A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification

Abstract

Background Detoxification with psychosocial counseling remains a standard opioid-use disorder treatment practice but is associated with poor outcomes. This study tested the efficacy of a newly-developed psychosocial intervention, Community Reinforcement Approach and Family Training for Treatment Retention (CRAFT-T), relative to psychosocial treatment as usual (TAU), for improving treatment outcomes. Methods A randomized, 14-week trial with follow-up visits at 6 and 9 months post-randomization conducted at two substance use disorder (SUD) treatment programs. Opioid-dependent adults (i.e., identified patient - IP) enrolled in a residential buprenorphine-detoxification program and their identified concerned significant other (CSO) were randomized to CRAFT-T (n=28 dyads) or TAU (n=24 dyads). CRAFT-T consisted of 2 sessions with the IP and CSO together and 10 with the CSO alone, over 14 weeks. TAU for the CSOs was primarily educational and referral to self-help. All IPs received treatment as usually provided by the SUD program in which they were enrolled. The primary outcome was time to first IP drop from treatment lasting 30 days or more. Opioid and other drug use were key secondary outcomes. Results CRAFT-T resulted in a moderate but non-significant effect on treatment retention (p = 0.058, hazard ratio = 0.57). When the CSO was parental family, CRAFT-T had a large and significant effect on treatment retention (p < 0.01, hazard ratio = .040). CRAFT-T had a significant positive effect on IP opioid and other drug use (p<0.0001). Conclusion CRAFT-T is a promising treatment for opioid use disorder but replication is needed to confirm these results.

Feasibility of a Supportive Other Intervention for Opiate-Dependent Patients Entering Inpatient Detoxification

“…Results from the current study are promising for SO interventions insofar as the majority of patients were able to name an SO who was not using opioids, and described their SO as being supportive of and willing to participate in recovery efforts. Most SOs were immediate family members or partners, suggesting emotionally close relationships, and validating reliance on partners and family members as the designated SO’s in previous interventions (Ino & Hayasida 2000; O’Farrell et al 2008; O’Farrell et al 2008; Brigham et al 2014). Most patients described regular and frequent contact with SO’s, indicating that both the emotional and logistical support of SO’s was accessible for many patients.…”

“…The only previous study of SO interventions targeting aftercare among opioid users examined an intensive family treatment called Community Reinforcement and Family Training (CRAFT; (Brigham et al 2014). CRAFT works with SOs (defined in this study as relatives or partners that live with or plan to live with the identified patient after randomization) to encourage treatment-resistant individuals with substance use disorders to engage in aftercare (Meyers, Smith & Miller 1998; Kirby et al 1999; Miller, Meyers & Tonigan 1999; Meyers, Smith & Lash 2003; Meyers, Roozen & Smith 2011; Brigham et al 2014).…”

“…CRAFT works with SOs (defined in this study as relatives or partners that live with or plan to live with the identified patient after randomization) to encourage treatment-resistant individuals with substance use disorders to engage in aftercare (Meyers, Smith & Miller 1998; Kirby et al 1999; Miller, Meyers & Tonigan 1999; Meyers, Smith & Lash 2003; Meyers, Roozen & Smith 2011; Brigham et al 2014). CRAFT involved 12 weeks of hour-long meetings, with the first 2 sessions involving the dyad, and the final 10 involving the SO alone.…”

“…Despite preliminary data supporting the value of involving SO’s in substance treatment more generally (Klostermann & Fals-Stewart 2008), and more specifically in the utility of engaging SO’s to enhance aftercare treatment following detoxification (Ino & Hayasida 2000; O’Farrell et al 2007; Brigham et al 2014; Timko et al 2015), no survey data exist regarding the proportion of patients in opiate detoxification who are able and willing to involve SO’s during opioid detox so as to promote long-term abstinence. Further, existing studies do not directly examine reasons for disinterest or dropout.…”

When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids

“…The study by Brigham et al (2014) was a pilot study in the context of detoxification and the Marsch et al (2014) study in methadone treatment found that replacing some in-person counseling sessions with computerized counseling was superior to standard methadone and hence did not provide evidence that addin g psychosocial treatment improves outcomes. Finally, the study by Ruetsch et al (2012) had only a 66% follow-up rate at 12 months and no urine testing data.…”