Community Reinforcement and Family Training (CRAFT)
Denial is a common theme among those suffering with addiction. If someone is regularly abusing alcohol, prescription drugs, or illicit substances, denial might have them convinced that there is no problem or that any perceived problems are only the perceptions of their loved ones.
Denial can significantly hamper treatment, as someone who’s addicted to a substance but doesn’t think they have a problem may refuse treatment, attend treatment inconsistently, or leave treatment early. This can take an enormous toll on the loved ones of this person as they try to remedy the situation.
Community reinforcement and family training (CRAFT) has been shown to have success in helping individuals with substance use disorders (SUDs) reduce their use and get into treatment. It also shows friends and family how to better communicate with their addicted loved ones.
What Is CRAFT?
CRAFT is a set of therapeutic techniques taken from the community reinforcement approach (CRA) and applied to the substance abusing population. Rather than targeting the person with addiction directly, the CRAFT method works with their concerned significant others (CSOs) so that they can assist the identified patients (IPs).
The CRAFT approach aids CSOs by:
- Teaching them to modify their usual behaviors towards, reactions to, and expectations of the IP.
- Reducing or eliminating current substance use and addictive behaviors in the IP.
- Helping to motivate the IP to seek treatment.
- Showing them the importance of self-care as they manage concerns with the IP and seek to maintain or rebuild feelings of happiness.
The final point is elemental to the goal of CRAFT because CSOs are exposed to high levels of stress and anxiety as a result of the IP’s addiction. Some of the hardships associated with being the loved one of someone with a substance use disorder include:
- Increased risk of violence, as well as mental, verbal, and physical abuse.
- Higher tendencies toward negative financial situations stemming from attempts to help the IP or the IP stealing money directly.
- Poor relationship satisfaction with the IP.
- Other social and relationship issues with other members of the community.
- More mental health complaints, such as depression, anxiety, and low self-esteem.
- Increased rates of physical health problems.
The CRAFT method allows CSOs to build feelings of confidence and power in order to actively assist the IP in moving addiction treatment forward.
Understanding the Principles of CRAFT and the CRA
Since many of CRAFT’s principles are grounded in the community reinforcement approach, it is necessary to have a solid understanding of the two. The CRA is a therapeutic style based in the ideas of cognitive behavioral therapy. The thought behind the CRA is that rewards and punishments highly influence the level of a person’s substance use. With this being true, the CRA works to change these reinforcements and punishments in order to decrease or end substance use altogether. The CRA will inspect aspects of:
- Family relationships.
- Social relationships.
- Work-related supports.
- Other community-based relationships.
Originally developed as a treatment for people abusing alcohol, the CRA became a viable option for those with a range of addictions and drug abuse problems. CRA treatment has been effective for inpatient, outpatient, and day treatment populations. It utilizes 8 procedures to adjust the contingencies that the client experiences.
8 Procedures to Adjust Contingencies
1. Functional Analysis
This is the process of understanding all of the factors present that trigger or lead to substance use, the thoughts and feelings experienced during drug or alcohol use, and the positive and negative consequences of use. By gathering this information, the treatment team can begin formulating a plan of action based on current aspects of a person’s use.
2. Sobriety Sampling
Since the notion of lifelong abstinence can be overwhelming and lead to reluctance to enter treatment, the goal of the CRA is to establish finite periods of time during which the IP to commits to sobriety. During this time, the systems rewarding addiction are discussed and coping skills are developed. Before the period ends, the team will meet to discuss the positives of continuing the duration of sobriety.
3. Treatment Plan
The IP is given an inventory to rate their happiness, and based on these responses, they establish goals that are attainable, clear, and able to be measured.
4. Behavioral Skills Training
With the information gathered from the previous steps, areas of improvement are identified, and a plan of action is developed. Typical skills include problem-solving, communication, and substance refusal. By developing these skills, the IP will be in a better position to change the contingencies around them.
5. Job Skills
The CRA will aid in the process of finding or maintaining employment, but community-based treatment goes beyond this. In this step, the CRA will work to ensure that the job is desirable and pleasurable for the IP.
6. Social/Recreational Counseling
If the IP’s life was previously built around substance use, abstinence will bring about excessive free time, and IPs may not know what to do with this. The CRA helps to identify and encourage appropriate social and recreational activities.
7. Relapse Prevention
Using the identified triggers of use, relapse prevention will focus on predicting risky situations and planning ways to manage these.
8. Relationship Counseling
The IP will work with their CSO to assess the current state of their relationship and identify how they would like it to be in the future. Focus on addressing issues of the past is minimized and replaced with daily positive experiences in the relationship.
Components of CRAFT
In CRAFT, the therapist will teach CSOs about the basis of the CRA, as described above. It can be taught in a support group setting comprised of approximately 7 hour-long sessions. Each session will focus on one of the aspects below.
CSOs will learn to:
Decide if they are a good match for the CRAFT treatment model.
The major factor here will be the risk of new or continued violence from the IP towards the CSO if treatment is initiated.
Appropriately employ a functional analysis as outlined in #1 above.
Much of the desired change will come from accurately identifying triggers and consequences of drug use, so it is imperative for the CSO to perceive the environment correctly. Many CSOs will have distorted views of their role in their loved one’s substance use. The CRAFT method will improve this area.
Improve their communication style with the IP.
Over time, communication with the IP has likely become more aggressive, more passive, or almost absent. This communication training will bring the focus back to assertive communication that is clear, direct, and respectful of all parties.
Provide positive reinforcement for sober behaviors.
Too often, relationships between CSOs and IPs are based on punishments, as the CSO will become upset, yell, or display guilt regarding the drug use. This will make the relationship less desirable for both people. The CRAFT approach works to reverse this trend by encouraging CSOs to consistently deliver reinforcement in the form of tangible rewards or verbal praise. This will rebuild the relationship and increase the likelihood of these behaviors continuing.
Allow natural consequences for using behaviors.
Rather than feeling the need to administer punishment, CRAFT uses the notion of natural consequences to reduce the likelihood of using behaviors. IPs will face issues with the law, health consequences, social issues, and work problems from using. CRAFT teaches that this is enough to end the behaviors.
Begin looking inward to find ways to improve their own life.
If the CSO spends too much time interested in the well-being of the IP, they lose their individual identity. CSOs are encouraged to engage in more pleasurable activities and reward their own positive behaviors.
Identify the best opportunities and ways to mention treatment to the IP.
An intervention is based on high levels of pressure persuading the IP into treatment. CRAFT teaches the CSO to be aware of times and places that reveal an opening for treatment. When a situation presents, the CSO will mention program options while having a plan for a “rapid intake” established so that treatment can move forward quickly and any doubt felt by the IP is avoided.
Be prepared and patient.
If the IP enters treatment that utilizes family supports—like CRAFT—it will be up to the CSO to remain interested and engaged in the process in order to act as an aid. Patience is needed at this stage as well, since the IP may be reluctant to try treatment or refuse directly. Additionally, the IP may initially agree to treatment, only to end it early or ignore recommendations. At this point, the CSO will benefit from reassessing and restarting the process of CRAFT while putting more emphasis on their own needs and well-being.
CRAFT’s wider success is inhibited by a limited knowledge of CRAFT among the public and a limited number of therapists trained to use the style. It may be a newer model of treatment, but it has already found success in studies done on alcohol use and substance use populations. CRAFT is backed by evidence to make a positive impact on the IP as well as the CSO.
Find Community Reinforcement and Family Training Near Me
Treatment can start anyone battling a substance use problem on the path to a happier and healthier life. Rehab programs are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for facilities. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.
American Addiction Centers (AAC) is a leading treatment provider and has trusted rehab facilities across the country. To find a program that incorporates CRAFT or any other therapy type, please call us free at . A caring advisor will walk you through your options.
AAC maintains a strong partnership with a large group of health insurance companies at our addiction treatment facilities. Start the journey to recovery and find out instantly using the form below whether your insurance provider may be able to cover all or part of the cost of rehab and associated therapies.