A protocol to empower family members: Robert J. Meyers discusses the effective elements of the CRAFT model.
Robert J. Meyers, PhD, is a clinical psychologist and researcher who has been involved in developing and evaluating treatment protocols for people with addictions for 30 years. He and I first met when we were working on a randomized clinical trial randomized clinical trial,
n a clinical study where volunteer participants with comparable characteristics are randomly assigned to different test groups to compare the efficacy of therapies. of the Community Reinforcement reinforcement /re·in·force·ment/ (-in-fors´ment) in behavioral science, the presentation of a stimulus following a response that increases the frequency of subsequent responses, whether positive to desirable events, or Approach with heroin addicts in 1988. We have been colleagues and friends ever since.
Meyers had been involved in the evolution of CRA See Community Reinvestment Act. , an approach that uses environmental reinforcers to assist individuals in the recovery process, since its creation in the 1970s by prominent behavioral researcher Nate Azrin. After working in clinical and research settings for eight years, Meyers was recruited by the University of New Mexico's Alcohol and Drug Division as a program director. He and William Miller William Miller or Bill Miller may refer to (items are alphabetized according to the word in boldface): Australia
But Meyers wasn't content to rest on his laurels. Because his father was a heavy drinker who never received treatment, Meyers had a keen personal interest in developing a protocol for family members of alcoholics and addicts who refused to get treatment. He would not accept that family members are powerless to influence a drinker or addict Any individual who habitually uses any narcotic drug so as to endanger the public morals, health, safety, or welfare, or who is so drawn to the use of such narcotic drugs as to have lost the power of self-control with reference to his or her drug use. , so he got to thinking.
Part of CRA is couples or family therapy designed to positively reinforce sobriety on the drinker's part. Meyers saw that spouses and family members had a big influence in this way. So why not focus these positive strategies to motivate the drinker to get into treatment in the first place? This began what has come to be known as the Community Reinforcement Approach and Family Training (CRAFT). I interviewed Meyers about his work in this area.
Bob, what, in a nutshell nut·shell
The shell enclosing the meat of a nut.
in a nutshell
In a few words; concisely: Just give me the facts in a nutshell.
Adv. 1. , is CRAFT?
The CRAFT protocol helps concerned significant others (CSOs) learn new ways to interact with their substance-abusing loved one with the goal of reinforcing sober behaviors and not responding to using behaviors. The ultimate goal is to motivate the person to change his/her drinking or drug use and get into treatment.
How effective is CRAFT?
Randomized clinical trials of CRAFT have consistently found that CSOs are successful in getting their treatment-resistant loved one into treatment 65 to 75% of the time. These studies were done with "real-world" populations of severely dependent drinkers and drug abusers drug abuser n → chi fa uso di droghe . In comparisons with the Johnson Institute "intervention" approach, CRAFT had significantly higher success rates in getting treatment-resistant individuals into treatment. (1)
What sort of positive impact does it have on the concerned significant others?
CSOs were less anxious and less depressed and had fewer stress-related physical problems compared to their functioning when they entered CRAFT. These positive changes occurred regardless of whether they were successful in getting their substance-abusing loved one into treatment.
What are the principles that give CSOs hope and a sense of empowerment? What do they need to know?
* Your love has power. Research has shown that family members can be taught techniques to successfully engage their substance-abusing loved ones loved ones npl → seres mpl queridos
loved ones npl → proches mpl et amis chers
loved ones love npl into life-altering treatment. This is where the CRAFT program comes in. (2)
* You are not alone. As isolated as you may feel as you cope with your loved one's 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 doesn't lessen less·en
v. less·ened, less·en·ing, less·ens
1. To make less; reduce.
2. Archaic To make little of; belittle.
To become less; decrease. your pain, you may take hope from knowing that many have "solved" their problems and learned to live more satisfying lives. You can too.
* You can catch more flies with honey than vinegar vinegar, sour liquid consisting mainly of acetic acid and water, produced by the action of bacteria on dilute solutions of ethyl alcohol derived from previous yeast fermentation. . Just as it is easier to attract flies with sweet honey than sour vinegar, it is easier to get your loved one to listen to your loving words than your criticism. And this is more than simply one of those supposedly wise old sayings; it is proven by research! So choose the honey alternative to nagging and threatening and help your loved one move toward sobriety by talking about what you do like about him or her and what positive changes please you.
* You have as many tries as you wish to take. Relationships are a process--they exist over time. One event or discussion rarely defines an entire relationship, so the truth is that you probably have as many tries at improving your relationship as you wish to take. As you work on developing alternative ways to interact with your loved one, take heart when things go well, but do not be overly discouraged when they go poorly. The next word, the next day, the next interaction gives you another chance to make a positive change.
* You can live a happier life whether or not your loved one sobers up. In a perfect world, you will successfully encourage your loved one to sober up Verb 1. sober up - become sober after excessive alcohol consumption; "Keep him in bed until he sobers up"
become, get, go - enter or assume a certain state or condition; "He became annoyed when he heard the bad news"; "It must be getting more serious"; . In the real world, this often happens, and sometimes it does not. Whether or not your loved one's lifestyle improves, you can enhance yours. An important part of CRAFT is learning to take care of yourself, regardless of your loved one's behavior. Get Your Loved One Sober: Alternatives to Nagging, Pleading Asking a court to grant relief. The formal presentation of claims and defenses by parties to a lawsuit. The specific papers by which the allegations of parties to a lawsuit are presented in proper form; specifically the complaint of a plaintiff and the answer of a defendant plus any , and Threatening (3) teaches you how to do that and feel good about it.
What are some of the things you ask CSOs to remember while they're working this program?
* You have alternatives. No matter the nature of the problem, it can only go one of three ways. It can get worse, it can stay the same, or it can get better. Odds are that if you change nothing, your loved one's drinking or drug use will continue to get worse, or at best stay the same. On the other hand, if you choose to learn alternatives to nagging, pleading, and threatening, you can help the problem to get better. So the choice is yours--if you want a better life, go for it!
* Small steps carry you long distances. Although it may sometimes feel like right now is not soon enough for change to happen, small steps can make a huge difference in relationships. When taking those steps, think about when the best time to make your move is and what small change would be most likely to have a positive outcome. Keep your safety, and those for whom you are responsible, at the forefront of your mind. Small carefully timed changes will carry you the farthest.
* Emotions are fluid. When you are frustrated frus·trate
tr.v. frus·trat·ed, frus·trat·ing, frus·trates
a. To prevent from accomplishing a purpose or fulfilling a desire; thwart: , hurt, angry, and exhausted, remind yourself that these feelings are reactions to current situations. As you change the way you interact with your loved one, the situation changes and so these feelings dissipate dis·si·pate
v. dis·si·pat·ed, dis·si·pat·ing, dis·si·pates
1. To drive away; disperse.
2. . As you adopt alternative ways of addressing his or her substance abuse, your emotional pain will gradually transform into feelings of confidence and hope.
* Asking for help is a good thing. Humans are communal beings. We thrive best when we work together and share our experiences and our abilities. As you strive to enhance the quality of your life and help your loved one, turn to the people who love you and turn to the people who have learned to deal with similar problems. Ask for help, accept help, and breathe a sigh of relief as things get better.
* Patience pays. Family problems usually do not develop overnight and seldom go away in a single day. Take small steps and remind yourself that change takes time and if you patiently invest that time, your efforts will be rewarded with a happier future.
Reid K. Hester, PhD, is Director of the Research Division at Behavior Therapy behavior therapy or behavior modification, in psychology, treatment of human behavioral disorders through the reinforcement of acceptable behavior and suppression of undesirable behavior. Associates, LLP LLP - Lower Layer Protocol , a New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). organization of psychologists providing clinical services, research, training, and consultation to health and behavioral health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or providers. Hester is the developer of the award-winning Drinker's Check-Up program (www.drinkerscheckup.com). His e-mail address See Internet address.
e-mail address - electronic mail address is firstname.lastname@example.org. For more information about the Community Reinforcement Approach or about CRAFT, visit www.robertjmeyersphd.com.
1. Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three intervention strategies. J Consult Clin Psychol 1999;67:688-97.
2. Hoffman J, Froemke S (eds). Addiction: Why Can't They Just Stop? New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. : Rodale Books; 2007.
3. Meyers RJ, Wolfe BL. Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. Center City, Minn.: Hazelden Publishing; 2004.
BY REID K. HESTER, PHD