The Community Reinforcement and Family Training (CRAFT) intervention is a research-supported treatment designed to help family members to engage treatment-refusing substance abusers into treatment.
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.
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.
Manuel, J. K., Austin, J. L., Miller, W. R., McCrady, B. S., Tonigan, J.S., Meyers, R. J., Smith, J. E., & Bogenschutz, M. P. (2012).
Community reinforcement and family training: A pilot comparison of group and self-directed delivery.
Journal of Substance Abuse Treatment, 43, 129-136
Read more
Meyers RJ, Miller WR, Smith JE & Tonigan JS (2002).
A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others.
Journal of Consulting & Clinical Psychology,70(5), 1182-5
Read more
Miller, W.R., Meyers, R.J., & Tonigan J.S. (1999).
Engaging the unmotivated in treatment for alcohol problems: A comparison of three intervention strategies.
Journal of Consulting and Clinical Psychology, 67, 5,688-697.
Read more
Roozen HG, de Waart R &van der Kroft P (2010).
Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment.
Addiction, 105(10), 1729-38.
Read more
Smith, J.E., Campos-Melady, M. Meyers, R.J. (2009).
Community reinforcement and Community reinforcement and family training.
Journal of Behavioral Analysis in Health, Sports, Fitness and Medicine, Vol. 2, Spring, Number 1.
Read more
Meyers, R.J., Smith, J.E., & Villanueva, M. (2005).
The Community Reinforcement Approach: History and New Directions.
Journal of Cognitive Psychotherapy: An International Quarterly, Volume 19, Number 3, Fall. 19(3):247-260.
Read more
Meyers, R.J., Apodaca, T.R.,Flicker, S.M., & Slesnick, N., (2002).
Evidence-Based approaches for the Treatment of Substance Abusers by Involving Family Members.
The Family Journal: Counseling and Therapy for Couples and Families, Vol.10, No. 3, July 2002, 281-288.
Read more
Roozen, H.G., Blaauw, E., & Meyers, R.J. (2009).
Advances in Management of Alcohol Use Disorders and Intimate Partner Violence: Community Reinforcement and Family Training.
Psychiatry, Psychology and Law Vol. 16:1,Supplement, 2009, S74-S80.
Read more
Smith, J. E., Meyers, R. J., & Austin, J. L. (2008).
Working with family members to engage treatment-refusing drinkers: The CRAFT program.
Alcoholism Treatment Quarterly, 26, 169-193.
Read more
Meyers, R.J., Smith, J.E., & Lash, D.N. (2005).
A Program for Engaging Treatment-Refusing Substance Abuser into Treatment: CRAFT.
International Journal of Behavioral and Consultation Therapy, Volume 1, No. 2, Spring.
Read more
Meyers, R. J., Austin, J. L., & Smith, J. E. (2006).
Enlisting Family Members to Address Treatment Refusal in Substance Abusers.
Psychiatric Times, 23, 31-34.
Read more
Kirby KC, Benishek LA, Kerwin ME, Dugosh KL, Carpenedo CM, Bresani E, Meyers RJ (2017).
Analyzing components of community reinforcement and family training (CRAFT): is treatment entry training sufficient?
Psychology of Addictive Behaviors, 31(7), 818-827.
Read more
Bischof G, Iwen J, Freyer-Adam J & Rumpf HJ(2016).
Efficacy of the community reinforcement and family training for concerned significant others of treatment-refusing individuals with alcohol dependence: a randomized controlled trial.
Drug & Alcohol Dependence, 163,179-85.
Read more
Brigham GS, Slesnick N, Winhusen TM, Lewis DF, Guo X & Somoza E (2014).
A randomized pilot clinical trial to evaluate the efficacy of community reinforcement and family training for treatment retention (craft-t) for improving outcomes for patients completing opioid detoxification.
Drug & Alcohol Dependence, 138, 240-3.
Read more
Dutcher, L.W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R.J., Delaney, H.D. & Smith J.E., (2009).
The community reinforcement and family training (CRAFT) An effectiveness study.
Journal of Behavioral Analysis in Health, Sports, Fitness and Medicine, Vol. 2, Spring, Number 1.
Read more
Smith, J.E., & Meyers, R. J. (2023).
The CRAFT treatment manual for substance use problems: Working with family members.
New York, NY: The Guilford Press
Get the manual
The Adolescent Community Reinforcement Approach (A-CRA) is a developmentally-appropriate behavioral treatment for youth and young adults ages 12 to 24 years old with substance use disorders.
Learn more >The Community Reinforcement Approach (CRA) is a comprehensive behavioral program for treating substance-abuse problems. It is based on the belief that environmental contingencies can play a powerful role in encouraging or discouraging drinking or drug use.
Learn more >