CRAFT

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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

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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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What is CRAFT?

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

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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.

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Ten Basic Messages for CSOs

• Research has shown that family members can
  successfully learn techniques to engage their
  substance-abusing loved ones into treatment.
• We cannot emphasize this enough!

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Ten Basic Messages for CSOs

• You are not alone.
• As isolated as you may feel as you cope
  with your loved ones 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 doesnt lessen your pain, you
  may take hope from knowing that many have
  solved their problems and learned to live more
  satisfying lives.

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Ten Basic Messages for CSOs

• 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.

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Ten Basic Messages for CSOs

• 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.

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Ten Basic Messages for CSOs

• 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 ones
  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.

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Helping Yourself Helps.

• 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.

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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.

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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.

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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.

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CRAFTS 3 MAJOR GOALS

• Reduce loved ones harmful substance use
• Engage loved one into treatment
• Improve the functioning of CSO
• (emotional, physical, relationships)

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Things to Be Thinking about Right from the Start

• Always be on the lookout for engagement
  opportunities

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Basic Questions to Consider

• CSOs 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?

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NIAAA

• Funded in part by a grant from the National
  Institute on Alcohol Abuse and Alcoholism

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Traditional Interventions for CSOs

• 12-Step Programs
• Johnson Institute Intervention
• Mental Health Counseling
• Nothing

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CRAFT Randomized Alcohol StudyMiller, Meyers,
Tonigan (1999)

• 130 CSOs randomly assigned
• Al-Anon Facilitation Therapy (AFT)
• Johnson Institute Therapy (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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CSO Demographics
Mean age 47
Years of education 14
Females () 91
Anglos () 52
Hispanic () 39
Prior Al-Anon () 58
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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?)

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NIDA

• Funded by grants from the National Institute on
  Drug Abuse

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CRAFT Demonstration ProjectMeyers, Miller, Hill,
Tonigan (1999)

• CSOs family/friends of 62 treatment -
• refusing illicit drug users

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IP Drug of Choice (CSO report)

• Cocaine 37
• Marijuana 35
• Stimulants 16
• Opiates 8
• Sedatives/ 3
• Tranquilizers

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CSO Demographics
Gender Gender
Females 97 Males 3
Ethnicity Ethnicity
White 47 Hispanic 48 Other 5 White 47 Hispanic 48 Other 5
Age Age
Range 18 to 73 Mean 44.7
Relationship to IP Relationship to IP
Spouse 34 Parent 56
Sibling 6 Child 4
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Engagement 74 (46/62) of the resistant drug
abusers entered treatment
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CRAFT Randomized Drug StudyMeyers, Miller,
Smith, Tonigan (2002)

• 90 CSOs randomly assigned
• CRAFT
• CRAFT Aftercare
• Al-Nar/FT

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CSO Demographics

• 88 female
• 49 Hispanic
• Mean Age 46 yrs.
• Relationship to IPs
• 53 parents
• 29 spouses
• 18 other (sister, grandfather)

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Treatment 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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More CRAFT Studies
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Kirby et al., (1999)

• 32 CSOs
• CRAFT or 12-step program
• 56 spouses of IPs, 38 parents of IPs
• 75 Anglo, 23 African American
• IPs drug of choice 56 cocaine, 22 heroin
• CRAFT engaged 64, 12-step 17
• CSOs improved functioning overall

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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

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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

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CRAFT STUDIES
Sisson 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
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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