Community Reinforcement and Family Training

CRAFT Overview

The Community Reinforcement Approach and Family Training (CRAFT) intervention is a research-supported treatment for family members (e.g., spouses, partners, siblings, adult children) or friends of individuals with substance use problems. The family members are called Concerned Significant Others (CSOs) and the individuals with the substance use problems who should be in treatment (but refuse to attend) are called Identified Patients (IPs). CRAFT was developed to support CSO's who did not know where to turn to get help for the IP with the belief that since family members can, and do make important contribution in other areas of addiction treatment (i.e. family and couples therapy), that the CSO can play a powerful role in helping to engage the substance user in treatment. In addition, it is often the substance user who reports that family pressure or influence is the reason sought treatment. Also, CSOs who attend the CRAFT program also benefit by becoming more independent and reducing their depression, anxiety and anger symptoms even if their loved one does not enter treatment.

CRAFT uses an overall positive approach and steers clear of confrontation.

CRAFT is a culturally sensitive program that works with the client's mores and beliefs to develop an appropriate treatment plan. The program emphasizes learning new skills to cope with old problems. Some of the components include how to stay safe, outlining the context in which substance abusing behavior occurs, teaching CSOs how to use positive reinforcers (rewards) and how to let the substance user suffer the natural consequences for their using behavior.

Scientific Support for CRAFT

CRAFT has an excellent research record. Studies show that, through work with CSO's, CRAFT is successful at getting treatment-refusing substance-abusing individuals (IPs) to seek treatment about two-thirds of the time (with multiple studies showing even higher rates). This success has been found across a variety of CSO-IP relationships (romantic partners, parents/children, siblings, friends) and drug or alcohol choices (Archer et al. 2019). Importantly, in addition to the research demonstrating high treatment-engagement rates, CRAFT has also shown very good outcomes as far as improvements in CSO's anxiety, depression, family cohesion, and relationship happiness regardless of whether their IP started treatment (Roozen et al., 2010).

Several web-based studies of CRAFT have shown promising results but have not replicated a key outcome of IP treatment entry. Recently completed research on our own web-based CRAFT program has shown results very similar to the successful in-person studies. In a pilot study the proportion of CSOs reporting their IPs entered new treatment was higher in digital CRAFT conditions (73%-77%) compared to a digital PEER support condition (40%). CRAFT participants showed physical health improvements, decreases in mood disturbance and improvements in relationship satisfaction relative to PEER. Results from a fully-powered randomized controlled trial are currently being analyzed and suggest outcomes comparable to in-person CRAFT studies.