Community Reinforcement and Family Training (CRAFT)

Science and Management of AddictionFrank Couch, MA, LMFT, CDP, NCACI

Beth Meyer, MA, LMFT, CDPT

CRAFT

• This presentation is given with the permission of Dr. Robert J. Meyers, PhD, co-creator of Community Reinforcement and Family Training (CRAFT)

• For more information visit:• http://robertjmeyersphd.com/

Upcoming CRAFT training!

• Dr. Meyers is conducting a full 2.5 day CRAFT training in Houston Texas on June 23rd, 24th, & 25th, 2014. For further information please contact: Tammy Samour, MS, LPC, LCDC Direct: 281-407-0777 ts@aodresource.com

Role of the Family

• Why do families need support?• How do you or your agency currently

support families?• What are challenges in working with

families?• Resources working with families

Community Reinforcement and Family Training• Terms

• CSO – concerned significant other• IP – Identified patient (substance user)

• History• Not many options for family support• Al-Anon, Johnson Institute Intervention,

Changes support group, mental health counseling, nothing

12 Step Programs (Al-Anon, Nar-Anon)• Loving detachment• Acceptance of CSO’s inability to control

IP’s behavior• Group support for CSO

Johnson Institute Intervention

• Only 29% of CSO’s complete the training

• Of that 29% only 24% engage in treatment

(Lipman et al 1989)

Changes Parent Support Network

• Peer support• “Tough Love” model• Action steps

Why use CRAFT?

• Because It works…

• HBO Addictions series video

Sisson & Azrin, 1986

Miller, Meyers, et al 1999

Kirby, et al.,1999

Meyers, Miller, et al, 1999

Meyers, Miller, et al,2002

Waldron, et al,. 2007

14 CSOs 130 CSOs 32 CSOs75% Anglo; 23% AA

62 CSOs80% Hispanic

90 CSOs88% female; 49% Hispanic

42 CSOs 48% Hispanic 48% Anglo

Alcohol Alcohol 56% Cocaine 22% Opiate

37% Cocaine35% Marijuana16% Stimulants8% Opiates

MarijuanaCocaineStimulants

Marijuana Alcohol

Randomized(CRAFT / 12-step)

Randomized(CRAFT / JI / Al-Anon)

Randomized(CRAFT / 12-step)

Non -randomized

Randomized(CRAFT / Al-Anon)

Non-randomized

86% vs 0%CSOsbetter

64% vs 23% vs 13%CSOs better

74% vs 17%CSOs better

74%

CSOs better

67% vs 29%CSOs better

71% CSOs better

CRAFT: 3 Goals

• Reduce loved one’s harmful substance use

• Engage loved one into treatment• Improve the functioning of CSO

• Emotional• Physical• Relationships

CRAFT Program Description for the CSO• Problem focused• Skills based• Active during sessions (role play)• Active between sessions (assignments)

Rapport Building Across Sessions• Always remember to:

• Use empathy• Reinforce attendance• Stop the blaming• Re-label negative behavior• Emphasize family & adolescent strengths;

aspects of the family life that are going well

CRAFT’s Principles

• Eliminate positive reinforcement for drinking and/or using behavior

• Enhance positive reinforcement for non-drinking (sober) and non-using (clean) behavior

Positive Reinforcement vs Enabling• Enabling: something the CSO does that

increases drinking/drug using behavior or allows it to continue

• CRAFT’s Positive Reinforcement: something the CSO does that increases non-drinking/non-drug using (pro-social) behavior

Daily Reminder To Be Nice

1. Did you express appreciation to your adolescent today?

2. Did you compliment your adolescent today?3. Did you give your adolescent any pleasant

surprises today?4. Did you express affection to your adolescent

today?5. Did you initiate a pleasant conversation

today?6. Did you offer to help your adolescent today?

Benefits of Group Therapy: Support• CSOs can discuss their difficulty in

trying to carry out certain CRAFT procedures

• CSOs can congratulate each other for making important changes

• CSOs can share resentment about having to work so hard in CRAFT

Benefits of Group Therapy: Skills Practice Arena• Opportunities for sharing of ideas/

brainstorming• Chance to practice with “real world”

cases• Opportunities for feedback from others

in similar situations

Benefits of Group Therapy: Modeling• Learn from successes and failures of

CSOs• Hear how others manage strong

reactions from their adolescents• Observe how others manage their own

strong emotions• Witness examples of others continuing

to try despite setbacks

Group # 1: Communication Skills(Overview)(1) Offer rationale(2) Describe positive communication

components(3) Generate adolescent examples(4) Role Play(5) Do a reverse role play(6) Assign homework

(1) Communication SkillsRationale Why bother working on communication?• More likely to get what you want• Positive communication is “contagious”• Will open door to more satisfaction in

other life areas as well (social support)• Positive communication is the

foundation for other CRAFT procedures

(2) Positive Communication Components: PIUS• P = say it in a positive way and say

what you want as opposed to what you don’t want.

• I = start with an “I” statement and express a feeling.

• U = offer an understanding statement• S = share the responsibility or offer to

help

(3) Negative to Positive Examples: Words Matter* When you’re high, the I really have fun with you; time we spend together we all do, when you’re as a family seems like clean and sober. a waste. * Don’t you know I’m a I appreciate it when complete wreck when it’s you let me know in after midnight and you’re advance that you’re not home? going to be late.

* You never lift a ^@#%*! I know you’re busy, but itfinger around here! would mean a lot to me

if you could help clean out the garage

Saturday.

(4) Role-Playing Guidelines

• Acknowledge discomfort• Use less difficult scenes first• Get adequate description of the scene• Start it for them• Keep it brief (2-3 minutes)• Reinforce any effort• Get CSO’s reactions• Offer supportive, specific feedback• Repeat, repeat, repeat

(5) Reverse Role-Play

• Advantages:• Serves as a good starting point for a

CSO who is reluctant to do a role-play• Allows therapist to model good

positive communication• Helps CSO develop empathy for

adolescent

(6) Assign Homework

• Practice Communication Skills in a conversation with adolescent over _________ issue on ____ (day/time)

• Use Daily Reminder To Be Nice

Remaining Sessions

(2) Proven ways to help your child stay sober

(3) Goal setting guidelines(4) Functional analysis part 1(5) Functional analysis part 2(6) Problem solving task

Remaining Sessions cont’d

(7) Happiness scale and personal goal setting

(8) Components of supporting sober/clean behavior

(9) Natural Consequences(10) Relapse prevention

CRAFT: 3 Goals

• Reduce loved one’s harmful substance use

• Engage loved one into treatment• Improve the functioning of CSO

• Emotional• Physical• Relationships

Thank you!