Community reinforcement approach and family training

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Community reinforcement approach and family training (abbr. CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning (also called contingency management) techniques to assist those with addictions live healthily. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." [1] CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to commence and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Contents

Overview

CRA treatment is time-limited, [2] meaning that it typically involves a specified number of sessions, such as 16, or a time frame, like one year, which is determined early in the therapy process. [3]

This approach aims to increase the likelihood that substance users who are resistant to treatment will seek help, while also enhancing the well-being of their concerned family members. [1] [2] CRAFT promotes the use of healthy rewards to encourage positive behaviors and focuses on supporting both the substance user and their family. [4]

Adolescent community reinforcement approach (A-CRA) adapts CRA specifically for adolescents facing substance use issues and their caregivers. [1]

Description

CRAFT is a motivational model of family therapy. [5] It is reward-based [5] —that is, based on positive reinforcement. CRAFT is aimed at the families and friends of treatment-refusing individuals who have a substance use disorder. [5] "CRAFT works to affect [influence] the substance users' behavior by changing the way the family interacts with them." [5]

"CRAFT grew out of the understanding that although individuals who truly need help with substance use problems often are strongly opposed to treatment. On the other hand, the concerned significant others (CSOs) of the people who use substances are commonly highly motivated to get help for them." [2]

In the model, the following key terms are used:

Three goals

When a loved one is abusing substances and refusing to get help, CRAFT is designed to help families learn practical and effective ways to accomplish three goals:

  1. Move their loved one toward treatment,
  2. Reduce their loved one's alcohol and drug use
  3. Simultaneously improve their own lives. [5]

Family influence

Robert J. Meyers, PhD wrote about the influence that concerned family members have in treatment of the substance user, and the benefits for themselves:

The Community Reinforcement Approach and Family Training (CRAFT) intervention ... method was developed with the belief that since family members can, and do make important contribution[s] in other areas of addiction treatment (i.e. family and couples therapy), that the CSO can play a powerful role in helping to engage the substance user who is in denial to submit to treatment. In addition, it is often the substance user who reports that family pressure or influence is the reason [they] sought treatment. Also, CSOs who attend the CRAFT program also benefit by becoming more independent and reducing their depression, anxiety and anger symptoms even if their loved one does not enter treatment. [6]

CRA procedures

The following CRA procedures and descriptions are from Meyers, Roozen, and Smith for the substance user: [1] : 382–384 

  1. Functional Analysis of Substance
    • Explore the antecedents of a client's substance use.
    • Explore the positive and negative consequences of a client's substance use.
  2. Sobriety Sampling
    • A gentle movement toward long-term abstinence that begins with a client's agreement to sample a time-limited period of abstinence.
  3. CRA Treatment Plan
    • Establish meaningful, objective goals in client-selected areas.
    • Establish highly specified methods for obtaining those goals.
    • Tools: Happiness Scale, and Goals of Counseling form.
  4. Behavior Skills Training
    • Teach three basic skills through instruction and role-playing:
    1. Problem-solving
      • Break overwhelming problems into smaller ones.
      • Address smaller problems.
    2. Communication skills
      • A positive interaction style
    3. Drink/drug refusal training
      • Identify high-risk situations.
      • Teach assertiveness.
  5. Job Skills Training
    • Provide basic steps for obtaining and keeping a valued job.
  6. Social and Recreational Counseling
    • Provide opportunities to sample new social and recreational activities.
  7. Relapse Prevention
    • Teach clients how to identify high-risk situations.
    • Teach clients how to anticipate and cope with a relapse.
  8. Relationship Counseling
    • Improve the interaction between the client and his or her partner.

Communication

Dr. Bob Meyers:
Family Communication

Interviewer: "So, if you can, explain [to] us a little bit about how the CRAFT technique works. What's it all about?"

Dr. Bob Meyers: "Well, the CRAFT technique is a process. We bring in a family member, and what we do is we teach them how to interact differently with the drinker or the drug user. Instead of yelling and screaming when they're using drugs, we tell them to kind of just stay away from them, leave that person alone. But, then when they're sober—when they're not using drugs—we talk to them ... to tell them how much you love them, how much you care about them, how important they are to the family, and we try to help them pick their spots: when do you talk to them, when do you stay away from them.

"So, it takes a little bit of time, but we've been very successful here, being funded by the National Institutes of Health through the University of New Mexico to run a couple of scientific studies, where we've actually proven that my CRAFT intervention is much more powerful than anything that is used out there currently." [7]

From an online news clip by KRQE News at Robert J. Meyers, PhD: "CRAFT Video Clip".

With CRAFT, families/friends (CSOs) are trained in various strategies, including positive reinforcement, various communication skills, and natural consequences. "One of the big pieces that has a lot of influence over all the other strategies is positive communication. [8] "There are seven steps in the CRAFT model for implementing positive communication strategies." [8]

  1. Be Brief
  2. Be Positive
  3. Refer to Specific Behaviors
  4. Label your Feelings
  5. Offer an Understanding Statement – For example, "I appreciate that you have these concerns, ... [or] I understand that you really want to talk right now, and that this feels urgent, ... [or] I would love to be there for you." [9]
  6. Accept Partial Responsibility – This step "is really designed to decrease defensiveness on the part of your loved one. ... It's not about accepting responsibility for things you are not responsible for. ... [Rather, it's to] direct you towards the piece that you can own for yourself. ... [For example, ] what you can take responsibility for are the ways that you communicate," etc. [9]
  7. Offer to Help

"The overarching goals for the strategies for communicating are to help decrease defensiveness on the part of the loved one that you are speaking to, and increase the chances that your message is really going to be heard—so, increasing the ability that you have to really get across the message that you want." [8] In fact, the title of Robert J. Meyers' and Brenda L. Wolfe's book based on CRAFT is, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. [10]

"Consequences being in place is really important and helpful in terms of communicating your message, but it's also really important, maybe even more so, to be consistent in following through with those consequences and rewards." [8]

A Conversation:
Engaging v. Detaching

Dr. Nicole Kosanke: "Of course, all of us get to the point of frustration, ... it's pretty hard not to if you're dealing with a situation like this with your child. So, at times, yes, you're going to be frustrated and put your hands up. But, as a general rule, staying engaged and managing your feelings, asking people for help, asking people to give feedback directly to [your child]—all of that communicates a sense of engagement, rather than detaching. And, it also communicates a sense of love and caring for your child, which ultimately — even when you're detaching — that's what you have inside, and that's a real ingredient for helping impact someone [to] change."

Dr. Josh King: "I would say this [engagement] is almost the opposite of detaching. ... [Detachment] is either you can give them the feedback or not [as if] the best thing you can do is step away, which I don't agree with. I think when you step away, you have no impact on the ability to make change."

Dr. Nicole Kosanke: "In [the example] situation, you're also inviting the community to have an impact on your child. CRAFT stands for 'Community Reinforcement and Family Training.' It's the community that we're really talking about. We're talking about the community having an impact on your child in a global sense. [The ultimate goal is] to impact that person's motivation in a more healthy direction." [11]

From an online video by cmc: Center for Motivation and Change at YouTube: "Negative Consequences vs Detaching".

The "Hitting Bottom" Myth

[It is one of the myths that] no one enters treatment until they "hit bottom" so using CRAFT while your loved one is still functioning is a waste of time.

People enter treatment when the reasons not to use outweigh the reasons to use. And as research has clearly shown, family members can help shift the balance so that the [substance] user develops enough reasons to stop. [4]

From Robert J. Meyers, PhD, "CRAFT: An Alternative to Intervention".

Compatibility

CRA can be combined with other treatment methods. For example, ... CRA has recently [in 1999] been combined with motivational interviewing to form an integrated treatment. Similarly, CRA is consistent with involvement in 12-step programs. [12]

From William R. Miller, PhD, et al. "The Community-Reinforcement Approach" published in the Alcohol Research and Health journal by NIAAA .

CRAFT view

Motivation & Abstinence

Even the most extreme "disease model" programs that profess solely neurochemical origins of addiction ultimately rely upon the client's volitional abstinence (Milam & Ketcham, 1981). [13]

Studies in the 1960s clearly demonstrated that even chronically dependent drinkers with access to alcohol could regulate their drinking given sufficient incentives to do so, at least under controlled laboratory conditions (Heather & Robertson, 1983). [13]

To say that choice is involved in addictive behavior [does not ...] say that it is only a matter of choice. [13]

From William Miller, PhD, "Toward a Motivational Definition and Understanding of Addiction".

Although the majority of medical and legal professional bodies such as the World Health Organization, American Medical Association and the American Bar Association all state that alcoholism is a disease that is demonstrated by brain abnormalities, contrary assessments exist. Dr. Gene Heyman [14] and others assert alcoholism is not a progressive, incurable disease. See disease theory of alcoholism for a full discussion. The diagnostic assessment of alcoholism in someone can include an assessment of co-morbidity with conditions such as mental illness, and domestic violence.

From SMART Recovery, section: Family & Friends:

The work of Robert Meyers' CRAFT Community Reinforcement Approach and Family Training program ... differs significantly from Al-Anon in that it is a behavioral program which advocates that the CSO [Concerned Significant Other] can have a positive impact on the person using substances. The CRAFT program has been demonstrated in Meyers' research to be more effective than the Vernon Johnson type intervention or Al-Anon, with less negative side-effects and better outcomes, whether or not the person using substances enters treatment. [15] [16]

The CRAFT program uses a variety of interventions based on functional assessment including a module to prevent domestic violence.

Intervention

"There are questions about the long-term effectiveness of interventions for those addicted to drugs or alcohol. A study examining addicts who had undergone a classic intervention, known as the Johnson Intervention, found that they had a higher relapse rate than any other method of referral to outpatient Alcohol and Other Drug treatment". [17]

Smith, Campos-Melady and Meyers describe the Johnson intervention as uncomfortable for many CSOs:

“The Al-Anon approach's emphasis upon detaching from the substance abuser is unappealing to many CSOs. On the other end of the spectrum is the Johnson Institute Intervention: a "surprise party" in which the IP is confronted by family members and a therapist with the objective of getting the IP to enter treatment. When the intervention is actually carried out, it often results in a high rate of engagement in treatment, and yet only a small number of CSOs who begin the program ever follow through with the intervention (Liepman, Nirenberg, & Begin, 1989; Miller et al., 1999), and many report feeling uncomfortable with its confrontational nature” (Barber & Gilbertson, 1997). [2]

Research suggests that CRAFT has had greater success than the Johnson Intervention method or Al-Anon/Alateen as far as engaging loved ones in treatment, though the goal of Al-Anon and Alateen is not to work on the person with substance abuse issues, but to help the person impacted by someone else's substance abuse. [18]

Development

Robert J. Meyers, the psychologist who developed the CRAFT approach to alcoholism, wrote in an introduction to one of his books that "although my mother was blessed by the support and comfort she found in Al-Anon meetings, she was never able to achieve her most cherished goals of getting my father into treatment and getting him to stay sober". [19] Witnessing this as a child inspired Meyer to seek an approach that was more effective for people with those goals. The origin of CRAFT:

“Drs. Robert J. Meyers and Jane Ellen Smith of the University of New Mexico developed the CRAFT program to teach families how to impact their loved one while avoiding both detachment and confrontation, the respective strategies of Al-Anon (a 12-Step based approach), and traditional (Johnson Institute-style) interventions in which the substance user is confronted by family members and friends during a surprise meeting. While all three approaches have been found to improve family members' functioning and relationship satisfaction, CRAFT has proven to be significantly more effective in engaging loved ones in comparison to the Johnson Institute Intervention or Al-Anon/Nar-Anon facilitation therapy.” [20]

Having worked with Nathan Azrin in the early 1970s whilst Azrin was developing the community reinforcement approach, Meyers started to look into using the process in other settings. CRAFT combines CRA with family training, which equips the families and friends of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on loved ones.

CRA

The community reinforcement approach was developed by Nathan Azrin in the early 1970s and has considerable research supporting its effectiveness in working with addicts. [21] [22]

The community reinforcement approach (CRA) was "originally developed for individuals with alcohol use disorders, [but] has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning [a type of learning], CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use." [1]

CRA was designed by Nate Azrin in the early 1970s:

“The most influential behaviorist of all times, B. F. Skinner, largely considered punishment to be an ineffective method for modifying human behavior (Skinner 1974). Thus it was no surprise that, many years later, research discovered that substance use disorder treatments based on confrontation were largely ineffective in decreasing the use of alcohol and other substances (Miller and Wilbourne 2002, Miller et al. 1998). Nate Azrin already was convinced of this back in the early 1970s, when he designed an innovative treatment for alcohol problems: the Community Reinforcement Approach (CRA). Azrin believed that it was necessary to alter the environment in which people with alcohol problems live so that they received strong reinforcement for sober behavior from their community, including family, work, and friends. As part of this strategy, the program emphasizes helping clients discover new, enjoyable activities that do not revolve around alcohol, and teaching them the skills necessary for participating in those activities.” [1]

Community reinforcement has both efficacy and effectiveness data. [23] Started in the 1970s, community reinforcement approach is a comprehensive program using operant conditioning based on a functional assessment of a client's drinking behavior and the use of positive reinforcement and contingency management to achieve a goal of non-drinking. [24] When combined with disulfiram (a prescribed substance acting as Aversion therapy) community reinforcement was particularly effective. [25] A notable component of the program is the non-drinking club. [26] As of 2007, applications of community reinforcement to public policy has become a focus of study. [27]

"The Community Reinforcement Approach has also been found to be effective in outpatient setting. In one study, clients treated with CRA and the disulfiram compliance component were abstinent an average of 97% of the days during the last month of the 6-month followup, whereas clients treated with a combination of a 12-step program and the CRA disulfiram compliance training were abstinent an average of 74% of the days. For those clients who received a 12-step program and a prescription for disulfiram, an average of only 45% of the comparable days were abstinent (Azrin, Sisson, Meyers, & Godley, 1982)." [2] : 5 

Recent developments

As of 2009, CRAFT and CRA programs were not widespread amongst addiction counselors. The adoption of evidence-based treatments have been slow. [28] Instead, many addiction counselors were tied to a twelve-step model with less research support. The National Institute on Drug Abuse (NIDA), a federally funded organisation aiding scientific research into addiction has supported CRAFT intervention techniques among others. [29] In 2007, CRAFT was being used in 25 clinics in the United States. [30]

However CRAFT has been adopted by a number of commercial and self-help organisations in the United States. Meyers and the Treatment Research Institute (TRI) worked with Cadence Online to create a ParentCRAFT course where parents pay a one-off fee for a series of videos presenting the CRAFT process, aimed at teaching them skills to meet the risks of substance use in their adolescent children. An undisclosed “major share” [31] of the revenues goes to TRI. Meyer’s work was partially funded with a grant from NIDA [31] Allies in Recovery provides a series of videos, eBook, blog, live calls and other services to families of people with addiction based on the CRAFT method. The states of Massachusetts, Rhode Island, and Mississippi are providing free access for all residents to the Allies in Recovery service. [32] Based in Rhode Island, Resources Education Support Together (REST) is a peer-led mutual aid group that uses CRAFT and the Allies in Recovery service for its members. [33]

Research and outcomes

CRAFT vs. Alternatives

70% of people who use CRAFT are likely to get their loved into treatment as opposed to 30% of people using an intervention ... . And then, for Al-Anon, you've got like 12% of people getting their loved one into treatment. Now, that's sort of not a fair comparison because Al-Anon is not designed to get someone else to do something. Al-Anon is specifically designed to help the family member feel better, and that it does quite well, but in terms of influencing change in the loved one [—the substance user], not so well. And, the only reason to make those comparisons ... is simply because there are no other options in our society. So, if you go to a therapist or a clergyman or something and say "my kid is smoking too much pot, and I don't know what to do about it," they are going to send you to Al-Anon or a therapist, or talk to you about getting an intervention [not CRAFT]. So, those are the options [to CRAFT] we have in the world.

Dr. Nicole Kosanke in an online video by cmc: Center for Motivation and Change at YouTube: "Intro to CRAFT: CRAFT vs Alternatives ".

CRAFT compared with other approaches

An offshoot of the community reinforcement approach is the community reinforcement approach and family training. [21] This program is designed to help family members of people who use substances feel empowered to engage in treatment. Community reinforcement approach and family training (CRAFT) has helped family members to get their loved ones into treatment. [21] [34] The rates of success have varied somewhat by study but seem to cluster around 70%. [34] [35] [36] [37] CRAFT is one of the only family-aimed treatments with proven results for getting people with drug or alcohol problems into treatment. [34] The program uses a variety of interventions based on functional assessment including a module to prevent domestic violence. Partners are trained to use positive reinforcement, various communication skills and natural consequences.

Intervention for Alcohol Use

Results and Safety

On results: People who adopt [CRAFT] experience a variety of results. Some do indeed arrive at the point where they know that letting go is the only way of moving forward. [38]

On safety: As always, the most important objective is to remain safe. [39]

Drs. Robert J. Meyers and Brenda L. Wolfe, from Get Your Loved One Sober.

From an article on the American Psychological Association (APA) website about the success of CRAFT in substance use treatment and intervention, [40] these are the success outcomes for engaging drinkers into treatment:

  1. 64% – CRAFT
  2. 23% – Johnson Intervention
  3. 13% – Twelve-Step Facilitation (TSF)

Elsewhere Robert Meyers has clarified that Twelve-Step Facilitation used in the Miller et al’s comparative study of 130 caretakers of problem drinkers was a control group structured to “simulate the kind of care and guidance CSO’s would traditionally receive from attending Al-Anon meetings... treatments were delivered one-on-one and included up to 12 hours of therapy.” [19]

Sisson and Azrin (1986) recruited 12 adult women with an alcoholic husband, brother, or father and randomly assigned them either to an early version of CRAFT or to a traditional intervention. Results indicated that CRAFT was considerably more successful in getting the persons with substance abuse into treatment and reducing their alcohol consumption in comparison to the Al-Anon group. Miller et al. (1999) conducted a controlled comparison of CRAFT, the Johnson Intervention, and Al-Anon facilitation (TSF) that randomized 130 caregivers of problem drinkers to receive 12 hours of contact in one of the three conditions. CRAFT and TSF had better retention than the Johnson Intervention. Consistent with previous studies, participants tended to drop out of the latter intervention in order to avoid the family confrontation with the drinker. The CRAFT intervention also engaged substantially more drinkers into treatment (64% vs 23% Johnson and 13% TSF). [40]

CRAFT Comparison - Al-Anon and Johnson Intervention.png

Comparisons

One experiment compared the two psychotherapy approaches of CRAFT and Twelve-step facilitation therapies (TFT), (not to be confused with the 12-Step programs such as Al-Anon since TFT is a time-limited program intended to "simulate the type of support and guidance... traditionally receive[d] from attending Al-Anon meetings" [41] ) for their impacts on addicts seeking to enter treatment. The finding was that concerned significant others who participated in facilitation therapy engaged 29.0% of addicts into treatment, whereas those who went through CRAFT engaged 67.2%. [42] [43] Another study compared CRAFT, Al-Anon facilitation therapy and a Johnson intervention. The study found that all of these approaches were associated with similar improvements in the functioning of concerned significant others and improvements in their relationship quality with the addicts. However, the CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the facilitation therapy (13%) and Johnson interventions (30%). [44]

Intervention for Substance use

From the same article on the American Psychological Association (APA) website about the success of CRAFT in substance use treatment and intervention, [40] these are the success outcomes for persons abusing drugs to enter treatment (the success outcomes were nearly the same as the alcohol use disorder outcomes):

  1. 64% – CRAFT
  2. 17% – Caregivers' Twelve-step Group (TSG)

From the article:

Kirby et al. (1999) randomly assigned 32 caregivers of drug users to CRAFT or a 12-step self-help group (TSG). Caregivers who were assigned to CRAFT attended more sessions than those in TSG and were more likely to complete a full course of counseling during which the persons abusing drugs were far more likely to enter treatment (64% vs 17%). Reductions in drug use occurred during the study, but there was no group x time interaction. Meyers et al. (2002) replicated and extended those findings with drug users with similar positive effects on engagement of the drug abusing family members in treatment. [40]

Note: When the articles states "there was no group x time interaction," it simply means the CRAFT outcome (64%) and the TSF outcome (17%) remained the same over time, even though there was a reduction in drug use during the study. [45]

Parallel study

"In a parallel study sponsored by the National Institute on Drug Abuse that focused on people who use other substances, family members receiving CRAFT successfully engaged 74 percent of initially unmotivated drug users in treatment (Meyers et al. 1999)." [12]

Professional organizations

CRAFT is a model of clinical behavior analysis which is of interest to the following professional organisations.

  1. The Association for Behavior Analysis International (ABAI) has a special interest group in clinical behavior analysis. [46]
  2. The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, ABCT has a special interest group on addictions. [47]

See also

Related Research Articles

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Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

Communal reinforcement is a social phenomenon in which a concept or idea is repeatedly asserted in a community, regardless of whether sufficient empirical evidence has been presented to support it. Over time, the concept or idea is reinforced to become a strong belief in many people's minds, and may be regarded by the members of the community as fact. Often, the concept or idea may be further reinforced by publications in the mass media, books, or other means of communication. The phrase "millions of people can't all be wrong" is indicative of the common tendency to accept a communally reinforced idea without question, which often aids in the widespread acceptance of factoids. A very similar term to this term is community-reinforcement, which is a behavioral method to stop drug addiction.

<span class="mw-page-title-main">Drug rehabilitation</span> Processes of treatment for drug dependency

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and medical consequences that can be caused.

An intervention is an orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with a substance use disorder or some kind of traumatic event or crisis, or other serious problem. Intervention can also refer to the act of using a similar technique within a therapy session.

Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance because of an adaptive state that has developed within the individual from psychoactive substance consumption that results in the experience of withdrawal and that necessitates the re-consumption of the drug. A drug addiction, a distinct concept from substance dependence, is defined as compulsive, out-of-control drug use, despite negative consequences. An addictive drug is a drug which is both rewarding and reinforcing. ΔFosB, a gene transcription factor, is now known to be a critical component and common factor in the development of virtually all forms of behavioral and drug addictions, but not dependence.

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<span class="mw-page-title-main">Substance use disorder</span> Continual use of drugs (including alcohol) despite detrimental consequences

Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include substance use problems and problematic drug or alcohol use.

<span class="mw-page-title-main">Addiction</span> Disorder resulting in compulsive behaviours

Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use often alters brain function in ways that perpetuate craving, and weakens self-control. This phenomenon – drugs reshaping brain function – has led to an understanding of addiction as a brain disorder with a complex variety of psychosocial as well as neurobiological factors that are implicated in the development of addiction.

The adolescent community reinforcement approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth, young adults, and families improve access to interpersonal and environmental reinforcers to reduce or stop substance use.

About 1 in 7 Americans reportedly suffered from active addiction to a particular substance. Addiction can cause physical, emotional and psychological harm to those affected by it. The American Society of Addiction Medicine defines addiction as "a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences."

Nathan H. Azrin was a behavioral modification researcher, psychologist, and university professor. He taught at Southern Illinois University and was the research director of Anna State Hospital between 1958 and 1980. In 1980 he became a professor at Nova Southeastern University, and entered emeritus status at the university in 2010. Azrin was the founder of several research methodologies, including Token Economics, the Community Reinforcement Approach (CRA) on which the CRAFT model was based, Family Behavior Therapy, and habit reversal training. According to fellow psychologist Brian Iwata “Few people have made research contributions equaling Nate’s in either basic or applied behaviour analysis, and none have matched his contributions to both endeavors.”

Linda Carter Sobell, Ph.D., ABPP, is the President's Distinguished Professor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida. She is a professor of clinical psychology, addiction specialist, co-director of NSU's Guided Self-Change clinic, a Motivational Interviewing Trainer, and is board-certified in cognitive and behavioral psychology.

Guided self-change (GSC) treatment has been accepted by American Psychological Association Division 12, Society of Clinical Psychology, as an empirically supported treatment.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a model that encourages mental health and substance use screenings as a routine preventive service in healthcare.

References

  1. 1 2 3 4 5 6 Meyers, Robert J.; Roozen, Hendrik G.; Smith, Jane Ellen (2011). "The Community Reinforcement Approach: An Update of the Evidence". Alcohol Research & Health. 33 (4). National Institute on Alcohol Abuse and Alcoholism: 380–8. PMC   3860533 . PMID   23580022. Archived from the original on May 1, 2021. Retrieved January 20, 2014.p. 380
  2. 1 2 3 4 5 Smith, Jane Ellen; Campos-Melady, Marita; Meyers, Robert J. (Spring 2009). "CRA and CRAFT" (PDF). Journal of Behavior Analysis of Sports, Health Fitness and Behavioral Medicine. 1. 2 (1). Behavior Analyst Online. Archived from the original (PDF) on December 29, 2010. Retrieved January 21, 2014.
  3. ↑ "Different types of therapy". United Kingdom: Brighton Therapy Works.
  4. 1 2 Meyers, Robert J. "CRAFT: An Alternative to Intervention". HBO.
  5. 1 2 3 4 5 6 Foote, Jeff; Manuel, Jennifer K. (2009). "Adapting the CRAFT approach for use in group therapy". Journal of Behavior Analysis in Health, Sports, Fitness and Medicine. 2 (1): 110. doi:10.1037/h0100378.
  6. ↑ "CRAFT". www.robertjmeyersphd.com. Robert J. Meyers, PhD. Retrieved January 20, 2014.
  7. ↑ Dr. Bob Meyers, PhD: "CRAFT Technique" Creator (2007). Craft Video Clip (wmv (Windows Media Video)). krqe.com (video). Albuquerque, New Mexico: KRQE News. Retrieved January 23, 2014. Time: 1:20 to 2:09
  8. 1 2 3 4 Dr. Josh King, Psy. D., Center for Motivation and Change (CMC), and Dr. Nicole Kosanke, PhD, Director of Evaluations and Family Services at CMC. CRAFT Series: Positive Communication When You're Angry 1/3 (video). The Center for Motivation and Change (CMC). Event occurs at 2:41 to 3:26, 12:12 to 12:30. Retrieved January 23, 2014.
  9. 1 2 Dr. Josh King, Psy. D., Center for Motivation and Change (CMC), and Dr. Nicole Kosanke, PhD, Director of Evaluations and Family Services at CMC. CRAFT Series: Positive Communication When You're Angry 2/3 (video). The Center for Motivation and Change (CMC). Event occurs at 0:30 to 1:06, 1:15 to 1:18, 7:35 to 8:21. Retrieved January 23, 2014.
  10. ↑ LCCN Permalink 2003057149. Library of Congress. 2004. ISBN   9781592850815 . Retrieved January 23, 2014.{{cite book}}: |website= ignored (help)
  11. ↑ Dr. Josh King, Psy. D., Center for Motivation and Change (CMC), and Dr. Nicole Kosanke, PhD, Director of Evaluations and Family Services at CMC. CRAFT Series Part 3: Negative Consequences vs Detaching (4/5) (video). The Center for Motivation and Change (CMC). Event occurs at 5:59 to 8:17. Retrieved January 23, 2014.
  12. 1 2 Miller, William R.; Meyers, Robert J.; Hiller-Sturmhöfel, Susanne (1999). "The Community-Reinforcement Approach" (PDF). Alcohol Research and Health. 23 (2). National Institute on Alcohol Abuse and Alcoholism: 116–21. PMC   6760430 . PMID   10890805.p. 119
  13. 1 2 3 Miller, William (1998). "Toward a Motivational Definition and Understanding of Addiction". Motivational Interviewing Newsletter for Trainers. 5 (3). International Association of Motivational Interviewing Trainers: 2–6. Archived from the original on April 19, 2013. Retrieved January 22, 2014.
  14. ↑ Heyman, Gene M. (2010). Addiction: A Disorder of Choice (paperback). Cambridge, MA: Harvard University Press (published October 2010). ISBN   978-0-674-05727-2 . Retrieved January 21, 2014.
  15. ↑ Smith, J.E. & Meyers, R.J. (2004) Motivating Substance Abusers to Enter Treatment: Working with Family Members; Guilford Press
  16. ↑ Meyers, RJ & Wolfe, B. (2004) Get Your Loved One Sober: Alternative to Nagging, Pleading and Threatening by Meyers, Hazelden Press
  17. ↑ "The Johnson intervention and relapse during outpatient treatment". American Journal of Drug and Alcohol Abuse 22.n3 (August 1996): pp36
  18. ↑ Lee, Katherine (2017). "An underappreciated intervention". Monitor on Psychology. 48 (11): 18.
  19. 1 2 Meyers, R.J.; Wolfe, B.L. (2009). Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. Hazelden Publishing. p. xvii. ISBN   978-1-59285-775-3 . Retrieved January 14, 2020.
  20. ↑ "What Is CRAFT". www.motivationandchange.com. The Center for Motivation and Change (CMC). Retrieved January 23, 2014.
  21. 1 2 3 Smith, J.E.; Milford, J.L.; Meyers, R.J. (2004). "CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals". The Behavior Analyst Today. 5 (4): 391–403. doi:10.1037/h0100044.
  22. ↑ JANE E. BRODY (February 4, 2013). "Effective Addiction Treatment". New York Times. Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe.
  23. ↑ Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R.J., Delaney, Harold D., and Smith, J.E. (2009). Community Reinforcement and Family Training (CRAFT): An Effectiveness Study. Journal of Behavior Analysis of Sports, Health Fitness and Behavioral Medicine, 2 (1), "Archived copy" (PDF). Archived from the original (PDF) on December 29, 2010. Retrieved January 21, 2014.{{cite web}}: CS1 maint: archived copy as title (link)
  24. ↑ Hunt, G.M.; Azrin, N.H. (1973). "A community-reinforcement approach to alcoholism". Behaviour Research and Therapy. 11 (1): 91–104. doi:10.1016/0005-7967(73)90072-7. PMID   4781962.
  25. ↑ Azrin, N.H.; Sisson, R.W.; Meyers, R.J.; Godley, M.D. (1982). "Alcoholism treatment by disulfiram and community reinforcement therapy". Journal of Behavior Therapy and Experimental Psychiatry. 3 (2): 105–112. doi:10.1016/0005-7916(82)90050-7. PMID   7130406.
  26. ↑ Mallams, J.H.; Godley, M.D.; Hall, G.M.; Meyers, R.J. (1982). "A social-systems approach to resocializing alcoholics in the community". Journal of Studies on Alcohol. 43 (11): 1115–1123. doi:10.15288/jsa.1982.43.1115. PMID   7182672.
  27. ↑ Milford, Jaime L.; Austin, Julia L.; Ellen Smith, Jane (2007). "Community Reinforcement and the Dissemination of Evidence-based Practice: Implications for Public Policy". International Journal of Behavioral Consultation and Therapy. 3 (1): 77–87. doi:10.1037/h0100174.
  28. ↑ Foote, J. and Manuel, J.K. "Adapting the CRAFT approach for use in group therapy". The Journal for Behavior Analysis in Sports, Fitness and Medicine, 2009 Vol 2, Issue 1, (Spr). Retrieved January 13, 2020.{{cite web}}: CS1 maint: multiple names: authors list (link)
  29. ↑ Purvis, G., and MacInnis, D.M. (2009). Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic. Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine, 2 (1), 33–44 BAO Archived December 29, 2010, at the Wayback Machine
  30. ↑ Robert J. Meyers, PhD (2007). Getting an Addict into Treatment: The CRAFT Approach (Video). HBO. Retrieved January 22, 2014. CRAFT is currently being used in 25 clinics in the United States.
  31. 1 2 "About Us". Cadence Online. 2020. Retrieved January 18, 2020.
  32. ↑ "Choose Your Plan". Allies in Recovery. 2020. Retrieved January 20, 2020.
  33. ↑ "REST: Resources Education Support Together". Resources Education Support Together. 2020. Retrieved January 20, 2020.
  34. 1 2 3 Meyers, R.J., Smith, J.E. & Lash, D.N. (2005): A Program for Engaging Treatment-Refusing Substance Abusers into Treatment: CRAFT. IJBCT, 1 (2), Page 90–100 BAO
  35. ↑ Kirby, K.C.; Marlowe, D.B.; Festinger, D.S.; Garvey, K.A.; LaMonaca, V. (1999). "Community reinforcement training for family and significant others of drug abusers: Aunilateral intervention to increase treatment entry of drug users". Drug and Alcohol Dependence. 56 (1): 85–96. doi:10.1016/s0376-8716(99)00022-8. PMID   10462097.
  36. ↑ 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: 1–18.
  37. ↑ 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 (5): 688–697. doi:10.1037/0022-006x.67.5.688. PMID   10535235.
  38. ↑ Meyers, Robert J.; Wolfe, Brenda L. (2004). "The Program". Get Your Loved One Sober. Center City, Minn.: Hazelden. p. 11. ISBN   1-59285-081-2. LCCN   2003057149.
  39. ↑ Meyers, Robert J.; Wolfe, Brenda L. (2004). "The Road Map". Get Your Loved One Sober. Center City, Minn.: Hazelden. p. 37. ISBN   1-59285-081-2. LCCN   2003057149.
  40. 1 2 3 4 "CRAFT". American Psychological Association. Retrieved January 20, 2014.
  41. ↑ Meyers, R.J.; Wolfe, B.L. (2009). Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. Hazelden Publishing. p. A Note From Bob Meyers. ISBN   978-1-59285-775-3 . Retrieved January 14, 2020.
  42. ↑ Meyers, Robert J.; Miller, William R.; Smith, Jane Ellen; Tonigan, J. Scott (2002). "A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others". Journal of Consulting and Clinical Psychology. 70 (5). American Psychological Association (APA): 1182–1185. doi:10.1037/0022-006x.70.5.1182. PMID   12362968.
  43. ↑ Cf. Kirby, Kimberly C; Marlowe, Douglas B; Festinger, David S; Garvey, Kerry A; LaMonaca, Vincent (1999). "Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users". Drug and Alcohol Dependence. 56 (1). Elsevier BV: 85–96. doi:10.1016/s0376-8716(99)00022-8. PMID   10462097.
  44. ↑ Miller, William R.; Meyers, Robert J.; Tonigan, J. Scott (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 (5). American Psychological Association (APA): 688–697. doi:10.1037/0022-006x.67.5.688. PMID   10535235.
  45. ↑ "Community Reinforcement and Family Training (CRAFT)" APA article
  46. ↑ https://www.abainternational.org/constituents/special-interests/special-interest-groups.aspx ABAI special interest groups list
  47. ↑ http://www.abct.org/Members/?m=mMembers&fa=SIG_LinkToAll ABCT special interest groups list
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