Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment

Abstract

Although motivation for drug abuse treatment is a substantial problem, unilateral intervention through concerned significant others (CSOs) represents a promising method for engaging unmotivated individuals. The Community Reinforcement and Family Training (CRAFT) program, based on principles of reinforcement, was developed for this specific purpose. In Phase I, CSOs received the CRAFT intervention, whereby they were taught skills for modifying a loved one's drug-using behavior and for enhancing treatment engagement. CSOs were evaluated at 3 and 6 months. In Phase II, engaged drug users received treatment using the Community Reinforcement Approach (CRA). A total of 62 CSOs participated in this evaluation of the effectiveness of CRAFT. CSOs completed, on average, 87% of offered treatment sessions. During the 6-month study period, 74% succeeded in engaging their resistant loved one in treatment. Reported abstinence both from illicit drugs and alcohol increased significantly for drug users engaged in treatment, but not for unengaged cases. All CSOs showed significant reductions in depression, anxiety, anger, and physical symptoms, with average scores dropping into the normal range on all measures. CRAFT provides a promising alternative to confrontational and detachment approaches in counseling CSOs to help their loved ones.

Engaging resistant adolescents in drug abuse treatment

“…One promising approach for engaging treatment-elusive youth is the CRAFT intervention, a unilateral family treatment approach specifically designed to aid family members or concerned significant others (CSOs) in modifying the behavior of initially unmotivated adult drug and alcohol abusers and engaging them in treatment (Kirby et al, 1999;Meyers et al, 1999;Miller et al, 1999). CRAFT, recommended in recent reviews of the engagement literature Stanton & Heath, 2004), is an outgrowth of work by Azrin and his colleagues (Azrin, Sisson, Meyers, & Godley, 1982;Sisson & Azrin, 1986) and later adapted by Meyers and Miller and their colleagues Miller et al, 1999) for use with adult substance users refusing treatment.…”

“…A number of adult studies have demonstrated the potential of the family as a route for engaging treatment-resistant individuals with substance abuse or dependence (Garrett et al, 1997;Kirby, Marlowe, Festinger, Garvey, & LaMonaca, 1999;Marlowe, Merikle, Kirby, Festinger, & McLellan, 2001;Meyers, Miller, Hill, & Tonigan, 1999;. According to Marlowe et al (1996), substance abusers reported that family members exerted substantially more influence over their decision to enter treatment than other sources of influence, including legal pressures exerted by court-mandated treatment.…”

The Community Reinforcement Approach: History and New Directions

“…The uncontrolled pilot project (N = 62) demonstrated a 74% IP engagement rate for CRAFT-trained CSOs (Meyers, Miller, Hill, & Tonigan, 1999). A study by Kirby and colleagues randomly assigned 32 CSOs either to CRAFT or a 12-step intervention (Kirby et al, 1999).…”

Effectiveness of Community Reinforcement and Family Training (CRAFT) on Quality of Life and Depression in Families with Drug Abuse

“…Results showed the effectiveness of the two methods in improving the quality of life but both CRAFT and Nar-Anon were not effective in reducing the depression of family members of substance abusers This is consistent with the results of the improving the quality of life and inconsistent with the studies by Christo and Sutton (1994), Meyers et al (1998), Miller et al (1999, Richter et al (2000), Gilachen (2006) and Kanz (2009). They showed that people who participated in CRAFT and Nar-Anon showed higher interest in life and decreased depression, anxiety, hostility, improved physical and mental health compared to those who did not participate.…”