1. Community Reinforcement and Family Training (CRAFT) Science and Management of Addiction Frank Couch, MA, LMFT, CDP, NCACI Beth Meyer, MA, LMFT, CDPT

2. 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/

3. 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 ts@aodresource.comfull 2.5 day CRAFT training ts@aodresource.com

4. 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

5. 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

6. 12 Step Programs (Al-Anon, Nar-Anon) Loving detachment Acceptance of CSO’s inability to control IP’s behavior Group support for CSO

7. Johnson Institute Intervention Only 29% of CSO’s complete the training Of that 29% only 24% engage in treatment (Lipman et al 1989)

8. Changes Parent Support Network Peer support “Tough Love” model Action steps

9. Why use CRAFT? Because It works… HBO Addictions series videovideo

10. 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 CSOs130 CSOs32 CSOs 75% Anglo; 23% AA 62 CSOs 80% Hispanic 90 CSOs 88% female; 49% Hispanic 42 CSOs 48% Hispanic 48% Anglo 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 / Al- Anon) Non-randomized 86% vs 0% CSOs better 64% vs 23% vs 13% CSOs better 74% vs 17% CSOs better 74% CSOs better 67% vs 29% CSOs better 71% CSOs better

11. CRAFT: 3 Goals Reduce loved one’s harmful substance use Engage loved one into treatment Improve the functioning of CSO Emotional Physical Relationships

12. CRAFT Program Description for the CSO Problem focused Skills based Active during sessions (role play) Active between sessions (assignments)

13. 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

14. CRAFT’s Principles Eliminate positive reinforcement for drinking and/or using behavior Enhance positive reinforcement for non- drinking (sober) and non-using (clean) behavior

15. 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

16. 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?

17. 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

18. 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

19. 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

20. 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

21. (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

22. (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

23. (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 likeclean 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’readvance that you’re not home?going to be late. * You never lift a ^@#%*!I know you’re busy, but it finger around here! would mean a lot to me if you could help clean out the garage Saturday.

24. (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

25. (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

26. (6) Assign Homework Practice Communication Skills in a conversation with adolescent over _________ issue on ____ (day/time) Use Daily Reminder To Be Nice

27. 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

28. Remaining Sessions cont’d (7) Happiness scale and personal goal setting (8) Components of supporting sober/clean behavior (9) Natural Consequences (10) Relapse prevention

29. CRAFT: 3 Goals Reduce loved one’s harmful substance use Engage loved one into treatment Improve the functioning of CSO Emotional Physical Relationships

30. Thank you!