The community strengthening and family training approach ( CRAFT ) is a behavioral therapy approach for treating addiction. The original CRA strengthening approach, developed by Nate Azrin in the 1970s, uses operant conditioning to help people learn to reduce their addictive power and enjoy a healthy life. CRAFT combines CRA with family training, which equips families and friends with support techniques to encourage their loved ones to start and continue care, and provide defense against the damaging effects of addiction on loved ones.
Video Community reinforcement approach and family training
Introduction
The community-strengthening approach (CRA) "was originally developed for individuals with alcohol use disorders, [but] has been successfully used to treat a variety of substance use disorders for more than 35 years.Based on operant conditioning [a type of learning], CRA helping people rearrange their lifestyle so that a healthy and drug-free life becomes beneficial and thus competes with alcohol and drug use. "
"CRA is a limited time treatment." "In limited time therapy, the number of sessions defined (eg, 16 sessions) or time limits (eg, one year) is decided either at the beginning of therapy or in the early stages of therapy."
Community empowerment and family training (CRAFT) is a CRA that "works through family members." It is "designed to increase the likelihood of users of substances rejecting treatment to enter care, and improving the lives of family members concerned." CRAFT "teaches the use of healthy rewards to encourage positive behavior. In addition, the focus is to help users of substance and family. "
The Community Strengthening Approach (A-CRA) is a CRA that "targets teenagers with issues of substance use and their caregivers."
Maps Community reinforcement approach and family training
Description
CRAFT is a model of family therapy motivation. It is reward based - that is, based on positive reinforcement. CRAFT is intended for families and friends of individuals who refuse treatment that has substance abuse issues. "CRAFT works to influence [influence] substantial user behavior by changing the way families interact with them."
In the model, the following terms are used:
- Identified Patients (IP) Ã, - individuals with substance abuse issues refusing treatment, and
- Other Caring People Important (CSO) - relevant family members and friends from IP.
"CRAFT grew out of the understanding that although individuals who really need help with substance use issues are often very much against medication, on the other hand, caring people (CSOs) of substance actors are generally very motivated to get help for them.
Three goals
When loved ones abuse substance and refuse to get help, CRAFT is designed to help families learn practical and effective ways to achieve these three goals:
- Move their lover to care,
- Cut back on alcohol and their dear drug use, and
- Simultaneously improve their own lives.
Comparison
One trial compared CRAFT with Al-Anon and Nar-Anon facilitation therapy for its effects on addicts to enter treatment. These findings indicate that other important people who participated in the facilitation therapy of Al-Anon and Nar-Anon involved 29.0% of addicts into the treatment, while those who underwent CRAFT achieved 67.2%. Another study compares CRAFT, Al-Anon's facilitation therapy designed to encourage engagement in the 12-step program, and Johnson's intervention. The study finds that all of these approaches are associated with similar improvements in the functioning of others concerned and improvements in the quality of their relationships with addicts. However, the CRAFT approach was more effective in involving problem drinkers who were initially unmotivated in treatment (64%) than Al-Anon intervention (13%) and Johnson (30%).
Family influence
Robert J. Meyers, PhD writes about the influence of the family members in treating the user's substance, and the benefits for themselves:
Approach to Community Empowerment Approach and Family Training (CRAFT)... methods developed with the belief that because family members can, and do make important contributions [s] in other areas of addiction treatment (ie family and spouse therapy), that CSOs can play a role which is strong in helping to engage users of substance that is in denial to be subject to care. In addition, it is often the substance users who report that family pressure or influence is the reason [they] seek treatment. In addition, CSOs who attend CRAFT programs also benefit by becoming more independent and reducing their symptoms of depression, anxiety and anger even if their loved ones are not treated.
CRA procedure
The following CRA procedures and descriptions are from Meyers, Roozen, and Smith for substance users:
- Functional Substance Analysis
- Explore the antecedents of client substance use.
- Explore the positive and negative consequences of client substance use.
- Sobriety Sampling
- A gentle movement toward long-term taboos that begins with the client's consent to try time limited abstinence.
- CRA Treatment Plan
- Set objectives that are meaningful and objective in the area selected by the client.
- Specifies a very specific method for getting that goal.
- Tool: Happiness Scale, and Goal Counseling form.
- Behavioral Skills Training
- Teach three basic skills through instruction and role play:
- Troubleshooting
- Troubleshoot an extraordinary problem into a smaller problem.
- Bring up a smaller issue.
- Communication skills
- Positive interaction style
- Drink/drug rejection training
- Identify high-risk situations.
- Teach assertiveness.
- Vocational Training
- Provide basic steps to get and retain valuable work.
- Social and Recreation Counseling
- Provide opportunities to sample new social and recreational activities.
- Relapse Prevention
- Teach clients how to identify high-risk situations.
- Teach clients how to anticipate and overcome recurrence.
- Counseling Relations
- Increase interaction between client and partner.
(For details, please see the article: "Community Strengthening Approach: Evidence Reform" published in the journal Alcohol Research and Health by NIAAA.)
Communications
With CRAFT, family/friends (CSOs) are trained in a variety of strategies, including positive reinforcement, communication skills, and natural consequences. "One big part that has a lot of influence over all other strategies is positive communication." There are seven steps in the CRAFT model for implementing a positive communication strategy. "
- Short
- Positive
- View Specific Behavior
- Label Your Feelings
- Offer a Statement of Understanding - For example, "I appreciate that you have this problem,... [or] I understand that you really want to talk now, and it feels urgent, [or] I will be happy is there for you. "
- Accept Partial Responsibility - This step "is really designed to reduce defensive attitudes on the part of your loved ones.... It is not about accepting responsibility for things you are not responsible for... [ Instead, it's to] direct you to the parts you can have for yourself... [For example,] what you can take responsibility is how you communicate, "etc.
- Offer to Help
"The overarching goal for communication strategy is to help reduce the defense of your loved ones, and increase the chances that your message will actually be heard - so, improve the ability you have to actually deliver the message you want." In fact, the title the books of Robert J. Meyers and Brenda L. Wolfe based on CRAFT are, Get Your Lovers Sober: Alternatives to Crying, Pleading, and Threatening.
"The consequences are really important and helpful in communicating your message, but it's also very important, perhaps even more important, consistent in following up with the consequences and rewards."
Al-Anon
Al-Anon currently does not adopt, hold, or promote the view that the important persons concerned (CSOs) can, with any certainty, make a positive, direct, and active contribution to the compulsive drinking. However, Al-Anon said that by CSOs improving their own attitudes, and offering support and encouragement to users, "the family situation is definitely improving." On the other hand, the premise of CRAFT is that a deliberate and positive interaction can increase willingness and decrease user resistance to treatment. Al-Anon acknowledges that although increased willingness and decreased resistance can be a nice byproduct to escape the bad behavior of alcoholics, there is no guarantee that this will happen. Al-Anon is an alliance with a focus on helping families and friends, on their own, without promoting the process of direct intervention for alcoholics (see Al-Anon/Alateen) . Because "no one ever passes" from Al-Anon, Al-Anon can be seen as an open program, not limited time, while CRAFT is more specific.
Al-Anon Views
Regarding CSO's relationship with alcoholism and tranquility, the views of the Al-Anon organization can be summarized:
- Powerlessness . First Step Al-Anon promotes a helpless outlook for family and friends, "We recognize we are powerless because of alcohol - that our lives are becoming uncontrollable."
- Illness . Al-Anon writes, "As the American Medical Association will prove, alcoholism is a disease." Al-Anon also stated, "Although it can be arrested, alcoholism does not have a known drug."
- Three C . Al-Anon has a dictum called "Three C - I do not cause alcoholism, I can not control it, and I can not cure it."
- Release with Love. Al-Anon "supports the 'release of love' from the substance of the substance" (see sidebar: Engage v. Separate).
- Family illness . Al-Anon writes, "Alcoholism is a family disease," and "we believe alcoholism is a family disease and a changed attitude can aid recovery."
Regarding alcoholism, Al-Anon's recommended approach to CSOs (family/friends) is "detachment with love" and "giving understanding and encouragement to alcoholics."
No direct impact
As far as CSO has a direct and positive impact on the peace of others, Al-Anon asked and answered himself:
"But of course," we argued, "the calm is desirable, and there must be something we can do to help! There must be something we can say that will make a difference, or some kind of help or support or information we can provide that will convince our loved ones who are alcoholic to get the help they need or make sure they continue the journey to recovery! "
Alcoholism is a disease. Will the right words stop the spread of cancer or make chemotherapy more effective? Will our help, beauty, higher income, or a cleaner home cope with the development of Alzheimer's disease? Our compassion and support may make our loved ones struggle with illness more easily to bear it, but it is not at all our power to heal other people's diseases. We are powerless over the alcoholism of others.
This answer has three of these characteristics:
- Absolute results . Regarding help , Al Anon's answer tends toward a complete and comprehensive outcome, such as a person's ability to convince , treat or overcome i> alcoholism of others, or that they can guarantee (make sure) that someone is on the road to recovery. While this answer may help dispel the assumption that a person has permanent power, is guaranteed for the peace of others, it does not answer the question that a person can provide any the size of direct assistance or support for the carelessness or care of others. addicted to others, which is the basis of CRAFT.
- Incomplete analogy . Al-Anon writes that the right word can not make chemotherapy - the bio-chemical process - is more effective or stops cancer. However, the answer does not answer help or support or information which may make cancer treatment more effective or that can positively impact cancer.
- Medical opinion . A modern contrary judgment exists that alcohol (and drugs) addiction is not (progressive disease, incurable), coming from Dr. Gene Heyman and others (see the theory of alcoholism disease) . In 1960, Bill Wilson - one of the founders of A.A. (his wife Lois is the founder of Al-Anon) - called alcoholism a disease or a disease and does not see it as a disease. The diagnostic assessment of alcoholism in a person may include assessment of comorbidities, mental illness, and domestic violence.
CRAFT View
From SMART Recovery, sections: Family & amp; Friends:
Robert Meyers' work The CRAFT Community Reinforcement Approach and Family Training program... differs significantly from Al-Anon because it is a behavioral program that advocates that Concerned Significant Other (CSO) can have a positive impact on the substance. The CRAFT program has been shown in the Meyers study to be more effective than Vernon Johnson or Al-Anon type interventions, with fewer side effects and better outcomes, whether substance abuse enters care or not.
The CRAFT program uses various interventions based on functional assessment including modules to prevent domestic violence.
Interventions
"There are questions about the effectiveness of long-term interventions for those who are addicted to drugs or alcohol.A study examining addicts who have undergone standard intervention (called Johnson Intervention) found that they have a higher recurrence rate than other referral methods. Alcohol and other Drug treatments " (see Intervention, section: Controversy) .
Smith, Campos-Melady and Meyers describe Johnson Institute's intervention as an uncomfortable "surprise party" for many CSOs (family/friends):
Al-Anon's approach that emphasizes the separation of substance actors does not appeal to many CSOs. At the other end of the spectrum is the Johnson Institute Intervention: "surprise party" in which IP is confronted by family members and a therapist with the intention of getting an IP to enter care. When the intervention is actually done, it often results in a high degree of involvement in treatment, but only a small number of CSOs start programs that have followed through intervention (Liepman, Nirenberg, & Start, 1989; Miller et al., 1999), and many reports feel uncomfortable with its confrontational nature (Barber & Gilbertson, 1997).
Research shows that CRAFT has far greater success than Johnson or Al-Anon/Alateen Intervention methods, insofar as it involves a loved one in care.
Research and results
CRA
The community empowerment approach has many studies that support it as effective. Community empowerment has efficacy and data effectiveness. Beginning in the 1970s, the community empowerment approach is a comprehensive operand program built on the functional assessment of client drinking behavior and the use of positive reinforcement and contingency management for non-drinking. When combined with disulfiram (repetition of the procedure), strengthening the community shows remarkable effects. One component of a seemingly powerful program is a club that does not drink alcohol. Community empowerment applications for public policy have been the last focus of this approach.
Outpatient
"The Community Strengthening Approach has proven to be very effective in outpatient settings as well.In one study, clients treated with CRA and disulfiram compliance components averaged 97% of the days during the last month of 6 months of follow-up, while clients were treated with combination the 12-step program and the SSA disulfiram compliance training averaged 74% of the days. For clients who received a 12 step program and a prescription for disulfiram, on average only 45% of comparable days were fasting (Azrin, Sisson, Meyers , & Godley, 1982). "
CRAFT (and Al-Anon , intervention, etc.)
A branch of the community empowerment approach is the community empowerment and family training approach. This program is designed to help family members of substance abuse feel empowered to engage in care. The community strengthening and family training approach (CRAFT) has helped family members to get their loved ones in care. The success rate varies somewhat with the study but seems to group around 70%. CRAFT is the only treatment aimed at families with proven results to get people with drug or alcohol problems in care. The program uses various interventions based on functional assessment including modules to prevent domestic violence. Partners are trained to use positive reinforcement, communication skills, and natural consequences.
Alcohol abuse intervention
From an article on the website of the American Psychology Association (APA) on the success of CRAFT in the treatment and intervention of substance abuse, this is the result of success to involve the drinker into the treatment:
- 64% - CRAFT
- 23% Ã, - Johnson Intervention
- 13% Ã, - Al-Anon
Dari artikel:
Sisson and Azrin (1986) recruited 12 adult women with alcoholic husbands, brothers, or fathers and randomly assigned them to early versions of CRAFT or to traditional interventions. The results show that CRAFT is far more successful in getting people with substance abuse into care and reducing their alcohol consumption compared to the Al-Anon group. Miller et al. (1999) conducted a controlled comparison of CRAFT, Johnson Intervention, and Al-Anon facilitation (TSF) which randomized 130 troubled drinker caregivers to receive 12 contact hours in one of three conditions. CRAFT and TSF have better retention than Johnson Intervention. Consistent with previous research, participants tend to break up the last intervention to avoid family confrontation with drinkers. CRAFT interventions also involved more drinkers into treatment (64% vs 23% Johnson and 13% TSF).
Drug user intervention
From the same article on the American Psychology Association's (APA) website on the success of CRAFT in the treatment and substance abuse intervention, this is the result of success for people who abuse drugs to enter treatment (the result is almost the same as alcohol abuse):
- 64% - CRAFT
- 17% Ã, - Self Help Group Twelve Step Caregiver (TSG)
Dari artikel:
Kirby et al. (1999) randomly assigned 32 caregiver drug users to CRAFT or a 12-step self-help group (TSG). Caregivers assigned to CRAFT attend more sessions than those at TSG and are more likely to complete full counseling courses where people who abuse drugs are much more likely to enter treatment (64% vs 17%). Drug reduction occurred during the study, but there was no group x time interaction. Meyers et al. (2002) replicate and extend these findings with drug users with similar positive effects on the involvement of family members who abuse medications in treatment.
Note: When the article states "no group x time interaction," that only means CRAFT results (64%) and TSF results (17%) remain the same over time, despite the reduction of drug use during learning.
(For details, see the American Psychological Association (APA) article: "Community Strengthening and Family Training (CRAFT)", published by APA)
Parallel study
"In a parallel study sponsored by the National Institute on Drug Abuse that focuses on other drug abusers, family members who received CRAFT successfully involved 74 percent of drug users who were initially unmotivated in treatment (Meyers et al., 1999)."
History
The CRA was designed by Nate Azrin in the early 1970s:
The most influential behavior of all time, B. F. Skinner, mostly considers punishment as an ineffective method to modify human behavior (Skinner 1974). So it is not surprising that, many years later, the study found that treatment of confrontational substance use disorders was largely ineffective in reducing the use of alcohol and other substances (Miller and Wilbourne 2002, Miller et al., 1998). Nate Azrin had been convinced of this in the early 1970s, when he designed an innovative treatment for alcohol problems: Community Reinforcement Approach (CRA). Azrin believes that it is necessary to change the environment in which people with alcohol problems live so that they receive strong reinforcement for the conscious behavior of their communities, including family, work, and friends. As part of this strategy, the program emphasizes helping clients discover fun new activities that do not revolve around alcohol, and teach them the skills necessary to participate in such activities.
Asal-usul CRAFT:
Drs. Robert J. Meyers and Jane Ellen Smith of the University of New Mexico developed the CRAFT program to teach families how to influence their loved ones while avoiding both detachment and confrontation, their respective strategies from Al-Anon (12-Step based approach), and interventions traditional (Johnson Institute-style) where substance users are confronted by family members and friends during a surprise meeting. While these three approaches have been found to improve the functioning and satisfaction of family members' relationships, CRAFT has been shown to be significantly more effective in involving loved ones compared with Johnson Institute or Al-Anon/Nar-Anon intervention therapy.
2009
Until 2009, CRAFT and CRA programs were not widespread among addicted counselors. In contrast, many addicted counselors are tied to a twelve-step model that has much less research support. Recent trends by the National Institute on Drug Abuse (NIDA) have helped spread the technique of this intervention. In 2007, CRAFT was used in 25 clinics in the United States.
Professional organization
Association for International Behavioral Analysis
The Association for International Behavioral Analysis (ABAI) has a special interest group in clinical behavior analysis.
Association for Behavioral and Cognitive Therapy
The Association for Behavioral and Cognitive Therapy (ABCT) also has interest groups in behavioral analysis, which focuses on clinical behavior analysis. In addition, ABCT has a special interest group on addiction.
See also
- Behaviorism
- Cognitive behavioral therapy
- SMART Recovery Family & amp; Friends
- Al-Anon/Alateen
- National Institute of Alcohol Abuse and Alcoholism (NIAAA)
- The American Psychological Association (APA)
- National Institute on Drug Abuse (NIDA)
- Domestic violence
References
External links
- Robert J. Meyers, PhD - CRAFT
- Parent CRAFTÃ, - Online Video Course developed by Robert J. Meyers, PhD
- Community Strengthening Approach in Drugs & amp; Alcohol Rehab Asia (DARA), Thailand
- SMART Recovery Family & amp; Friends
- Community Strengthening and Family Coaching (CRAFT) Approach at the American Psychological Association
- Community Strengthening Approach: Evidence Updates at NIAAA
Source of the article : Wikipedia
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