Crisis Intervention

 

According to Dr. Kristi Kanel, author of the book A Guide to Crisis Intervention, most modern theorists use what is known as the trilogy definition of a crisis that defines a crisis as consisting of three separate events:

• I: a precipitating event that results in an emotional response
• II: a perception of the event that causes significant subjective distress in the person
• III: a failure of the individual’s usual coping methods/skills to deal with the stress

Of course, any number of issues can precipitate a crisis intervention; however, crisis interventions for individuals with substance use disorders can occur in the moment or right on the spot when the person’s use of a substance has caused or is believed to be capable of causing some type of potentially threatening or dangerous situation. Triggers for a crisis intervention may include the individual overdosing, making poor decisions that endanger them or others, being intoxicated in potentially hazardous situations, or neglecting or abusing children or minors. The individuals present during this time may immediately confront the person with a substance use disorder, or alternatively, individuals who have witnessed the situation may get together, briefly plan a crisis intervention, and then confront the individual with the substance use disorder.

 

There are a number of different models used in crisis interventions. This article will discuss some of the more established models.

The Seven-Stage Model

A popular model of crisis intervention developed by Dr. Albert Roberts and Dr. Allen Owens is the seven-stage model of crisis intervention for professional therapists and crisis interventionists. The stages of the intervention follow.

• Stage I: Plan and conduct a quick assessment of the situation. The crisis worker should perform a quick but thorough assessment of the situation, including the cognitive, behavioral, and emotional aspects of the crisis as it affects the individual as well as the potential for any trauma or harm (e.g., suicidality) to occur.
• Stage II: Quickly establish rapport with the individual (for individuals already familiar with the person, this stage may not need to be performed). In order to assist the individual in the crisis situation, the individual must trust the person intervening. This means that the crisis worker must establish a sense of trust and cooperation with the person or the intervention will not be effective.
• Stage III: Identify the major problems or precipitants of the crisis. Here, one needs to organize problems in a hierarchy, such that issues in the crisis that are more pressing or potentially dangerous are addressed first. Then, additional issues need to be addressed in order of their potential seriousness.
• Stage IV: Deal with feelings and emotions. This stage consists of two components:
  • The first component is to allow the individual to express their emotions and feelings in order to recognize and understand them. This is done through an active listening process where the worker listens to the person and, using reflection and other techniques, draws out the individual’s feelings regarding the situation.
  • The second component consists of actively challenging any dysfunctional or maladaptive perceptions that a person has regarding the crisis. Again, this is done through reflection, understanding, and guidance.
• Stage V: Identify alternative courses of action, feeling, and thinking. In this stage, the crisis professional works with individual to identify different ways to process and cope with the situation. This can be an extremely difficult stage and requires expert training and understanding to implement because by definition individuals in a crisis situation lack the resources to deal with the perceived crisis.
• Stage VI: Implement a plan of action. Based on the alternatives identified in the previous stage and on all the information gleaned up to this point, the crisis professional develops a plan of action to deal with the specific situation and works with the individual to implement a plan of action.
• Stage VII: The crisis individual makes certain to keep tabs on the patient in order to make sure that the intervention has resulted in the avoidance of any trauma or other significant issues that can affect the person.

The seven-stage model can only be applied by a professional mental health worker who has training and experience in crisis management. Individuals who wish to utilize this model to assist someone in a crisis should contact a trained mental health professional.

The seven-stage model might be difficult to apply to a person with a substance use disorder who has been actively using and is intoxicated or otherwise cognitively impaired as a result of their substance use.

ABC Model

Dr. Kristi Kanel proposed a simpler model of crisis intervention that directly referred to an earlier model of intervention. This ABC model includes:

• A: The focus here is to develop contact with the person and then maintain that contact. This is similar to the notion in the seven-stage model of developing rapport. The basic approach in the first stage is to maintain good eye contact, be attentive with body language but not threatening or otherwise negative, use a soothing calming voice, display warmth, and use reflection as the individual explains the situation.
• B: Identify the problem. In this stage, it is important to understand the precipitating event, the individual’s thoughts and feelings regarding the event, and how the person is functioning after the event.
• C: Identify useful coping strategies. If the person is able, have them identify what they want to do. In addition, the crisis intervention specialist should offer other useful alternatives to the situation. Once the coping strategies that will be used are identified, they are then implemented.

This intervention is a bit more applicable to individuals with substance use disorders who may be currently under the influence of their substance of choice. The crisis worker can assess the situation, identify the individual’s understanding of the situation and ability to interact, and make a choice regarding what action to take or get input from the individual regarding how to handle the situation. If an individual is incapable of making an informed decision as to how to handle the crisis, it is up to the professional crisis interventionists to decide whether the situation warrants an immediate resolution and to take appropriate action. If the person is a danger to themselves or others, a professional mental health worker has a duty to notify the authorities regarding the situation.

A comprehensive approach that expands on the ABC model includes 10 stages:

1. Assess for danger. In the first step, it is important for the crisis interventionist to assess the potential for danger occurring to the individual in the crisis, other individuals, or the crisis interventionist.
2. Consider the potential mechanisms of danger or injury. If there is a potential for injury, the interventionist should note the potential mechanisms in the current situation that can potentially produce injury or danger.
3. Assess the person’s level of responsiveness. Next, the interventionist should evaluate the subject’s ability to respond, interact, and proceed accordingly.
4. Assess and treat. Identify and attend to any current medical needs.
5. Make a thorough observation of the person for any signs of trauma or potential traumatic stress issues.
6. The crisis interventionist should introduce themselves and develop rapport with the person.
7. Build rapport. Continue to develop rapport throughout the interaction.
8. Provide support. Use empathetic listening techniques. This involves using reflection, asking questions, and acknowledging the person’s feelings and their current state of affairs.
9. Categorize the person’s feelings, stress level, and coping style. Help to normalize the situation.
10. Bring the person back to the moment. Attempt to bring the person into the present by acknowledging that the trauma was in the past and discuss how the person will respond in the future. Refer the person to treatment if needed (most likely, referring for treatment will occur in nearly every instance). Finally, the intervention specialist is to bring the person to the present, describe future events, and provide referrals as needed.

 

Crises intervention models are designed to assist individuals who are experiencing stressful events that are taxing or overwhelming their coping mechanisms. Individuals with substance use disorders often have a reduced capacity to deal with stress and traumatic events. The models of crisis intervention described above should only be attempted by trained professional mental health workers. In situations where there is no mental health worker present and there is a particular crisis that involves substance abuse, there are a couple of general rules that can be followed.

In applying crisis management to individuals with substance use disorders, the nature of the crisis needs to be identified before any other intervention can be implemented. If the crisis involves an individual who is intoxicated and performing potentially dangerous or hazardous behaviors that can affect themselves or others, it is important to remove the individual from the situation. If necessary, get help to restrain them, and get them into an environment, such as a hospital emergency department, where they can be allowed to stabilize.

Individuals who are under the influence of drugs or alcohol and behaving in a manner that suggests they are emotionally distraught should be restrained from injuring themselves or others and should also be transported to a safe situation, such as a hospital emergency department, inpatient drug clinic, or some other appropriate venue. It is often most prudent to notify local law enforcement officers or emergency medical response teams in these instances for assistance. In this situation, it is important to be firm with the individual, establish control by using eye contact and directly speaking to them, and attempt to calm them down. One must remain calm if they wish to calm down another person. If possible, speak to the person in a slow, monotone, even voice, and be deliberate and direct.

In the case of an individual with a substance use disorder who is neglecting the care of minors or elderly individuals or abusing these individuals, it is extremely important to stabilize the situation as soon as possible. Professional mental health workers are bound by law to notify the authorities of these types of instances.

In the case of performing a crisis intervention to get an individual into treatment for their substance use disorder, the actual process involved with depend on the level of danger that exists to the subject or to others around them. It may be necessary to immediately remove the person from the situation if there is a potential for serious harm to occur to someone, or it may be prudent to wait until the individual is no longer under the influence of drugs or alcohol to discuss treatment with them.