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A Protocol to Empower Family Members

September 1, 2007
by Reid K. Hester, PhD
| Reprints
Robert J. Meyers discusses the effective elements of the CRAFT model

Robert J. Meyers, PhD, is a clinical psychologist and researcher who has been involved in developing and evaluating treatment protocols for people with addictions for 30 years. He and I first met when we were working on a randomized clinical trial of the Community Reinforcement Approach with heroin addicts in 1988. We have been colleagues and friends ever since.

Meyers had been involved in the evolution of CRA, an approach that uses environmental reinforcers to assist individuals in the recovery process, since its creation in the 1970s by prominent behavioral researcher Nate Azrin. After working in clinical and research settings for eight years, Meyers was recruited by the University of New Mexico's Alcohol and Drug Division as a program director. He and William Miller, PhD, then began a collaboration on the first CRA project, which led to the creation of the research division of the Center on Alcoholism, Substance Abuse, and Addictions at the university. This collaboration also led to a number of randomized clinical trials of CRA, from which evidence of effectiveness has catapulted the approach into the top ranks of evidence-based programs.

Reid k. hester, phd

Reid K. Hester, PhD

But Meyers wasn't content to rest on his laurels. Because his father was a heavy drinker who never received treatment, Meyers had a keen personal interest in developing a protocol for family members of alcoholics and addicts who refused to get treatment. He would not accept that family members are powerless to influence a drinker or addict, so he got to thinking.

Part of CRA is couples or family therapy designed to positively reinforce sobriety on the drinker's part. Meyers saw that spouses and family members had a big influence in this way. So why not focus these positive strategies to motivate the drinker to get into treatment in the first place? This began what has come to be known as the Community Reinforcement Approach and Family Training (CRAFT). I interviewed Meyers about his work in this area.

Bob, what, in a nutshell, is CRAFT?

The CRAFT protocol helps concerned significant others (CSOs) learn new ways to interact with their substance-abusing loved one with the goal of reinforcing sober behaviors and not responding to using behaviors. The ultimate goal is to motivate the person to change his/her drinking or drug use and get into treatment.

How effective is CRAFT?

Randomized clinical trials of CRAFT have consistently found that CSOs are successful in getting their treatment-resistant loved one into treatment 65 to 75% of the time. These studies were done with “real-world” populations of severely dependent drinkers and drug abusers. In comparisons with the Johnson Institute “intervention” approach, CRAFT had significantly higher success rates in getting treatment-resistant individuals into treatment.1

What sort of positive impact does it have on the concerned significant others?

CSOs were less anxious and less depressed and had fewer stress-related physical problems compared to their functioning when they entered CRAFT. These positive changes occurred regardless of whether they were successful in getting their substance-abusing loved one into treatment.

What are the principles that give CSOs hope and a sense of empowerment? What do they need to know?

  • Your love has power. Research has shown that family members can be taught techniques to successfully engage their substance-abusing loved ones into life-altering treatment. This is where the CRAFT program comes in.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. You can too.

  • You can catch more flies with honey than vinegar. Just as it is easier to attract flies with sweet honey than sour vinegar, it is easier to get your loved one to listen to your loving words than your criticism. And this is more than simply one of those supposedly wise old sayings; it is proven by research! So choose the honey alternative to nagging and threatening and help your loved one move toward sobriety by talking about what you do like about him or her and what positive changes please you.

  • You have as many tries as you wish to take. Relationships are a process—they exist over time. One event or discussion rarely defines an entire relationship, so the truth is that you probably have as many tries at improving your relationship as you wish to take. As you work on developing alternative ways to interact with your loved one, take heart when things go well, but do not be overly discouraged when they go poorly. The next word, the next day, the next interaction gives you another chance to make a positive change.