Transcript CRAFT - Georgia School of Addiction Studies

CRAFT
Community Reinforcement and Family
Training
Created & Developed by
Robert J. Meyers, Ph.D.
Power Point program developed by
Robert J. Meyers, Ph.D.
& Jane Ellen Smith, Ph.D.
Department of Psychology, University of New Mexico
& Center on Alcoholism Substance Abuse and other Addictions (CASAA),
University of New Mexico, &
Robert J. Meyers, Ph.D. & Associates
Alphabet Soup
CRAFT
CRA
CSO
IP
Engagement
Community Reinforcement
and Family Training
Community Reinforcement
Approach
Concerned Significant Other
Identified Patient
(the substance user)
Entering Treatment
Rationale 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?
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?
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 CSOs
1. Research has shown that family
members can successfully learn
techniques to engage their substanceabusing loved ones into treatment.
We cannot emphasize this enough!
Ten 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 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 CSOs
4. You have as many tries as you want.
Relationships are a process; they exist over
time. One event or discussion rarely defines
an entire relationship, so you have as many
tries at improving your relationship as you
wish to take. CRAFT is designed move at
the pace you choose, you are in control.
People can be helped at any time.
Ten 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.
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 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 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 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 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 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
the National Institute on
Alcohol Abuse and Alcoholism
Traditional Interventions for
CSOs
12-Step Programs
Johnson Institute Intervention
Mental Health Counseling
Nothing
CRAFT Randomized Alcohol Study
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 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 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 Demographics
Mean age
47
Years of education
14
Females (%)
91
Anglos (%)
52
Hispanic (%)
39
Prior Al-Anon (%)
58
CRAFT (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?)
NIDA
Funded by grants from the
National Institute on Drug
Abuse
CRAFT Demonstration Project
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 Study
Meyers, Miller, Smith, & Tonigan (2002)
90 CSOs randomly assigned:
• CRAFT
• CRAFT + Aftercare
• Al-Nar/FT
CSO Demographics
•
•
•
•
88% female
49% Hispanic
Mean Age: 46 yrs.
Relationship to IPs:
– 53% parents
– 29% spouses
– 18% other (sister, grandfather)
Treatment 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 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)
• 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 STUDIES
sson &
zrin
986
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
SelfDirected
4 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
lcohol
Alcohol
55%
Cocaine
22%
opiates
37% Coca
35% MJ
16% Stim
8% opiate
MJ
MJ
Cocaine
Alcohol
Stimulants
Alcohol
90%
Cocaine
7%
Drugs/Alco
hol
andomized
Randomized
Randomized
NonRandomized
Randomized
Non-
Non-
Randomized
Randomized
Craft in
Group vs
SelfDirected
74%
CSOs
Better
65.5% vs
29%
CSOs
Better
71%
CSOs
Better
55%-65%
CSOs
Better
CRAFT vs
2 Step)
(CRAFT/JI
/12-step
(CRAFT vs
12-step)
6% vs
%
SOs
etter
64%
vs23%
vs13%
CSOs
Better
74% vs
17%
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