CRAFTCRAFTCommunity Reinforcement and Family Community Reinforcement and Family

TrainingTraining

Created & Developed byCreated & Developed by Robert J. Meyers, Ph.D.Robert J. Meyers, Ph.D.

Power Point program developed by Power Point program developed by Robert J. Meyers, Ph.D.Robert J. Meyers, Ph.D.

& Jane Ellen Smith, Ph.D.& Jane Ellen Smith, Ph.D.

Department of Psychology, University of New Mexico Department of Psychology, University of New Mexico & Center on Alcoholism Substance Abuse and other Addictions (CASAA), & Center on Alcoholism Substance Abuse and other Addictions (CASAA),

University of New Mexico, & University of New Mexico, & Robert J. Meyers, Ph.D. & AssociatesRobert J. Meyers, Ph.D. & Associates

Alphabet SoupAlphabet SoupCRAFT Community Reinforcement

and Family Training

CRA Community Reinforcement

Approach

CSO Concerned Significant Other

IP Identified Patient

(the substance user)

Engagement Entering Treatment

Rationale for Working with CSOsRationale for Working with CSOs

• Substance abusers often report that family pressure prompted treatment seeking

• CSOs can influence substance abusers’ behavior due to extensive contact

• CRA has always viewed CSOs as crucial collaborators

• CSOs also need help (victims of violence, verbal assaults, $ problems, marital conflict, etc. etc. etc.)

What is CRAFT?What is CRAFT?

The Community Reinforcement and Family Training (CRAFT) program, works to change the patient’s environment to make a non-substance using lifestyle more rewarding than one focused on using alcohol or other drugs.

What is CRAFT?What is CRAFT?

In the CRAFT model, concerned significant others (CSOs) are the focus of the therapy instead of the substance abuser. CSOs receive training to change their interactions with the substance using person, reducing their enabling behaviors and improving their communications strategies.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

1. Research has shown that family members can successfully learn techniques to engage their substance-abusing loved ones into treatment.

We cannot emphasize this enough!

Ten Basic Messages for CSOsTen Basic Messages for CSOs

2. You are not alone. As isolated as you may feel as you cope with

your loved one’s substance abuse, the fact is that you are not alone. Millions of families are at this very moment suffering from problems just like yours. Although knowing that others suffer certainly doesn’t lessen your pain, you may take hope from knowing that many have “solved” their problems and learned to live more satisfying lives.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

3. You can catch more flies with honey than vinegar.

Research has shown that it is easier to get your loved one to listen to loving words than to criticism. So choose ways to discuss about what you do like about him or her and what positive changes please you.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

4. You have as many tries as you want.Relationships are a process; they exist overtime. One event or discussion rarely definesan entire relationship, so you have as manytries at improving your relationship as youwish to take. CRAFT is designed move atthe pace you choose, you are in control.People can be helped at any time.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

5. You can live a happier life whether or not your loved one becomes abstinent.

An important part of CRAFT is learning to take care of yourself, regardless of your loved one’s behavior. Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening (Meyers & Wolfe, 2004) teaches you how to do that and feel good about it.

Helping Yourself Helps.Helping Yourself Helps.

6. When you help yourself you help

your family.

You become a positive role-model for the whole family.

Your resilience upbeat and healthy attitude can be infectious, in a good way.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

• 7. Neither you or your loved one are crazy. All people have problems and substance misuse is just that a problem.

• You did not cause it, your loved one did not set out to be an abuser, and problems have solutions.

Ten Basic Messages for CSOsTen Basic Messages for CSOs

• 8. The world is not black and white. Most problems vary in degree and difficulty. One should think of changing a bad habit in successive approximations. Change may be easier for an individual if they have more than one option.

Labels do more harm than goodLabels do more harm than good

9. Scientific studies have shown that labels Addict, Alcoholic) are a major barrier to people seeking help for substance use.

10. You have nothing to lose and a lot to gain by getting involved.

CRAFT’S 3 MAJOR GOALSCRAFT’S 3 MAJOR GOALS

• Reduce loved one’s harmful substance use

• Engage loved one into treatment

• Improve the functioning of CSO

(emotional, physical, relationships)

Things to Be Thinking about Right from the Start

Always be on the lookout for engagement opportunities………

Basic Questions to ConsiderBasic Questions to Consider

• CSO’s most successful past engagement attempts?

• Best time/place/day to approach the IP with requests in general?

• Most likely reason the IP would enter treatment (for the relationship, the kids, to keep his/her job)?

• Most influential person to talk with the IP about treatment?

NIAAA

Funded in part by a grant from Funded in part by a grant from the National Institute on the National Institute on

Alcohol Abuse and AlcoholismAlcohol Abuse and Alcoholism

Traditional Interventions for Traditional Interventions for CSOsCSOs

12-Step Programs

Johnson Institute Intervention

Mental Health Counseling

Nothing

CRAFT Randomized Alcohol StudyCRAFT Randomized Alcohol StudyMiller, Meyers, & Tonigan (1999)Miller, Meyers, & Tonigan (1999)

130 CSOs randomly assigned:

• Al-Anon Facilitation Therapy (AFT)

• Johnson Institute Therapy (JII)

• Community Reinforcement and Family Training (CRAFT)

Al-Anon Facilitation TherapyAl-Anon Facilitation Therapy

• 12 sessions (1 hr each)

• Purpose:

-get CSO to attend Al-Anon mtgs

-help CSO accept powerlessness

-emphasize detachment & self-care

Supervisor: Joseph Nowinski, Ph.D.

Johnson Institute InterventionJohnson Institute Intervention

• 6 sessions (2 hrs each)

• 4 sessions of preparation and training

• 1 family confrontation meeting

• 1 post-intervention evaluation

Supervisor: A. Lane Leekman, M.D.

CRAFT• 12-sessions (1 hr each)• Purpose:

– Empower CSO to influence change– Train CSO in behavior change skills– Improve CSO’s quality of life– Prepare CSO for treatment engagement

Supervisor: Robert J. Meyers, Ph.D.

CSO DemographicsCSO Demographics

Mean age 47

Years of education 14

Females (%) 91

Anglos (%) 52

Hispanic (%) 39

Prior Al-Anon (%) 58

CRAFT (alcohol) ConclusionsCRAFT (alcohol) Conclusions

• Problem drinkers who are initially unmotivated for change can be engaged in treatment through “unilateral family therapy” with CSOs

• Parents of adult children are particularly effective (An overlooked resource for engaging problem drinkers?)

NIDANIDAFunded by grants from the Funded by grants from the National Institute on Drug National Institute on Drug

Abuse Abuse

CRAFT Demonstration ProjectCRAFT Demonstration ProjectMeyers, Miller, Hill, & Tonigan (1999)Meyers, Miller, Hill, & Tonigan (1999)

CSOs: family/friends of 62 treatment -

refusing illicit drug users

IP Drug of Choice (CSO report)

• Cocaine = 37%

• Marijuana = 35%

• Stimulants = 16%

• Opiates = 8%

• Sedatives/ = 3%

Tranquilizers

CSO Demographics

Gender:

Females = 97% Males = 3%

Ethnicity:

White = 47% Hispanic = 48% Other = 5%

Age:

Range = 18 to 73 Mean = 44.7

Relationship to IP:

Spouse = 34% Parent = 56%

Sibling = 6% Child = 4%

Engagement

74% (46/62) of the resistant drug abusers entered treatment

CRAFT Randomized Drug StudyCRAFT Randomized Drug StudyMeyers, Miller, Smith, & Tonigan (2002)Meyers, Miller, Smith, & Tonigan (2002)

90 CSOs randomly assigned:

• CRAFT

• CRAFT + Aftercare

• Al-Nar/FT

CSO DemographicsCSO Demographics

• 88% female

• 49% Hispanic

• Mean Age: 46 yrs.

• Relationship to IPs: – 53% parents– 29% spouses– 18% other (sister, grandfather)

Treatment EngagementTreatment Engagement

CRAFT 59%

CRAFT + aftercare 77% [combined 67%]

Al-Nar/FT 29%

3 group comparison p <.0006– no difference between 2 CRAFT conditions

More CRAFT StudiesMore CRAFT Studies

Kirby et al., (1999)

• 32 CSOs

• CRAFT or 12-step program

• 56% spouses of IPs, 38% parents of IPs

• 75% Anglo, 23% African American

• IP’s drug of choice: 56% cocaine, 22% heroin

• CRAFT engaged 64%, 12-step 17%

• CSOs improved functioning overall

Waldron et al. (2007)

• CSOs = 42 parents/caregivers of drug abusing adolescents

• 2 parent households = 49%

• IPs: 79% Male

• 74% used cannabis

• Engagement rate = 71%

Dutcher et al. (2009)Dutcher et al. (2009)

• Study conducted in a Santa Fe, NM community agency

• Few exclusionary criteria• 99 CSOs• 59% Hispanic• IPs’ Drug of choice: 90% alcohol; 7%

cocaine• Engagement rates: 55-65%

CRAFT STUDIESCRAFT STUDIESSisson & Azrin

1986

Miller, Meyers, et al., 1999

Kirby, et al.,

1999

Meyers, Miller, et al., 1999

Meyers, Miller, et al., 2002

Waldron, et. al., 2007

adolescent

Dutcher, et al., 1999

Manual, et al.,2012 Group vs Self-Directed

14 CSOs 130 CSOs 32 CSOs

75% Anglo 23% AA

62 CSOs 80% Hispanic

90 CSOs 49% Hispanic

42 CSOs 48% Hispanic

99 CSOs

59% Hispanic

40 CSOs

60% Anglo

Alcohol Alcohol 55% Cocaine 22% opiates

37% Coca 35% MJ 16% Stim 8% opiate

MJ

Cocaine

Stimulants

MJ

Alcohol

Alcohol 90% Cocaine 7%

Drugs/Alcohol

Randomized

(CRAFT vs 12 Step)

Randomized

(CRAFT/JI

/12-step

Randomized

(CRAFT vs 12-step)

Non-Randomized

Randomized Non-Randomized

Non-Randomized

Craft in Group vs Self-Directed

86% vs 0%

CSOs Better

64% vs23% vs13%

CSOs Better

74% vs 17%

CSOs

Better

74%

CSOs

Better

65.5% vs 29%

CSOs

Better

71%

CSOs

Better

55%-65%

CSOs

Better

60% -71%

Vs 40%

Better

New CRAFT Adaptations• CRAFT in Groups• CRAFT with Gambling Problems• CRAFT with a family member CSO) who

already has IP (USER) in treatment• CRAFT with returning war veterans with PTSD &

SUD• CRAFT groups on the internet

(Smart Recovery)• CRAFT with adolescent (CSO) for Parent