Community Reinforcement and Family Training (CRAFT)

Purpose

Increase family compliance with an intervention for persons with substance abuse in order to increase the rate of engagement of those addicted individuals in treatment

Strategy

The specific procedures involved in CRAFT include motivation building, functional analysis, contingency management training, communication skills training, treatment entry training, immediate treatment entry, life enrichment, and safety training:

Target Population

Family members of persons who abuse alcohol or drugs

Research Outcomes

Alcohol Abusers Intervention
CRAFTSisson and Azrin (1986) recruited 12 adult women with an alcoholic husband, brother, or father and randomly assigned them either to an early version of CRAFT or to a traditional intervention. Results indicated that CRAFT was considerably more successful in getting the persons with substance abuse into treatment and reducing their alcohol consumption in comparison to the Al-Anon group. Miller et al. (1999) conducted a controlled comparison of CRAFT, the Johnson Intervention, and Al-Anon facilitation (TSF) that randomized 130 caregivers of problem drinkers to receive 12 hours of contact in one of the three conditions. CRAFT and TSF had better retention than the Johnson Intervention. Consistent with previous studies, participants tended to drop out of the latter intervention in order to avoid the family confrontation with the drinker. The CRAFT intervention also engaged substantially more drinkers into treatment (64% vs 23% Johnson and 13% TSF).

Drug Abusers Intervention
Kirby et al. (1999) randomly assigned 32 caregivers of drug users to CRAFT or a 12-step self-help group (TSG). Caregivers who were assigned to CRAFT attended more sessions than those in TSG and were more likely to complete a full course of counseling during which the persons abusing drugs were far more likely to enter treatment (64% vs 17%). Reductions in drug use occurred during the study, but there was no group x time interaction. Meyers et al. (2002) replicated and extended those findings with drug users with similar positive effects on engagement of the drug abusing family members in treatment.

Outcomes Research References

Kirby, K.C., Marlowe, D.B., Festinger, D.S., Garvey, K.A., & LaMonaca, V. (1999). Community reinforcement training for family and significant others of drug abusers: A unilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence, 56(1), 85-96.

Meyers, R.J. & Wolfe, B.L. (2004). Get Your Loved One Sober: Alternatives to nagging, pleading and threatening. Hazelden Publishing & Educational Services: Center City MN.

Miller, W.R., Meyers, R.J., & Tonigan, J. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting & Clinical Psychology, 67(5), 688-697.

Copello, A., Templeton, L., Orford, J., Velleman, R., Patel, A., et al., (2009). The relative efficacy of two levels of a primary care intervention for family members affected by the addiction problem of a close relative: a randomized trial. Addiction, 104, 49-58.

Clinical Approaches References

Smith, J.E. & Meyers, R.J. (2004): Motivating Substance Abusers to Enter Treatment: Working with Family Members, Guilford Press: New York, NY.

Meyers, R.J. & Wolfe, B.L. (2004): Get Your Loved One Sober: Alternatives to nagging, pleading and threatening, Hazelden Publishing & Educational Services, Center City MN.

Meyers, R.J., (Author), & Yu, J. (Director) (2007): “Getting an Addict into Treatment: The CRAFT Approach” [television series episode]. In J. Hoffman & S. Froemke (Producers), The HBO Addiction Series; Why Can’t They Stop? HBO New York, New York.