Community Reinforcement and Family Training (CRAFT) Model
In the past, there have been few options to help those who are concerned about a loved ones drinking or drug use. Alcohol and drug programs tend to focus most all the attention on the user. CRAFT, on the other hand, gives help first to those who are frustrated with trying to get their loved one or friend into treatment. We call this person a CSO, or a Concerned Significant Other. CSO’s can be anybody – a spouse, a mother, a brother, a sister – just about anybody. If you have cared about someone that you believe drinks or drugs too much, you might be a concerned significant other. You have done all you know how to do – pour the bottle down the drain, nag, and plead with the person to get help. Some give up and leave; some have stayed many years in a relationship that has led to discouragement and despair. Others have watched some of their loved ones die due to drinking or drugging.
CRAFT teaches those who have loved ones how to get the drinker or drug user into treatment who has formerly been resistant to getting help. In addition, CRAFT has been shown to reduce anxiety and depressive symptoms for CSO’s. That’s good news – learning how to get your loved one into treatment, and be able to help yourself at the same time.
In CRAFT the therapist uses a cognitive-behavioral approach to teach the concerned significant other how to use behavioral principles to reduce the loved one’s substance use and to encourage the user to seek treatment. Additionally, it assists the concerned significant other in alleviating other types of stress and in introducing meaningful reinforcers into his or her own life. Specific components of this intervention will include:
1. Teaching the significant other to recognize the potential for domestic violence as behavioral changes are introduced at home, and introducing precautions to reduce the risk of harm to self and others.
2. Utilizing a functional analysis to outline the substance user’s triggers for using alcohol and/or drugs as well as the consequences. The latter includes the significant other’s coping responses.
3. Motivating the significant other to make some difficult changes through reminders about the specific reasons for starting treatment in the first place, and the potential gains.
4. Demonstrating more effective ways to communicate with the substance-using loved-one.
5. Teaching the appropriate use of positive and negative reinforcement to discourage harmful using behavior.
6. Providing instruction in how to reduce other types of stress that are experienced by the significant other, and in how to introduce meaningful “rewards” into their own life.
7. Preparing the significant others to suggest treatment at the most appropriate time and in a manner that is most likely to succeed.
8. Arranging to have treatment available at the time the decision is made to enter therapy, and preparing the significant other to support the substance user during treatment.
Studies have shown that approximately 60-80% of CSO’s get their resistant substance abuser into treatment. Both the concerned significant other as well as the substance user has had an average of about 7 out of 12 sessions. From our SAMHSA grant between January 2001 and April 2004, we engaged approximately 6.5 – 6.8 loved ones out of 10. This was not a clinical trial, but a demonstration project. For more information regarding our project, call (505) 438-0010 and ask for Raymond Anderson. Training in CRAFT from the Life Link Training Institute