CRAFT, which stands for Community Reinforcement and Family Training, is a family intervention approach for engaging unmotivated substance abusers into treatment. Robert J. Meyers, PhD, created this model to give family members an optimal strategy for addressing their in-denial, treatment-resistant loved one. He has documented its success through several studies, including a recent study that earned him the 2002 Dan Anderson Research Award.

The seventh-annual award, given by the Butler Center for Research at Hazelden and announced in December, recognizes outstanding research that advances the knowledge of addiction recovery. The work of this year's winner offers the potential for far-reaching impact. "Our award sometimes recognizes work that shows more promise than actual application," says Patricia Owen, PhD, director of the Butler Center for Research. "But the work of Meyers could have tremendous impact. It is ready to be applied."

Addressing 'a family disease'
What makes Meyers' work so special is that it addresses an area of great need in solving substance abuse problems. "The saying, 'Alcoholism is a family disease,' really fits," says Dennis Donovan, PhD, director of the Alcohol and Drug Abuse Institute at the University of Washington in Seattle and a member of the Butler Center Scientific Panel that selected the award winner. "And yet in many cases, there has been no real successful avenue to persuade a loved one into treatment. Now, CRAFT may offer the best way."

The CRAFT approach has been documented to be more effective than traditional approaches, such as Al-Anon and the Johnson Institute intervention model. Meyers, associate director of the Clinical Research Branch of the Center on Alcoholism, Substance Abuse and Addiction at the University of New Mexico in Albuquerque, earned the Hazelden award for "A Randomized Trial of Two Methods for Engaging Treatment-Refusing Drug Users Through Concerned Significant Others," a study published in the Journal of Consulting and Clinical Psychology (2002, Vol. 70, No. 5, pages 1182-1185). His study compared CRAFT (and an expansion of it) to an Al-Anon/Nar-Anon facilitation therapy method. Both models sought to provide concerned significant others with the tools to persuade a loved one into treatment.

In Meyers' study, 90 concerned significant others of drug abusers were randomly assigned to either CRAFT, CRAFT with additional group aftercare sessions, or Al-Anon and Nar-Anon facilitation therapy. Participants in each of the groups received 12 hours of manual-guided individual training/therapy. Those assigned to CRAFT received behavioral skills training designed to influence their loved one's drug use and persuade them into treatment; those in the Al-Anon/Nar-Anon group learned the principles of their Twelve Step groups, with a special emphasis on getting loved ones into treatment. The results: CRAFT engaged 58.6 percent into treatment, CRAFT with aftercare engaged 76.7 percent, and Al-Anon/Nar-Anon engaged 29 percent.

In a similar study of families of alcoholics (coinvestigated by Meyers), CRAFT was significantly more successful at engaging the alcoholic into treatment (64 percent) than was the Johnson Institute intervention group (30 percent) or an Al-Anon facilitation therapy group (13 percent).

"Al-Anon is invaluable for families of recovering people," says Owen. "But sometime, especially early on when the family is struggling with what to do with their drug-using loved one, something more is needed. And it looks like Meyers has found an approach that is quite effective."

Motivated by personal experience
Meyers has been inspired by his family experience with alcoholism. "I come from an alcoholic family," he says. "I grew up and saw my mother suffer because of my dad's alcoholism. There's been so much emphasis on the drinker and so few resources for families. I've just had a soft spot in my heart for helping family members find solutions to addiction. My mother went to Al-Anon, but it didn't give her much to help change the drinking behavior of my dad. And that's why so much of my research has been based on people who have lived with a drinker who has refused to get help."

Meyers says that every study conducted on his CRAFT approach has found that six or seven out of every 10 people in denial of their problem have been persuaded to seek treatment. "Bob Meyers has a better mousetrap than the industry standard," says Timothy J. O'Farrell, PhD, chief of the Harvard Families and Addiction Program at the Harvard Medical School, who nominated Meyers for the award.

The most widely used options for concerned significant others have been Twelve Step programs, such as Al-Anon and Nar-Anon, and the Johnson Institute Intervention. The Twelve Step programs focus on detachment with love and acceptance of the significant other's inability to change the loved one's drinking behavior. The Johnson Institute (JI) approach attempts to confront the person's drinking behavior with a family meeting, but only 30 percent of families who seek the JI approach ever carry through with the family meeting, according to Meyers. Those who do are very successful, sending 85 to 90 percent of loved ones to treatment.

"Family members have a lot of information about the drinker/drug user, but they don't know how to use it to help get the drinker into treatment," says Meyers. "One of the things we do with CRAFT is train the family member how to react to drinking/drugging situations. We look at what is an appropriate response, meaning how can you act in a way that is most likely to get the results you want."

Components of CRAFT include communication training, domestic violence precautions, motivational strategies, assessing the context of the loved one's drinking, positive-reinforcement training, discouragement of drug use, training significant others to reward themselves, and techniques for suggesting treatment.

"We also help significant others learn how to be honest with the drinker," says Meyers. "For instance, we may train them to say, 'I really love you and want to spend quality time with you, but I am not going to spend time with you when have been drinking.' Teaching clients when and how to give new messages is very important. Never discuss new ideas when the drinker has been drinking, is hung over, or is in a bad mood."

According to Barbara McCrady, PhD, professor and clinical director of the Center of Alcohol Studies at Rutgers University in Piscataway, New Jersey, and a member of the Butler Center Scientific Panel, the CRAFT approach blends the best elements of traditional approaches with new techniques. "The CRAFT approach has several unique features: a dual focus on the well-being of the concerned family member and the drinker; an approach that is appealing to families; and a model that is effective in improving family well-being and motivating the drinker to seek treatment. For too long practitioners have had just two options when counseling a family member. Each of these options had limits, but the CRAFT approach overcomes these."

In addition to his seminal work on CRAFT, Meyers has been active in work on the Community Reinforcement Approach (CRA), from which CRAFT is derived. He coauthored the first therapist guidebook on CRA (Guilford Press, 1995) and is senior editor and author of a volume on CRA from Cambridge University Press.

Putting it to use
Meyers feels his work on CRA and CRAFT is well documented. Now he hopes to make these models accessible to practitioners, through books, workshops, training tapes, and his work with the Center for Substance Abuse Treatment. "I'm trying to spread the word--not many people are applying these models," says Meyers.

He has two books on CRAFT in the works: one for consumers--a self-help book for significant others of the addicted person--and a manual for therapists. CRAFT can be easily learned and applied by a range of professionals, including marriage and family therapists, addiction counselors, psychologists, and social workers.

The Hazelden research award is named in honor of Dan Anderson, PhD, president emeritus of Hazelden and one of the major architects of the Minnesota Model. Past award winners include Stephen T. Higgins, PhD, University of Vermont; Michael Fiore, MD, University of Wisconsin; Dace Svikis, PhD, Johns Hopkins University; Richard Longabaugh, EdD, Brown University; Henri Begleiter, PhD, State University of New York; and Bankole Johnson, MD, University of Texas Health Science Center.

Published in The Voice, Winter 2003