A protocol to empower family members: Robert J. Meyers discusses the effective elements of the CRAFT model.
Meyers had been involved in the evolution of CRA, 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, PhD, then began a collaboration on the first CRA project, which led to the creation of the research division of the Center on Alcoholism, Substance Abuse, and Addictions at the university. This collaboration also led to a number of randomized clinical trials of CRA, from which evidence of effectiveness has catapulted the approach into the top ranks of evidence-based programs.
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, 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, 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. 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 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 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. 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. 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, 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, 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. 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 Associates, LLP, a New Mexico organization of psychologists providing clinical services, research, training, and consultation to health and behavioral health providers. Hester is the developer of the award-winning Drinker's Check-Up program (www.drinkerscheckup.com). His e-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: 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
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|Author:||Hester, Reid K.|
|Date:||Sep 1, 2007|
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