Treating the concerned family members of alcohol and drug users : a randomized study

The Community Reinforcement and Family Training (CRAFT) approach is an empirically-supported treatment for the concerned significant others (referred to as CSOs) of treatment-refusing substance users (referred to as identified patients or IPs). Previous studies have examined the efficacy of CRAFT when delivered via individual therapy. The goal of the current study was to examine two less-costly alternatives to the individual CRAFT approach. Forty concerned family members of treatment-refusing alcohol and drug users were randomized to either Group CRAFT or a Self-Directed CRAFT condition in which CSOs received a CRAFT self-help book. In both conditions, free treatment was available to substance users who agreed to enter treatment within a six-month treatment window. Two sets of hypotheses were tested: (1) that CSOs in both the Group and Self-Directed CRAFT conditions would engage their loved ones into treatment and report increases in CSO, family, and IP functioning from the baseline to the viii three and six-month follow-up interviews; and (2) that participants in the Group condition would demonstrate greater increases in these three domains and would have higher engagement rates than CSOs in the Self-Directed condition. Results indicated that both conditions were successful in engaging treatment-refusing IPs into treatment, with no statistically significant difference between Group and Self-Directed CRAFT. Of the CSOs in the Group CRAFT condition, 60% engaged their loved one into treatment, compared to 40% in Self-Directed CRAFT. Of the CSOs in the Group condition who received at least one session of group therapy, 71% engaged their IP into treatment. CSOs in both conditions reported significant improvements in family cohesion and conflict, IP substance-related consequences, and IP total days of substance use at the three and six-month follow-up. Effect sizes comparing the engagement rates of previous individual CRAFT studies with the current Group CRAFT engagement rates were in the small range (.05 - .13) and effect sizes comparing individual CRAFT and Self-Directed CRAFT engagement rates were in the small to moderate range (.23 - .31).American Psychological Association; Graduate Research and Development Grant; Student Research and Allocations GrantPsychologyDoctoralUniversity of New Mexico. Dept. of PsychologyMcCrady, BarbaraMiller, WilliamTonigan, J. ScottMeyers, RobertSmith, JaneBogenschutz, Michae