Community Reinforcement Approach and Family Training and Community reinforcement approach and family training: Difference between pages

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'''Community Reinforcement Approach (CRA)''' and '''Community Reinforcement Approach and Family Training (CRAFT)''' are [[behavior therapy]] approaches to treating [[substance abuse]].
'''Community reinforcement approach (CRA)''' and '''Community reinforcement approach and family training (CRAFT)''' are [[behavior therapy]] approaches to treating [[substance abuse]].


== About ==
== About ==


The '''Community Reinforcement Approach (CRA)''', "originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of [[substance use disorders]] for more than 35 years."<ref name="MeyersRoozenSmith2011p380">
The '''Community reinforcement approach (CRA)''', "originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of [[substance use disorders]] for more than 35 years."<ref name="MeyersRoozenSmith2011p380">
{{cite journal
{{cite journal
| last = Meyers
| last = Meyers
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</ref>
</ref>


'''Community Reinforcement Approach and Family Training (CRAFT)''' "works through family members to engage treatment­-refusing individuals into treatment."<ref name="MeyersRoozenSmith2011p380" />
'''Community reinforcement approach and family training (CRAFT)''' "works through family members to engage treatment­-refusing individuals into treatment."<ref name="MeyersRoozenSmith2011p380" />


'''Adolescent Community Reinforcement Approach (A-CRA)''' "targets adolescents with substance use problems and their caregivers."<ref name="MeyersRoozenSmith2011p380" />
'''Adolescent community reinforcement approach (A-CRA)''' "targets adolescents with substance use problems and their caregivers."<ref name="MeyersRoozenSmith2011p380" />


CRA and CRAFT programs are not widespread amongst [[addiction]] counselors. Instead, many [[addiction]] counselors are tied to a [[Twelve-step program|twelve-step]] model that has much less research support. Recent trends by [[National Institute on Drug Abuse|NIDA]] has been to help deploy these intervention techniques. Several successful programs are underway.<ref>Purvis, G., and MacInnis, D.M. (2009). Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic. ''Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine'', 2 (1), 33–44 [http://baojournal.com/Health%20Journal/JBAHSFM-2-1.pdf BAO]</ref>
CRA and CRAFT programs are not widespread amongst [[addiction]] counselors. Instead, many [[addiction]] counselors are tied to a [[Twelve-step program|twelve-step]] model that has much less research support. Recent trends by [[National Institute on Drug Abuse|NIDA]] has been to help deploy these intervention techniques. Several successful programs are underway.<ref>Purvis, G., and MacInnis, D.M. (2009). Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic. ''Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine'', 2 (1), 33–44 [http://baojournal.com/Health%20Journal/JBAHSFM-2-1.pdf BAO]</ref>

Revision as of 06:07, 21 January 2014

Community reinforcement approach (CRA) and Community reinforcement approach and family training (CRAFT) are behavior therapy approaches to treating substance abuse.

About

The Community reinforcement approach (CRA), "originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of substance use disorders for more than 35 years."[1]

Community reinforcement approach and family training (CRAFT) "works through family members to engage treatment­-refusing individuals into treatment."[1]

Adolescent community reinforcement approach (A-CRA) "targets adolescents with substance use problems and their caregivers."[1]

CRA and CRAFT programs are not widespread amongst addiction counselors. Instead, many addiction counselors are tied to a twelve-step model that has much less research support. Recent trends by NIDA has been to help deploy these intervention techniques. Several successful programs are underway.[2]

History

CRA was designed by Nate Azrin in the early 1970s:

The most influential behaviorist of all times, B. F. Skinner, largely considered punishment to be an ineffective method for modifying human behavior (Skinner 1974). Thus it was no surprise that, many years later, research discovered that substance use disorder treatments based on confrontation were largely ineffective in decreasing the use of alcohol and other substances (Miller and Wilbourne 2002, Miller et al. 1998). Nate Azrin already was convinced of this back in the early 1970s, when he designed an innovative treatment for alcohol problems: the Community Reinforcement Approach (CRA). Azrin believed that it was necessary to alter the environment in which people with alcohol problems live so that they received strong reinforcement for sober behavior from their community, including family, work, and friends. As part of this strategy, the program emphasizes helping clients discover new, enjoyable activities that do not revolve around alcohol, and teaching them the skills necessary for participating in those activities.[1]

Benefits

CRAFT

Robert J. Meyers, Ph.D. writes about the benefits and influence that concerned family members—called Concerned Significant Others (CSOs)—have in treatment of the substance user, and the benefits for themselves:

The Community Reinforcement Approach and Family Training (CRAFT) intervention … method was developed with the belief that since family members can, and do make important contribution[s] 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 who is in denial to submit to treatment. In addition, it is often the substance user who reports that family pressure or influence is the reason [they] 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.[3]

CRA Procedures

The following CRA procedures and descriptions are from Meyers, Roozen, and Smith:[4]

  1. Functional Analysis of Substance - explores the antecedents and positive and negative consequences of a client’s substance use.
  2. Sobriety Sampling - is a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence.
  3. CRA Treatment Plan - Tools:
    1. Happiness Scale.
    2. Goals of Counseling form.
  4. Behavior Skills Training - teaches three basic skills through instruction and role-playing:
    1. Problem-solving - break overwhelming problems into smaller ones in order to address them.
    2. Communication skills - a positive interaction style.
    3. Drink/drug refusal training - identify high-risk situations and teaches assertiveness.
  5. Job Skills Training - provides basic steps for obtaining and keeping a valued job.
  6. Social and Recreational Counseling - provides opportunities to sample new social and recreational activities.
  7. Relapse Prevention - teaches clients how to identify high-risk situations and to anticipate and cope with a relapse.
  8. Relationship Counseling - focuses on improving the interaction between the client and his or her partner.

Research

CRA

The community reinforcement approach has considerable research supporting it as effective.[5][6] Community reinforcement has both efficacy and effectiveness data.[7] Started in the 1970s, community reinforcement approach is a comprehensive operant program built on a functional assessment of a client's drinking behavior and the use of positive reinforcement and contingency management for non-drinking.[8] When combined with disulfiram (an aversive procedure) community reinforcement showed remarkable effects.[9] One component of the program that appears to be particularly strong is the non-drinking club.[10] Applications of community reinforcement to public policy has become the recent focus of this approach.[11]

CRAFT

An off-shoot of the community reinforcement approach is the community reinforcement approach and family training.[5] This program is designed to help family members of substance abusers feel empowered to engage in treatment. Community reinforcement approach and family training (CRAFT) has helped family members to get their loved ones into treatment.[5][12] The rates of success have varied somewhat by study but seem to cluster around 70%.[12][13][14][15] CRAFT is one of the only family-aimed treatments with proven results for getting people with drug or alcohol problems into treatment.[12] The program uses a variety of interventions based on functional assessment including a module to prevent domestic violence. Partners are trained to use positive reinforcement, various communication skills and natural consequences.

Outcomes

The CRAFT program has been demonstrated in Meyers' research to be more effective than the Vernon Johnson type intervention or Al-Anon, with less negative side-effects and better outcomes, whether or not the substance abuser enters treatment. [16] [17]

Alcohol Abusers Intervention

From an article on the American Psychology Association (APA) website about the success of CRAFT in substance abuse treatment and intervention, here are the success outcomes for engaging drinkers into treatment:

  1. 64% - CRAFT
  2. 23% - Johnson Intervention
  3. 13% - Al-Anon

From the article:

Sisson and Azrin (1986) recruited 12 adult women with an alcoholic husband, brother, or father and randomly assigned them either to an early version of CRAFT or to a traditional intervention. Results indicated that CRAFT was considerably more successful in getting the persons with substance abuse into treatment and reducing their alcohol consumption in comparison to the Al-Anon group. Miller et al. (1999) conducted a controlled comparison of CRAFT, the Johnson Intervention, and Al-Anon facilitation (TSF) that randomized 130 caregivers of problem drinkers to receive 12 hours of contact in one of the three conditions. CRAFT and TSF had better retention than the Johnson Intervention. Consistent with previous studies, participants tended to drop out of the latter intervention in order to avoid the family confrontation with the drinker. The CRAFT intervention also engaged substantially more drinkers into treatment (64% vs 23% Johnson and 13% TSF).[18]

Drug Abusers Intervention

From the same article on the American Psychology Association (APA) website about the success of CRAFT in substance abuse treatment and intervention, here are the success outcomes for persons abusing drugs to enter treatment (the success outcomes were nearly the same as the alcohol abuse outcomes):

  1. 64% - CRAFT
  2. 17% - Caregivers' Twelve-step Self-help Group (TSG)

From the article:

Kirby et al. (1999) randomly assigned 32 caregivers of drug users to CRAFT or a 12-step self-help group (TSG). Caregivers who were assigned to CRAFT attended more sessions than those in TSG and were more likely to complete a full course of counseling during which the persons abusing drugs were far more likely to enter treatment (64% vs 17%). Reductions in drug use occurred during the study, but there was no group x time interaction. Meyers et al. (2002) replicated and extended those findings with drug users with similar positive effects on engagement of the drug abusing family members in treatment.[18]

Note: When the articles said there was "no group x time interaction," it simply means the CRAFT outcome (64%) and the TSF outcome (17%) remained the same over time, even though there was a reduction in drug use during the study.

Professional Organizations

Association for Behavior Analysis International

The Association for Behavior Analysis International (ABAI) has a special interest group in clinical behavior analysis and behavioral counseling ABA:I. The association is developing a special interest group for behavioral pharmacology and addictions. The association serves as the core intellectual home for behavior analysts.[19][20] The ABAI sponsors two conferences per year—one in the U.S., and one internationally.

Association for Behavioral and Cognitive Therapies

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, ABCT has a special interest group on addictions.

The World Association for Behavior Analysis

The World Association for Behavior Analysis, a subsidiary of the Behavior Analyst Online Organization, offers a certification in behavior therapy that includes Community Reinforcement as well as Community Reinforcement and Family Training as content areas for the test [4].

See also

References

  1. ^ a b c d Meyers, Robert J.; Roozen, Hendrik G.; Smith, Jane Ellen (2011). "The Community Reinforcement Approach: An Update of the Evidence". Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism. 33 (4). National Institute on Alcohol Abuse and Alcoholism: 380. Retrieved January 20, 2014.
  2. ^ Purvis, G., and MacInnis, D.M. (2009). Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic. Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine, 2 (1), 33–44 BAO
  3. ^ "CRAFT". www.robertjmeyersphd.com. Robert J. Meyers, Ph.D. Retrieved 2014-01-20.
  4. ^ Meyers, Robert J.; Roozen, Hendrik G.; Smith, Jane Ellen (2011). "The Community Reinforcement Approach: An Update of the Evidence". Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism. 33 (4). National Institute on Alcohol Abuse and Alcoholism: 382–384. Retrieved January 20, 2014.
  5. ^ a b c Smith, J.E., Milford, J.L. & Meyers, R.J. (2004) CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals. The Behavior Analyst Today, 5 (4), Page 391–403 [1]
  6. ^ JANE E. BRODY (February 4, 2013). "Effective Addiction Treatment". New York Times. Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, "Get Your Loved One Sober," with co-author Brenda L. Wolfe.
  7. ^ Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R.J., Delaney, Harold D., and Smith, J.E. (2009). Community Reinforcement and Family Training (CRAFT): An Effectiveness Study. Journal of Behavior Analysis of Sports, Health Fitness and Behavioral Medicine, 2 (1), [2]
  8. ^ Hunt, G.M. & Azrin, N.H. (1973). A community-reinforcement approach to alcoholism. Behavior Research and Therapy, 11, 91–104.
  9. ^ Azrin, N.H., Sisson, R.W., Meyers, R.J., & Godley, M.D. (1982). Alcoholism treatment by disulfiram and community reinforcement therapy. Journal of Behavior Therapy and Experimental Psychiatry, 3, 105–112.
  10. ^ Mallams, J.H., Godley, M.D., Hall, G.M., & Meyers, R.J. (1982). A social-systems approach to resocializing alcoholics in the community. Journal of Studies on Alcohol, 43, 1115–1123.
  11. ^ Jaime L. Milford, Julia L. Austin, and Jane Ellen Smith (2007): Community Reinforcement and the Dissemination of Evidence-based Practice: Implications for Public Policy. International Journal of Behavioral Cconsultation and Therapy, 3 (1), 77–87 [3].
  12. ^ a b c Meyers, R.J., Smith, J.E. & Lash, D.N. (2005): A Program for Engaging Treatment-Refusing Substance Abusers into Treatment: CRAFT. IJBCT, 1 (2), Page 90–100 BAO
  13. ^ Kirby, K.C., Marlowe, D.B., Festinger, D.S., Garvey, K.A., & LaMonaca, V. (1999). Community reinforcement training for family and significant others of drug abusers: Aunilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence, 56, 85–96.
  14. ^ Meyers, R.J., Miller, W.R., Hill, D.E., & Tonigan, J.S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10, 1–18.
  15. ^ Miller, W.R., Meyers, R.J., & Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688–697.
  16. ^ Smith, J.E. & Meyers, R.J. (2004) Motivating Substance Abusers to Enter Treatment: Working with Family Members; Guilford Press
  17. ^ Meyers, RJ & Wolfe, B. (2004) Get Your Loved One Sober: Alternative to Nagging, Pleading and Threatening by Meyers, Hazelden Press
  18. ^ a b "CRAFT". American Psychology Association. Retrieved 2014-01-20.
  19. ^ Twyman, J.S. (2007). A new era of science and practice in behavior analysis. Association for Behavior Analysis International: Newsletter, 30 (3), 1–4.
  20. ^ Hassert, D.L., Kelly, A.N., Pritchard, J.K. & Cautilli, J.D. (2008). The Licensing of Behavior Analysts:Protecting the profession and the public. Journal of Early and Intensive Behavior Intervention, 5 (2), 8–19 BAO

External links

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