How To Get Your Loved One Sober: An Evidence Based Intervention

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How To Get Your Loved One Sober An Evidence
Based Intervention

• Robert J. Meyers, Ph.D.
• Research Associate Professor in Psychology,
  Clinical Research Branch, Center on Alcoholism,
  Substance Abuse Addictions (CASAA), University
  of N. M.

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CRAFT

• Community Reinforcement and Family Training
• Created 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

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Alphabet Soup

• CRAFT Community Reinforcement and Family
  Training
• CRA Community Reinforcement
• Approach
• CSO Concerned Significant Other
• IP Identified Patient
• (the substance user)
• Engagement Entering Treatment

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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.)

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130 CSOs randomly assigned to 1 of 3 interventions

• Al-Anon Facilitation Therapy (AFT)
• Johnson Institute Intervention (JII)
• Community Reinforcement and Family Training
  (CRAFT)

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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.

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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.

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CRAFT

• 12-sessions (1 hr each)
• Purpose
• Empower CSO to influence change
• Train CSO in behavior change skills
• Improve CSOs quality of life
• Prepare CSO for treatment engagement
• Supervisor Robert J. Meyers, Ph.D.

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Characteristics of CSOs
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CRAFT D1

• The Demonstration Project
• Meyers, Miller, Hill,
• Tonigan (1999)

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Engagement 74 (46/62) of the resistant drug
abusers entered treatment.
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CRAFT - D2Treatment Engagement

• CRAFT 59
• CRAFT aftercare 77 combined 67
• Al-Nar/FT 29
• 3 group comparison p lt.0006
• no difference between 2 CRAFT conditions

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CRAFT STUDIES
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Conclusions

• You can raise the bottom!
• Initially unmotivated/resistant problem
  drinkers/drug users can be engaged in treatment
  through CRAFT-trained CSOs

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More Conclusions

• CSO functioning improves regardless of engagement
  status
• Primary reason for failure of the Johnson
  Institute approach Unwillingness of the family
  to proceed with the confrontation

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CRAFT Procedures

• Motivational Focus
• Domestic Violence Precautions
• Functional Analysis of IPs Using Behavior
• Communication Training
• Use of Positive Reinforcement

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CRAFT Procedures

• Time Out from Positive Reinforcement
• Natural Consequences for Using
• Reinforcers for the CSO
• Suggestion of Treatment to the User
• Rapid Intake

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CRAFT Program Description for CSO

• 3 Major Goals
• reduce loved ones harmful drinking
• engage loved one into treatment
• improve the functioning of CSO
• (emotional, physical, relationship)

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CRAFT Induction

• Client focused
• Positive reinforcement
• Clarify assessment information
• Begin to establish reinforcers
• Describe the Program What is expected

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Initial Meeting Motivational Strategies

• Let the CSO express frustration with IPs
  substance abuse
• Have CSO describe problems created by the
  drinking/drug use
• Show empathy and support build rapport
• Demonstrate an understanding of the problem

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Initial Meeting Motivational Strategies

• Explore CSOs past attempts to help stop the
  substance abuse
• Begin to identify problem areas
• Present positive expectations - build hope
• Place responsibility where it belongs
• Discuss confidentiality and safety
• Review the assessment material

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CRAFT Treatment

• Domestic Violence PrecautionsAssess the
  Presence of Violence
• Assess Level of Social Support
• Develop a Protection Plan
• Open expression of feelings in session
• Recognition of triggers or Red Flags to
• violence
• Developing safer Red Flag responses
• Advocacy and referral

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Drinking/Using Road Map The Functional Analysis

• CSOs wealth of information
• CSOs behavior is worth examining
• Identify triggers for the drinking/using
• Describe the drinking/using behavior
• List the consequences the IP experiences for
  alcohol/drug use

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CRAFT Treatment

• Communication Training
• Role-Playing
• Use of Positive Reinforcement
• Enabling vs. Positive Reinforcement
• Time Out from Positive Reinforcement The Big
  Chill
• Problem Solving

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CRAFT Treatment

• Identifying the Natural Consequences for Using
• Allowing the Natural Consequences for Using
• Increasing the CSOs Quality of Life Finding CSO
  Reinforcers
• get by with a little help from my friends

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Suggestion of Treatment Overview

• Prepare for Rapid Intake (for IP to be seen
  within 24-48 hrs.)
• Role-play the conversation (use positive
  communication)
• Include important motivational hooks
• Discuss windows of opportunity

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Basic Questions to Consider

• CSOs past engagement attempts that have been the
  most successful?
• Time, place, day the IP is most approachable
  about requests in general?
• Most likely reason the IP would enter treatment
  (for the relationship, kids, to keep his/her
  job)?
• Most influential person to talk with IP about
  treatment?

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Motivational Hooks

• Ask IP to informally meet CSOs therapist
• Mention having ones own (a different) therapist
• Invite IP to sample treatment
• State that the IP wont have to do anything
  he/she doesnt want to
• Explain that theres no confrontation/judgment
• Mention that IP can focus on topics besides just
  alcohol/drugs (e.g., job, depression)
• Tie in IPs reinforcers

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Windows of Opportunity

• Is IP approachable when feeling remorseful for a
  drug-related crisis?
• Is IP acting upset upon overhearing a negative
  remark about his substance use?
• Is IP asking about whats happening in the CSOs
  therapy?
• Is IP inquiring about why the CSOs behavior has
  changed lately?

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For further information on CRAFT

• Email bmeyers_at_unm.edu
• Web page http//robertjmeyersphd.com
• Phone [phone] UNM
• Phone [phone] RJM Assoc.