Category:

Motivating Substance Abusers to Enter Treatment

By Jane Ellen Smith, PhD; and Robert J. Meyers, PhD

Course Description

Filling a crucial need, this course presents a time- and cost- effective therapy program oriented to concerned significant other (CSO) who wants to motivate a family member or partner to seek help. Community Reinforcement and Family Training (CRAFT) is a non- confrontational approach that teaches CSOs how to change their own behavior in order to reward sobriety, discourage substance use, and ultimately to help get the substance abuser into treatment. The CSO also gains valuable skills for problem- solving and self-care. Step-by-step instructions for implementing CRAFT are accompanied by helpful case examples and reproducibles.

About the Authors

Jane Ellen Smith, PhD, is a professor in the Psychology Department at the University of New Mexico in Albuquerque, where she is also the Director of Clinical Training. She received her doctorate in Clinical Psychology from the State University of New York at Binghamton. Specializing in both alcoholism and eating disorders, Dr. Smith has written numerous articles and chapters on these topics. She is the coauthor of Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach, also with Robert J. Meyers. She has received federal grants from the National Institute on Alcohol Abuse and Alcoholism to test the Community Reinforcement Approach with homeless individuals. Dr. Smith is the newest recipient of the University of New Mexico’s highest teaching award: The Presidential Teaching Fellowship (2007-2009).

Robert J. Meyers, PhD, is the Director of Robert J. Meyers, PhD, and Associates, and an Adjunct Research Associate Professor of Psychology at the University of New Mexico, where his primary affiliation is with the Center on Alcoholism, Substance Abuse, and Addictions (CASAA). Dr. Meyers is the recipient of the 2002 Dan Anderson Research Award from the Hazelden Foundation, and the 2003 Young Investigator Award from the Research Society on Alcoholism. He has published dozens of scientific articles and several books, including Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening. Dr. Meyers has been in the addictions field since 1976. He was recently featured prominently for his work in O, the Oprah Magazine and in the HBO documentary series, Addiction.

Learning Objectives

  1. List the 3 major goals of CRAFT.
  2. Discuss how CRAFT was developed.
  3. List 3 CSO Treatment Options.
  4. Briefly list the 8 components of CRAFT.
  5. Define “drift.”
  6. State who is the most suitable CSO for CRAFT, according to studies.
  7. List one complicating factor for treating CSOs.
  8. List 2 considerations required when reviewing initial assessment material.
  9. State the role of the CRAFT therapist.
  10. Describe how CRAFT is a motivation approach.
  11. List several benefits for CSOs.
  12. Discuss the 3 main goals of CRAFT.
  13. State the purpose of a functional analysis.
  14. Define an episode.
  15. Describe external and internal triggers.
  16. Describe the final segment of the CRAFT functional analysis and its major purpose.
  17. List the 4 issues encountered when completing a functional analysis.
  18. Discuss the findings of Gondolf and Foster (1991), regarding men seeking alcohol treatment.
  19. Describe the “Conflict Tactics Scale.”
  20. State the main purpose of a functional analysis of violent behavior.
  21. Describe the predictability of violent behavior.
  22. List several strategies for protection of ongoing serious violence.
  23. List several ways a CSO can benefit from positive communication.
  24. List the 7 “Guidelines for Positive Communication Skills.”
  25. State why therapists are reluctant to participate in role play.
  26. Describe reverse role play.
  27. Define a positive reinforcer and how it is presented to the CSO.
  28. List several reinforcers and why the CSO should rate them.
  29. List the 4 criteria used to reinforce behavior.
  30. List the most common reaction from an IP after receiving a “reward.”
  31. List the 10 criteria, according to Table 6.3 relating to the CSOs readiness to deliver a positive reinforce.
  32. Describe the results of the CSO stopping certain positive behaviors.
  33. List the 7 guidelines the CSO can follow when withdrawing a reinforcer.
  34. Describe the reinstatement of reinforcers when previous ones prove to be inadequate.
  35. Describe the “natural consequences” procedure.
  36. List the 8 problem-solving guidelines.
  37. State the purpose of the “Happiness Scale” and briefly describe it.
  38. State the purpose of the “Pleasant Events Schedule.”
  39. Describe the 4 “Windows of Treatment.”
  40. List 6 motivational hooks.
  41. Describe one unorthodox way of inviting an IP to begin treatment.
  42. Define “rapid intake.”
  43. List several ways of handling refusal by an IP to enter treatment.
  44. Describe the “Intervention.”
  45. Describe “unilateral family therapy.”
  46. Describe ARISE.
  47. List what would exclude a CSO from a CRAFT project.
  48. Describe the typical CSO in drug treatment, according to NIDA(1999.)
  49. List the 4 categories of instruments administered to CSOs about themselves.

Course Contents

  1. Description of Community Reinforcement and Family Training
  2. Building and Sustaining Motivation of Concerned Significant Others
  3. Functional Analysis of a Problem Behavior
  4. Domestic Violence
  5. Improving Communication Skills of Concerned Significant Others
  6. Positive Reinforcement of Clean and Sober Behavior
  7. The Use of Negative Consequences
  8. Helping Concerned Significant Others Enrich Their Own Lives
  9. Inviting the Identified Patient to Enter Treatment
  10. Empirical Support for CRAFT

Comments

“What can you do for people with a substance-abusing loved one who refuses to get help? Quite a lot, as it turns out… Smith and Meyers describe the CRAFT method that they have shown to be highly effective not only in reducing family members’ distress, but also in getting their loved one into treatment. Their clearly written and well-organized narrative provides step-by-step guidelines for delivering this evidence-based approach.” – William R. Miller, PhD, Department of Psychology, University of New Mexico

“I wish I had had this book years ago to give my staff in the alcoholism treatment clinic, and I also recommend it to counselors and therapists in more general settings. An invaluable contribution!” – Carlos C. DiClemente, PhD, Department of Psychology, University of Maryland, Baltimore County

“This book is ‘must’ reading for all current and future practitioners in the field of substance abuse, and should be a required text in master’s-level substance abuse courses in clinical psychology, social work, and other helping professions.” – Allen Rubin, PhD, School of Social Work, University of Texas at Austin

“Years of research show that the approach described in this book works. CRAFT is more effective than our traditional methods for dealing with this difficult clinical challenge.” – Timothy O’Farrell, PhD, Department of Psychiatry, Harvard Medical School