Community Reinforcement and
Family Training (CRAFT)
Science and Management of Addiction
Frank 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
[email protected]
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 CSOs
75% Anglo;
23% AA
62 CSOs
80%
Hispanic
90 CSOs
88% female;
49%
Hispanic
42 CSOs 48%
Hispanic 48%
Anglo
Alcohol
Alcohol
56%
Cocaine
22% Opiate
37%
Cocaine
35%
Marijuana
16%
Stimulants
8% Opiates
Marijuana
Cocaine
Stimulants
Marijuana
Alcohol
Randomized
(CRAFT /
12-step)
Randomized
(CRAFT / JI /
Al-Anon)
Randomized
(CRAFT /
12-step)
Non randomized
Randomized
(CRAFT / AlAnon)
Non-randomized
86% vs 0%
CSOs
better
64% vs 23%
vs 13%
CSOs better
74% vs 17%
CSOs better
74%
67% vs 29%
CSOs better
71%
CSOs better
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 nondrinking (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 Skills
Rationale
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
time we spend together
as a family seems like
a waste.
* Don’t you know I’m a
complete wreck when it’s
after midnight and you’re
not home?
I really have fun with you;
we all do, when you’re
clean and sober.
* You never lift a ^@#%*!
finger around here!
I know you’re busy, but it
would mean a lot to me
if you could help clean
out the garage Saturday.
I appreciate it when
you let me know in
advance that you’re
going to be late.
(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!
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CRAFT - Washington Association of Alcoholism and Addiction