1. CRAFT Community Reinforcement and Family Training Created & Developed by Robert J. Meyers, Ph.D. Robert J. Meyers, Ph.D. Power Point program developed by Robert J. Meyers, Ph.D. & Jane Ellen Smith, Ph.D. Department of Psychology, University of New Mexico & Center on Alcoholism Substance Abuse and other Addictions (CASAA), University of New Mexico, & University of New Mexico, & Robert J. Meyers, Ph.D. & Associates

2. Alphabet Soup CRAFTCommunity Reinforcement and Family Training CRACommunity Reinforcement Approach CSO Concerned Significant Other IPIdentified Patient (the substance user) EngagementEntering Treatment

3. Rationale for Working with CSOs Substance abusers often report that family pressure prompted treatment seeking CSOs can influence substance abusers’ behavior due to extensive contact CRA has always viewed CSOs as crucial collaborators CSOs also need help (victims of violence, verbal assaults, $ problems, marital conflict, etc. etc. etc.)

4. What is CRAFT? The Community Reinforcement and Family Training (CRAFT) program, works to change the patient’s environment to make a non-substance using lifestyle more rewarding than one focused on using alcohol or other drugs.

5. What is CRAFT? In the CRAFT model, concerned significant others (CSOs) are the focus of the therapy instead of the substance abuser. CSOs receive training to change their interactions with the substance using person, reducing their enabling behaviors and improving their communications strategies.

6. Ten Basic Messages for CSOs 1.Research has shown that family members can successfully learn techniques to engage their substance- abusing loved ones into treatment. We cannot emphasize this enough!

7. Ten Basic Messages for CSOs 2.You are not alone. As isolated as you may feel as you cope with your loved one’s substance abuse, the fact is that you are not alone. Millions of families are at this very moment suffering from problems just like yours. Although knowing that others suffer certainly doesn’t lessen your pain, you may take hope from knowing that many have “solved” their problems and learned to live more satisfying lives.

8. Ten Basic Messages for CSOs 3.You can catch more flies with honey than vinegar. Research has shown that it is easier to get your loved one to listen to loving words than to criticism. So choose ways to discuss about what you do like about him or her and what positive changes please you.

9. Ten Basic Messages for CSOs 4.You have as many tries as you want. Relationships are a process; they exist over time. One event or discussion rarely defines an entire relationship, so you have as many tries at improving your relationship as you wish to take. CRAFT is designed move at the pace you choose, you are in control. People can be helped at any time.

10. Ten Basic Messages for CSOs 5.You can live a happier life whether or not your loved one becomes abstinent. An important part of CRAFT is learning to take care of yourself, regardless of your loved one’s behavior. Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening (Meyers & Wolfe, 2004) teaches you how to do that and feel good about it.

11. Helping Yourself Helps. 6.When you help yourself you help your family. You become a positive role-model for the whole family. Your resilience upbeat and healthy attitude can be infectious, in a good way.

12. Ten Basic Messages for CSOs 7. Neither you or your loved one are crazy. All people have problems and substance misuse is just that a problem. You did not cause it, your loved one did not set out to be an abuser, and problems have solutions.

13. Ten Basic Messages for CSOs 8.The world is not black and white. Most problems vary in degree and difficulty. One should think of changing a bad habit in successive approximations. Change may be easier for an individual if they have more than one option.

14. Labels do more harm than good 9.Scientific studies have shown that labels Addict, Alcoholic) are a major barrier to people seeking help for substance use. 10. You have nothing to lose and a lot to gain by getting involved.

15. CRAFT’S 3 MAJOR GOALS Reduce loved one’s harmful substance use Engage loved one into treatment Improve the functioning of CSO (emotional, physical, relationships)

16. Things to Be Thinking about Right from the Start Always be on the lookout for engagement opportunities………

17. Basic Questions to Consider CSO’s most successful past engagement attempts? Best time/place/day to approach the IP with requests in general? Most likely reason the IP would enter treatment (for the relationship, the kids, to keep his/her job)? Most influential person to talk with the IP about treatment?

19. NIAAA Funded in part by a grant from the National Institute on Alcohol Abuse and Alcoholism

20. Traditional Interventions for CSOs 12-Step Programs Johnson Institute Intervention Mental Health Counseling Nothing

21. CRAFT Randomized Alcohol Study Miller, Meyers, & Tonigan (1999) 130 CSOs randomly assigned: Al-Anon Facilitation Therapy (AFT) Johnson Institute Therapy (JII) Community Reinforcement and Family Training (CRAFT)

22. Al-Anon Facilitation Therapy 12 sessions (1 hr each) Purpose: -get CSO to attend Al-Anon mtgs -help CSO accept powerlessness -emphasize detachment & self-care Supervisor: Joseph Nowinski, Ph.D.

23. Johnson Institute Intervention 6 sessions (2 hrs each) 4 sessions of preparation and training 1 family confrontation meeting 1 post-intervention evaluation Supervisor: A. Lane Leekman, M.D.

25. CRAFT 12-sessions (1 hr each) Purpose: –Empower CSO to influence change –Train CSO in behavior change skills –Improve CSO’s quality of life –Prepare CSO for treatment engagement Supervisor: Robert J. Meyers, Ph.D.

27. CSO Demographics Mean age47 Years of education14 Females (%)91 Anglos (%)52 Hispanic (%)39 Prior Al-Anon (%)58

30. CRAFT (alcohol) Conclusions Problem drinkers who are initially unmotivated for change can be engaged in treatment through “unilateral family therapy” with CSOs Parents of adult children are particularly effective (An overlooked resource for engaging problem drinkers?)

31. NIDA Funded by grants from the National Institute on Drug Abuse

32. CRAFT Demonstration Project Meyers, Miller, Hill, & Tonigan (1999) CSOs: family/friends of 62 treatment - refusing illicit drug users

33. IP Drug of Choice (CSO report) Cocaine = 37% Marijuana = 35% Stimulants = 16% Opiates = 8% Sedatives/= 3% Tranquilizers

34. CSO Demographics Gender: Females = 97%Males = 3% Ethnicity: White = 47% Hispanic = 48% Other = 5% Age: Range = 18 to 73Mean = 44.7 Relationship to IP: Spouse = 34%Parent = 56% Sibling = 6%Child = 4%

35. Engagement 74% (46/62) of the resistant drug abusers entered treatment

36. CRAFT Randomized Drug Study Meyers, Miller, Smith, & Tonigan (2002) 90 CSOs randomly assigned: CRAFT CRAFT + Aftercare Al-Nar/FT

37. CSO Demographics 88% female 49% Hispanic Mean Age: 46 yrs. Relationship to IPs: –53% parents –29% spouses –18% other (sister, grandfather)

38. Treatment Engagement CRAFT 59% CRAFT + aftercare 77% [combined 67%] Al-Nar/FT 29% 3 group comparison p <.0006 –no difference between 2 CRAFT conditions

39. More CRAFT Studies

40. Kirby et al., (1999) 32 CSOs CRAFT or 12-step program 56% spouses of IPs, 38% parents of IPs 75% Anglo, 23% African American IP’s drug of choice: 56% cocaine, 22% heroin CRAFT engaged 64%, 12-step 17% CSOs improved functioning overall

41. Waldron et al. (2007) CSOs = 42 parents/caregivers of drug abusing adolescents 2 parent households = 49% IPs: 79% Male 74% used cannabis Engagement rate = 71%

42. Dutcher et al. (2009) Study conducted in a Santa Fe, NM community agency Few exclusionary criteria 99 CSOs 59% Hispanic IPs’ Drug of choice: 90% alcohol; 7% cocaine Engagement rates: 55-65%

43. CRAFT STUDIES 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 adolescent Dutcher, et al., 1999 Manual, et al.,2012 Group vs Self- Directed 14 CSOs130 CSOs32 CSOs 75% Anglo 23% AA 62 CSOs 80% Hispanic 90 CSOs 49% Hispanic 42 CSOs 48% Hispanic 99 CSOs 59% Hispanic 40 CSOs 60% Anglo Alcohol 55% Cocaine 22% opiates 37% Coca 35% MJ 16% Stim 8% opiate MJ Cocaine Stimulants MJ Alcohol Alcohol 90% Cocaine 7% Drugs/Alco hol Randomized (CRAFT vs 12 Step) Randomized (CRAFT/JI /12-step Randomized (CRAFT vs 12-step) Non- Randomized Randomized Non- Randomized Craft in Group vs Self- Directed 86% vs 0% CSOs Better 64% vs23% vs13% CSOs Better 74% vs 17% CSOs Better 74% CSOs Better 65.5% vs 29% CSOs Better 71% CSOs Better 55%-65% CSOs Better 60% -71% Vs 40% Better

44. New CRAFT Adaptations CRAFT in Groups CRAFT with Gambling Problems CRAFT with a family member CSO) who already has IP (USER) in treatment CRAFT with returning war veterans with PTSD & SUD CRAFT groups on the internet (Smart Recovery) CRAFT with adolescent (CSO) for Parent