Question 1

What is CRAFT?

Robert Meyers · Accepted Answer

CRAFT is a program designed to help a family member who has a partner, son, daughter or another member of the family who has refused to enter a substance abuse program for help. We teach each CRAFT patient how to navigate around the substance use and learn new ways of communicating with the substance user.  We usually get a 70 % success rate, getting users to eventually go to treatment.

Question 2

What is the goal of CRAFT, given that it works with family members without the drinker/user present?

Robert Meyers · Accepted Answer

Our studies showed that all people who entered the program had a change in her well being. All of the clients reduced anxiety, anger, depression and physical problems like migraine headaches. Even clients who were not successful during the study also saw the same improvement as successful cases.

Question 3

Why is it important to include the family in substance addiction treatment?

Robert Meyers · Accepted Answer

The non-user coming into treatment can change the way they treat other family members not just the users. We teach communication, anger problems and many other ways to take care of themselves and supporting other members of the family.

Question 4

What are the basic principles underlying Community Reinforcement Approach and Family Training?

Robert Meyers · Accepted Answer

The basic principles of CRAFT is to teach family members to learn new skills in how to deal with a family member who is using alcohol or other drugs.  We look to help change the behavior of the clients so he or she does not continue to use old school ways that do not work.

Question 5

What is involved in the community reinforcement aspect of CRAFT?

Robert Meyers · Accepted Answer

Usually several sessions on how to take care or yourself.  The stronger the non user becomes, the more likely they are to change how they approach the substance use problem. CRAFT is an Evidenced program using skills trainings  and other methods to help our clients.

Question 6

What techniques does CRAFT use to promote motivation for change?

Robert Meyers · Accepted Answer

CRAFT is set up for the client to work on what she or he decides to work on..  There is no confrontation, no labeling, no lecturing. We use a conversation style to help clients believe in themselves.
We use skills training at the pace of the client and let them pick and choose what goes next.

Question 7

How does CRAFT address the individual’s resistance to change?

Robert Meyers · Accepted Answer

By using some positive reinforcement and stop putting the users down or disowning the user.  Once the client starts to change and become kind the user begins to see the effort of the client and begins to get curious of the new changes.  That is one way to increase the possibility that the user will enter treatment.

Question 8

How does CRAFT compare with Al-Anon?

Robert Meyers · Accepted Answer

In almost every way.  We did a clinical trial with AlAnon and CRAFT was superior in engaging their loved on into treatment.  We teach skills that are easy to learn and use.  We believe in our clients and  follow their lead on how to work the problems.  Alanon does preach that they cannot help the user. We teach them how to support the user in many different ways. We let the client know that she cannot change the user, but they can change how they grow and learn.

Question 9

CRAFT appears to be more behaviourally focused rather than cognitively or emotionally focused; what is your opinion on long-term outcomes for addiction when treatment does not target cognitive and emotional issues that may underpin the addiction?

Robert Meyers · Accepted Answer

That is an empirical question only a clinical trial between the 2 will give us some information.
CRAFT does use behavioral protocols but we do focus on emotions.  Both CRAFT books have
chapters on taking care of the client, or letting them talk about the severity of the problem and how we can help them with a negative belief system.

Question 10

Hi! I'm wondering about the applicability of CRAFT for behavioural addictions such as OCRD. Could your intervention help those with Hoarding who are unwilling to seek help? Looking forward to hearing from you.

Robert Meyers · Accepted Answer

OCRD has been helped by using a behavioral approach. Upon entering treatment with a CRAFT client we use a Happiness scale including mental health problems.  I suggest to all therapists that if there is a underlying mental health problem get assistant to a specialist or the OCRD.
Right now CRAFT is being used for gambling problems, autism problems and  and with parents of people suffering from schizophrenia and also misusing drugs or alcohol.  There are many good uses for CRAFT.  More studies are being done all the time from Iran to Finland.

Question 11

I am working with a client who struggles with alcohol abuse/addiction who does not have any direct support from family members or friends- what is your opinion on the likelihood of overcoming the addiction without the assistance of family or loved ones?

Robert Meyers · Accepted Answer

Try using CRA the program that I learned before I developed CRAFT.  It is imperative that your client needs to learn skills to help find a new lifestyle.  I do believe that if people have nothing in there life we need to support them in getting active.  I know, it is not easy but if they have nothing to do but drink things will not get better. Individuals need something in their life to live for.

Question 12

Why is it important for family members to reinforce the positive behaviours without focusing on pointing out the unwanted behaviours?

Robert Meyers · Accepted Answer

We do point out unwanted behaviors but only where the client is fully trained and ready to move forward.  CRAFT talks about negative consequences of the using behavior.  CRAFT teaches how the client discusses these problems with the user.  Role-plays are a big part of CRAFT.  We spend time working on ways to meet with the user and practice what we have learned until the client is ready to try new tactics.

Question 13

Is there evidence to show that CRAFT is as effective for opioid abuse as it is for alcohol dependence?

Robert Meyers · Accepted Answer

Yes several CRAFT studies with opioid clients  have been successful.  The Iran study was for opioid user and it was a successful trial.

Question 14

How would CRAFT help a family member modify their reaction to a partner returning from being away for 24 hours?

Robert Meyers · Accepted Answer

Carefully. CRAFT teaches safety before we ask them to change their greetings to such an episode.
I would find out if this is a one time thing or it happens all the time.  I would prepare the client with teaching communication skills and problem solving training.  Then we need to help the client find the optimal time to discuss this issue with the user.  Be prepared for the client to walk away in a non aggressive and safe way.  Then I would discuss what happened and what can we happened  during our next treatment session.

Question 15

Why is it important for the family members to focus on self-care?

Robert Meyers · Accepted Answer

The better they feel the less anxious anger and depressed they are the more likely the will work harder.  Many clients believe they have caused the problem. Once we get that out of her head they will work harder as well.

Question 16

How does CRAFT view the disease theory of alcoholism?

Robert Meyers · Accepted Answer

I don't believe in the disease theory, I believe in addiction and how it affects our society.

Question 17

How does CRAFT conceptualise the root cause of substance use/addiction?

Robert Meyers · Accepted Answer

Most people will drink alcohol and some will use drugs just to see what happens and they feel it brings them joy at the beginning of using.  And it does.  But in many cases people continue to use because they get sick. So they use to feel good and have fun, but they become addicted. 
Using is fun (positive reinforcement ) when a user gets sick he needs to use again to straighten out which is (negative reinforcement) it takes away the pain.

Question 18

Is it enabling to let my child continue to live at home whilst she is using? Our belongings aren't safe and her being here is impacting her siblings but I don't want to lose her.

Robert Meyers · Accepted Answer

I don't like the work enabling it is pejorative.  I think you should keep contact with her and use some of the CRAFT ideas with her as you go forward.  I worked with a women for years with a similar problem and she stayed in contact with her son until he finally  broke down and went to treatment.  It may be along process but it works sometimes.  If she gets sick and is vulnerable this is a good time to see if she will get  help.

Question 19

Can families have a positive impact on their loved one if they live far away?

Robert Meyers · Accepted Answer

It is much harder if they live far apart but it may work. There are ongoing studies now to see if tele medicine will work with CRAFT clients.  Have hope.

Question 20

How does CRAFT view a IP wanting to give up one substance (e.g., cannabis) but continue to use another (e.g., alcohol)?

Robert Meyers · Accepted Answer

Take what you can get. If he stops one praise him and give him positive reinforcement when appropriate.  See how they change and support them and eventually you can bring up the second drug, using CRAFT techniques.

Question 21

Does CRAFT align with a harm minimisation approach?

Robert Meyers · Accepted Answer

Yes harm reduction has be used by some of the therapists using CRAFT.  It may work since most people resist treatment because they think the cannot ever us any substances and it scares the hell out of them.  Ease them in is a good possibility.

Question 22

How does CRAFT differ from family therapy approaches?

Robert Meyers · Accepted Answer

It it very different, but the client can teach the family if she wishes.

Community Reinforcement Approach and Family Training (CRAFT)

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