the consequences of your actions . . .
"Your senior year wreaked total havoc in our household. We sent you to Arizona in the hope that new surroundings and new friends would change you and your judgment. Your choice of friends is now and has been for years governed by your disease, your addiction.
"I hate the thought of fearing that I might have my jewelry stolen and having to watch my purse any time you're in the house. I can't live with a thief." She started to cry; so did her son.
Then Dennis Hoffacker spoke. He was tired of the conflict in his family, he said, of seeing his wife constantly upset. He told John that he loved him and then gave him a choice: come back to Maryland and enter an alcohol and drug treatment center or stay in Arizona and go it alone, without financial support. The flight home left in two hours.
"I'll do it for you," said John.
The Hoffackers had engineered an "intervention," a rehearsed confrontation that has become an increasingly popular method of bringing an unwilling addict into treatment. The Johnson Institute in Minneapolis, a training center for substance abuse counselors, which pioneered the use of interventions in the 1960s, estimates that between 70 and 90 percent of them succeed in forcing an addict to enter treatment.
Interventions refute the notion that alcoholics and addicts must hit bottom on their own -- typically by getting arrested or divorced or losing their job -- before they will accept help.
"Hitting bottom for an alcoholic means suffering some severe consequences," said Billie White, a counselor who assisted the Hoffackers. "We believe that in an intervention we can raise that bottom. A person doesn't have to go out and kill someone in a car before he gets help."
Entering treatment through an intervention is a crucial first step, but it is no guarantee that a person will remain clean and sober. Substance abuse counselors say that relapse is not uncommon and that interventions are no more likely to reduce recidivism than entering treatment through the courts or an employee assistance program.
The most successful interventions, according to Johnson Institute staff member John Whalen, involve those in which the largest number of friends and relatives take part.
The purpose of an intervention, however, is not to blame the addict; the Hoffackers had yelled at their son often, and it had not altered his behavior. Instead, its proponents say, an intervention works because family members, friends and co-workers surprise the addict and, in a rehearsed situation, discuss the negative effects of alcohol and drugs. They clearly delineate behaviors they will no longer tolerate -- and convey how much they care for the addict.
"An intervention is a profound act of love," said White, a certified alcohol and drug counselor at the Seneca Melwood Treatment Centers, a private substance abuse facility in Montgomery County. "It's about presenting reality to a person in a way he can receive it."
In most cases, White said, family members who confront an addict on their own are not successful; the Hoffackers were an exception. Because they wanted to confront John in Arizona, they did so by themselves after planning their strategy with White.
White prepared the couple for the emotional intensity of the experience by telling them that addiction is disease, not a moral failing. Addicts lose the ability to regulate their use of drugs or alcohol. John's belief that he could control his use of booze and cocaine, White said, was the "sincere delusion" of an addict.
John had stolen thousands of dollars from his parents to support his cocaine habit. Stealing is classic behavior for addicts, White said, because nothing is as important to them as alcohol and cocaine. Although John's behavior caused serious problems, she told his parents, he wasn't a terrible person. And while his behavior had caused suffering in the family, he was in pain, too.
Because of the alcoholism in his extended family, John might have been genetically predisposed to addiction, White added. This relieved some of the guilt his parents felt.
For family members like the Hoffackers, an intervention provides a realistic look at the effect of addiction on their lives. "It provides the wisdom that allows a person to know when to let go," said White. Family members can then stop agonizing so much, knowing they have taken as much responsibility as they can for help.
"I know I'm not responsible for my disease, but I'm responsible for my recovery," said John Hoffacker, who now lives at home, works for his father and hasn't had a drink or taken a drug in nearly two years. If he "goes out" -- back to drinking and using drugs -- he has been told he won't be able to live at home.
Not long ago, he returned to Magruder High School in Rockville to talk to students about drugs. "They asked me what I learned at the treatment center," he said. "I said that they loved me until I learned how to love myself." He has repaired his relationship with his younger brother and with his parents. "It's hard to explain," John said. "My love for my family has never been as deep as it is now."
"He's making up for all those lost years when he didn't want to be home," his mother said. The Second Time Around
Nearly a year ago, Roxie McFarland of Danville, Calif., issued an ultimatum. McFarland told her father and brother that unless they assisted her in getting help for her 54-year-old alcoholic mother, she would no longer be part of the family.
Roxie, 25, said she worried constantly about her mother, Sherry McFarland, who routinely started drinking gin at 8 a.m. "She didn't look good at all," Roxie recalled. "She was bloated around her midriff, her eyes were yellowish, she had no spirit. She looked deadened."
Her father and brother agreed to help. Four years earlier, Sherry had been the subject of an intervention. But a few weeks after she left the treatment center, she started to drink again.
One of the problems, according to Roxie, was that the whole family had simply ignored it, denying her alcoholism, a familiar pattern in families that include an addict. Although Roxie had said during the first intervention that she would not have any contact with her mother unless she stopped drinking, "we didn't follow through with the consequences."
Family dynamics play a crucial role in alcoholism and addiction, according to the Johnson Institute's Whalen. The addict denies the problem, insisting that nothing is wrong, and pressures the family not to change. For their part, family members often unwittingly fuel the addiction by acting as "enablers": making excuses and paying the bills.
"There are some payoffs for the family," Whalen said. "They're taking total responsibility for another person. It's a heavy cost, but it's a power position."
Having an addict in the family may mean that other family members don't have to look at their own problems and goals, according to Steven J. Wolin, clinical professor of psychiatry at George Washington University School of Medicine. "It's always easier to look at somebody else's behavior."
This time, Roxie wanted to do everything she could to improve the chances of her mother's recovery. At the first intervention, only the immediate family had been present, along with a counselor. This time, Roxie wanted her mother's friends involved, because they could reach her in a way the family could not.
Roxie also decided that she wanted a treatment program that would suit her upper-middle-class mother. At the first center, her mother had complained about feeling uncomfortable with drug addicts from working class backgrounds and may have used it as an excuse not to get better, by denying she was like them. Roxie decided she wanted a center that offered family treatment so that she, her father and her brother could examine the ways they helped foster Sherry's alcoholism.
Roxie called the Betty Ford Center in Rancho Mirage, Calif. A staff member referred her to several counselors who specialize in helping families conduct an intervention. One of them was Ed Sorti, a certified alcohol and drug counselor in San Diego.
"With Ed, in the first 30 seconds, I knew he was the guy," Roxie recalled. "I knew he was someone my mother would listen to and be open to."
They arranged for a bed for her mother at the Ford center, and Roxie put together an intervention team: Sorti; her father; her older brother Brian, who would fly in from Alaska, allegedly on business, as well as two of her mother's closest friends and the McFarlands' next-door neighbors.
The group met in a motel room near the McFarlands' home in a posh San Francisco suburb, where they talked for more than two hours, outlining what they would each say, in what order they would speak and where they would sit in the McFarlands' living room early the next morning, before Sherry took her first drink of the day.
Roxie said she was anxious about it. Often, Sorti said, the person who instigates the intervention feels "buyer's remorse." Sorti encouraged the group and told them they were offering Sherry McFar a new life.
The next morning at 7 a.m., as Sherry ate a bowl of cereal, her son Brian opened the door to admit the group. "We have some visitors," he announced.
One of the women, Sherry's best friend from high school, started to cry and gave her a big hug. Sherry sat on her black leather sofa. The rest of the group sat around her, in fan-backed wicker chairs and at the edge of the fireplace. "I was trying to keep a look on my face of, 'This is okay, this is something you've got to do,' " recalled Roxie.
Sorti directed them to speak, one by one. The neighbor told Sherry how much she enjoyed talking to her on the telephone over coffee at 7 a.m. and how much she admired her. She said she wished she could talk to that same person at 7 p.m., without the personality change that alcohol caused Sherry to undergo during the day.
"I told her one reason I hadn't moved out was because I was afraid of something happening to her," Roxie recalled.
"Every night, I would drive home from work and I wouldn't know what I would find . . . I started to cry and told her I wanted my mommy back." By that time, she says, almost everyone in the room was crying.
"Then my dad talked," Roxie said. "He held both of her hands in his and told her, 'I'm as much to blame. I need as much help as you do. The last 15 years haven't been that great. If you'll give me the chance to get well, I'd like to ask you for the next 20 years."
With that, Sorti wrapped it up. He asked, "Do you know you have the disease of alcoholism?"
"Yes, I do," said Sherry.
"I think you're Betty Ford material," he said. He pulled out brochures. She agreed to go.
The intervention was over in less than 30 minutes.
Interventions, according to Sorti, can be divided into three phases. In the first, participants speak from the heart, saying, in effect, "I care about you, and I'm not going to lose you." This is largely the phase in which the intervention with Sherry took place. Sorti moves into the second phase "if the patient is just not getting it" and is minimizing the problem. In the second phase, participants offer specific instances during which the addict's behavior was out of control.
In the final phase, participants present consequences if the addict does not enter treatment. The McFarlands' intervention didn't get to this point, but it might have involved Roxie limiting or severing contact with her mother.
"Ninety percent of the time, participants never need that leverage," said Sorti. Because they may make threats that they are not prepared to carry out, such as divorce or eviction, "I'm careful on pushing them into leverage."
Recovery for Sherry and her family is a continuing process. During the five-day family program at Betty Ford, Roxie and her father began to look at the effects on their lives of living with an alcoholic. She has since moved out of her parents' house into her own apartment.
Her mother told her she felt guilty. "I told her I wouldn't have traded her for any mother in the world," Roxie said.
Even if Sherry resumes drinking -- which she has not -- "the family situation will never be the way it was," said Roxie. "The lines of communication are open; before, they didn't exist."
Sherry said that while the intervention "stunned" her, she was on some level ready to get better.
"You find out how much your friends care about you," she said. "If I had waited (longer) to go into treatment, I might have lost a lot."
Black Addicts: Special Needs
Mood swings and denial were hallmarks of Denise Embry's addiction. One week, she confided to her mother and her priest in Atlanta that she had an alcohol problem. "The next week," her mother, Yvonne Fason, recalled, "it would be 'Who has a problem? You must have a problem, not me.' "
Yvonne attributed her daughter's drinking to marital and health problems and hoped it would diminish. It didn't.
Every family has a hard time deciding to pursue an intervention but, for black families, that decision is even more difficult, according to Peter Bell, executive director of the Institute on Black Chemical Abuse in Minneapolis. "We black people have a higher tolerance for emotional pain, to survive somewhat brutal racism, and it keeps us sick longer," he said.
Furthermore, Bell added, blacks have less confidence in the effectiveness of treatment programs. "We have less trust as a people in the resources," he said. As a result, interventions in black families tend to occur later in the cycle of addiction.
As with white families, money also can be an issue. An intervention can cost from $250 to more than $1,500 depending on the person coordinating it, and 28-day in-patient treatment programs can range in price from $6,000 to more than $30,000, far beyond the means of most people, unless insurance will pay.
As Embry's addiction accelerated, so did her family's worrying. It got to the point where Yvonne called her daughter at night, then first thing in the morning to make sure she was alive.
"I thought she was going to go to sleep and not wake up," she said. "She had blackouts."
"I really saw where it was destroying her life," said John Fason, Embry's brother. "She has two kids, and I saw how it was affecting them, also. She had a bad auto accident . . . Alcohol was in her blood, but they couldn't confirm narcotics. I found myself fussing at my wife when I was really angry at my sister."
Yvonne began reading books about alcoholism and drug addiction. John and his wife started to attend meetings of Al-Anon, a self-help program for families and friends of alcoholics. "When I understood that it was a disease and that there was nothing I could do or say unless she wanted to quit, that helped me cope," he says.
Once, John and his father confronted Embry and asked her if she was using cocaine. She denied it but admitted to drinking "a bit more heavily."
John was about ready to give up, when he saw a program about interventions on "The Oprah Winfrey Show." He wanted to attempt one with a trained counselor, so he would know that he had done everything he could. He called the priest at the church where he and his sister attend Mass. The priest said he thought an intervention might work.
Fason and his family wanted a treatment center that specialized in working with blacks. "You're most comfortable there," said Yvonne. "You don't have to overcome anything. In some situations, you're maybe the only black, and you already are dealing with so many stresses."
"Many treatment centers don't create an environment conducive to blacks getting in touch with their inner feelings, to share what's at the heart of the matter for them," said Nate Mack, vice president of alcohol and drug abuse rehabilitation at Coalesce, a treatment center in Atlanta that specializes in treating black addicts.
A second Fason brother came up from Savannah for the intervention. The family and the priest met with counselors from Coalesce. "We made a pact," said John Fason. "If she did not go into treatment, she was basically on her own." If her addiction got worse, someone in the family would take her young children.
The next day, they showed up at Embry's apartment after church. "What's going on?" she asked. She was angry.
The priest began. "He said we were not trying to focus just on shortcomings," John Fason recalled. "He said the reason we were all there was that we do love her and want her to do better." The others spoke in turn.
John talked about how upset he was when Denise showed up three hours late for a Christmas party to which she was supposed to have brought the main dish. He told her he wasn't going to take time off from work any more to deliver her payment to the utility company so her electricity would not be cut off.
They talked for two hours. The decision was Embry's. She said she was interested but that she couldn't leave work right now. "There never is a right time, so the right time is now," her mother said. John agreed to take care of her children. Finally, Denise agreed to go.
She entered treatment in January and is continuing to eschew drugs and alcohol. "I think she's doing great," her brother said.
Embry said that although she was "a little resentful initially" about being pressured into treatment, "now I'm very grateful that they cared enough to intervene."
When she returned after treatment, Embry found she had lost her job.
"At the rate she was going before, she would have lost it anyway," her brother said. "But her attitude and everything about her has changed." Her employer, he added, "didn't give her a chance." But her family is "giving her a fresh start. I know now that we're not the only family in America that has a problem. We're on the road to healing ourselves."