Principal Investigator: William R. Miller, Ph.D.
Co Investigator: Robert J. Meyers, Ph.D.
Funding Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Dependence (NIDA)
CRAFT is a treatment approach developed by Dr. Robert J. Meyers, as a way of helping concerned significant others (CSOs) who call concerned about the alcohol/drug use of a loved one who refuses to seek treatment. Although conventional practice includes several approaches for helping such CSOs, research in this area has been sparse, and the outcomes of these interventions are unknown. Dramatically different counseling strategies follow from various approaches already in practice, sometimes leading to seemingly inconsistent recommendations (e.g., intervene vs. detach). Little is known regarding the nature and determinants of outcomes with Al-Anon, the most widely-used source of support for CSOs.
In an NIAAA-funded trial (Miller, Meyers & Tonigan, 1999), we randomly assigned 130 CSOs to receive (1) Al-Anon Facilitation Therapy, (2) a Johnson Institute intervention, or (3) CRAFT, all equated for intensity of treatment (12 hours). We studied outcomes of these unilateral interventions in terms of the rate of engagement of the identified patient (IP) in treatment, overall CSO functioning, IP substance use, and the IP-CSO relationship. All three interventions resulted in substantial and similar improvements in CSO functioning throughout a year of follow-up, regardless of whether or not the IP was engaged in treatment. The rates of treatment engagement, however, were significantly different across conditions. When the CSO was given Al-Anon Facilitation Therapy, only 13% of IPs entered treatment. The comparable figures were 30% with the Johnson intervention, and 64% with CRAFT. Treatment engagement occurred, on average, after 4-6 sessions of CRAFT counseling. As CSOs, parents had a higher rate of engaging the IP in treatment, as compared with spouses.
We next completed a NIDA Phase 1 feasibility trial (Meyers et al., 1999), testing CRAFT with the CSOs who were concerned about illicit drug use in a loved one who refused treatment. In this uncontrolled trial, 74% of IPs entered treatment, and again CSOs themselves showed significant improvement in depression, anxiety, anger, and physical symptoms. Parents again had a higher rate of IP engagement, as compared with spouses.
This led to a randomized trial, funded by NIDA (Meyers et al., in press), to compare CRAFT with Twelve-Step (Al-Anon/Nar-Anon) Facilitation Therapy. Half of the CRAFT CSOs were further randomized to receive or not receive weekly CRAFT aftercare group sessions for up to 6 months. CSOs had a 6-month window within which to engage their IP in treatment. Significantly more IPs were engaged in treatment when their CSO was given CRAFT (67%) as compared with Al-Anon/Nar-Anon Facilitation Therapy (31%). Assignment to the CSO aftercare group did not increase IP treatment engagement. In all conditions, CSOs showed similar and substantial improvement throughout a year of follow-up in mood states, social functioning, and physical symptoms.
Further analyses have indicated that when CSOs are assigned to CRAFT, their IP?s substance use declines even if the IP is not engaged in formal treatment. No such change was observed when CSOs were assigned to Al-Anon Facilitation.
In sum, family members are not powerless to influence their loved ones? treatment seeking and substance use. Encouraging involvement in 12-Step support groups appears to be helpful to CSOs themselves, but (consistent with the powerlessness beliefs promoted in Al-Anon) is unlikely to result in treatment engage or behavior change for the IP. CRAFT results in the same degree of improvement in CSO functioning, and also yields a substantially higher rate of successful IP engagement in treatment, and may promote IP behavior change even without treatment.
References:
Co Investigator: Robert J. Meyers, Ph.D.
Funding Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Dependence (NIDA)
CRAFT is a treatment approach developed by Dr. Robert J. Meyers, as a way of helping concerned significant others (CSOs) who call concerned about the alcohol/drug use of a loved one who refuses to seek treatment. Although conventional practice includes several approaches for helping such CSOs, research in this area has been sparse, and the outcomes of these interventions are unknown. Dramatically different counseling strategies follow from various approaches already in practice, sometimes leading to seemingly inconsistent recommendations (e.g., intervene vs. detach). Little is known regarding the nature and determinants of outcomes with Al-Anon, the most widely-used source of support for CSOs.
In an NIAAA-funded trial (Miller, Meyers & Tonigan, 1999), we randomly assigned 130 CSOs to receive (1) Al-Anon Facilitation Therapy, (2) a Johnson Institute intervention, or (3) CRAFT, all equated for intensity of treatment (12 hours). We studied outcomes of these unilateral interventions in terms of the rate of engagement of the identified patient (IP) in treatment, overall CSO functioning, IP substance use, and the IP-CSO relationship. All three interventions resulted in substantial and similar improvements in CSO functioning throughout a year of follow-up, regardless of whether or not the IP was engaged in treatment. The rates of treatment engagement, however, were significantly different across conditions. When the CSO was given Al-Anon Facilitation Therapy, only 13% of IPs entered treatment. The comparable figures were 30% with the Johnson intervention, and 64% with CRAFT. Treatment engagement occurred, on average, after 4-6 sessions of CRAFT counseling. As CSOs, parents had a higher rate of engaging the IP in treatment, as compared with spouses.
We next completed a NIDA Phase 1 feasibility trial (Meyers et al., 1999), testing CRAFT with the CSOs who were concerned about illicit drug use in a loved one who refused treatment. In this uncontrolled trial, 74% of IPs entered treatment, and again CSOs themselves showed significant improvement in depression, anxiety, anger, and physical symptoms. Parents again had a higher rate of IP engagement, as compared with spouses.
This led to a randomized trial, funded by NIDA (Meyers et al., in press), to compare CRAFT with Twelve-Step (Al-Anon/Nar-Anon) Facilitation Therapy. Half of the CRAFT CSOs were further randomized to receive or not receive weekly CRAFT aftercare group sessions for up to 6 months. CSOs had a 6-month window within which to engage their IP in treatment. Significantly more IPs were engaged in treatment when their CSO was given CRAFT (67%) as compared with Al-Anon/Nar-Anon Facilitation Therapy (31%). Assignment to the CSO aftercare group did not increase IP treatment engagement. In all conditions, CSOs showed similar and substantial improvement throughout a year of follow-up in mood states, social functioning, and physical symptoms.
Further analyses have indicated that when CSOs are assigned to CRAFT, their IP?s substance use declines even if the IP is not engaged in formal treatment. No such change was observed when CSOs were assigned to Al-Anon Facilitation.
In sum, family members are not powerless to influence their loved ones? treatment seeking and substance use. Encouraging involvement in 12-Step support groups appears to be helpful to CSOs themselves, but (consistent with the powerlessness beliefs promoted in Al-Anon) is unlikely to result in treatment engage or behavior change for the IP. CRAFT results in the same degree of improvement in CSO functioning, and also yields a substantially higher rate of successful IP engagement in treatment, and may promote IP behavior change even without treatment.
References:
- Meyers, R. J., Miller, W. R., Hill, D. E., & Tonigan, J. S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10(3), 1-18.
- Meyers, R. J., Miller, W. R., Smith, J. E., & Tonigan, J. S. (in press). A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others. Journal of Consulting and Clinical Psychology.
- Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688-697.
