Community Reinforcement and Family Training (CRAFT)
description
Transcript of Community Reinforcement and Family Training (CRAFT)
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 [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 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!