How To Get Your Loved One Sober: An Evidence Based Intervention - PowerPoint PPT Presentation


Title: How To Get Your Loved One Sober: An Evidence Based Intervention


1
How To Get Your Loved One Sober An Evidence
Based Intervention
  • Robert J. Meyers, Ph.D.
  • Research Associate Professor in Psychology,
    Clinical Research Branch, Center on Alcoholism,
    Substance Abuse Addictions (CASAA), University
    of N. M.

Important Legal DisclaimerAny reproduction or
modification of all or part of this presentation,
regardless of purpose, is strictly prohibited
unless written authorization has been obtained
beforehand by U.S. Journal Training, Inc. and
Health Communications, Inc.
2
CRAFT
  • Community Reinforcement and Family Training
  • Created Developed by
  • Robert J. Meyers, Ph.D.
  • Jane Ellen Smith, Ph.D.
  • Department of Psychology, University of New
    Mexico Center on Alcoholism Substance Abuse
    and other Addictions (CASAA), University of New
    Mexico

3
(No Transcript)
4
Alphabet Soup
  • CRAFT Community Reinforcement and Family
    Training
  • CRA Community Reinforcement
  • Approach
  • CSO Concerned Significant Other
  • IP Identified Patient
  • (the substance user)
  • Engagement Entering Treatment

5
Rationale for Working with CSOs
  • Substance abusers often report that family
    pressure prompted treatment seeking
  • CSOs can influence substance abusers behavior
    due to extensive contact
  • CRA has always viewed CSOs as crucial
    collaborators
  • CSOs also need help (victims of violence, verbal
    assaults, problems, marital conflict, etc. etc.
    etc.)

6
130 CSOs randomly assigned to 1 of 3 interventions
  • Al-Anon Facilitation Therapy (AFT)
  • Johnson Institute Intervention (JII)
  • Community Reinforcement and Family Training
    (CRAFT)

7
Al-Anon Facilitation Therapy
  • 12 sessions (1 hr each)
  • Purpose
  • -get CSO to attend Al-Anon mtgs
  • -help CSO accept powerlessness
  • -emphasize detachment self-care
  • Supervisor Joseph Nowinski, Ph.D.

8
Johnson Institute Intervention
  • 6 sessions (2 hrs each)
  • 4 sessions of preparation and training
  • 1 family confrontation meeting
  • 1 post-intervention evaluation
  • Supervisor A. Lane Leekman, M.D.

9
CRAFT
  • 12-sessions (1 hr each)
  • Purpose
  • Empower CSO to influence change
  • Train CSO in behavior change skills
  • Improve CSOs quality of life
  • Prepare CSO for treatment engagement
  • Supervisor Robert J. Meyers, Ph.D.

10
Characteristics of CSOs
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
CRAFT D1
  • The Demonstration Project
  • Meyers, Miller, Hill,
  • Tonigan (1999)

16
Engagement 74 (46/62) of the resistant drug
abusers entered treatment.
17
CRAFT - D2Treatment Engagement
  • CRAFT 59
  • CRAFT aftercare 77 combined 67
  • Al-Nar/FT 29
  • 3 group comparison p lt.0006
  • no difference between 2 CRAFT conditions

18
CRAFT STUDIES
19
Conclusions
  • You can raise the bottom!
  • Initially unmotivated/resistant problem
    drinkers/drug users can be engaged in treatment
    through CRAFT-trained CSOs

20
More Conclusions
  • CSO functioning improves regardless of engagement
    status
  • Primary reason for failure of the Johnson
    Institute approach Unwillingness of the family
    to proceed with the confrontation

21
(No Transcript)
22
CRAFT Procedures
  • Motivational Focus
  • Domestic Violence Precautions
  • Functional Analysis of IPs Using Behavior
  • Communication Training
  • Use of Positive Reinforcement

23
CRAFT Procedures
  • Time Out from Positive Reinforcement
  • Natural Consequences for Using
  • Reinforcers for the CSO
  • Suggestion of Treatment to the User
  • Rapid Intake

24
CRAFT Program Description for CSO
  • 3 Major Goals
  • reduce loved ones harmful drinking
  • engage loved one into treatment
  • improve the functioning of CSO
  • (emotional, physical, relationship)

25
CRAFT Induction
  • Client focused
  • Positive reinforcement
  • Clarify assessment information
  • Begin to establish reinforcers
  • Describe the Program What is expected

26
Initial Meeting Motivational Strategies
  • Let the CSO express frustration with IPs
    substance abuse
  • Have CSO describe problems created by the
    drinking/drug use
  • Show empathy and support build rapport
  • Demonstrate an understanding of the problem

27
Initial Meeting Motivational Strategies
  • Explore CSOs past attempts to help stop the
    substance abuse
  • Begin to identify problem areas
  • Present positive expectations - build hope
  • Place responsibility where it belongs
  • Discuss confidentiality and safety
  • Review the assessment material

28
CRAFT Treatment
  • Domestic Violence PrecautionsAssess the
    Presence of Violence
  • Assess Level of Social Support
  • Develop a Protection Plan
  • Open expression of feelings in session
  • Recognition of triggers or Red Flags to
  • violence
  • Developing safer Red Flag responses
  • Advocacy and referral

29
Drinking/Using Road Map The Functional Analysis
  • CSOs wealth of information
  • CSOs behavior is worth examining
  • Identify triggers for the drinking/using
  • Describe the drinking/using behavior
  • List the consequences the IP experiences for
    alcohol/drug use

30
CRAFT Treatment
  • Communication Training
  • Role-Playing
  • Use of Positive Reinforcement
  • Enabling vs. Positive Reinforcement
  • Time Out from Positive Reinforcement The Big
    Chill
  • Problem Solving

31
CRAFT Treatment
  • Identifying the Natural Consequences for Using
  • Allowing the Natural Consequences for Using
  • Increasing the CSOs Quality of Life Finding CSO
    Reinforcers
  • get by with a little help from my friends

32
Suggestion of Treatment Overview
  • Prepare for Rapid Intake (for IP to be seen
    within 24-48 hrs.)
  • Role-play the conversation (use positive
    communication)
  • Include important motivational hooks
  • Discuss windows of opportunity

33
Basic Questions to Consider
  • CSOs past engagement attempts that have been the
    most successful?
  • Time, place, day the IP is most approachable
    about requests in general?
  • Most likely reason the IP would enter treatment
    (for the relationship, kids, to keep his/her
    job)?
  • Most influential person to talk with IP about
    treatment?

34
Motivational Hooks
  • Ask IP to informally meet CSOs therapist
  • Mention having ones own (a different) therapist
  • Invite IP to sample treatment
  • State that the IP wont have to do anything
    he/she doesnt want to
  • Explain that theres no confrontation/judgment
  • Mention that IP can focus on topics besides just
    alcohol/drugs (e.g., job, depression)
  • Tie in IPs reinforcers

35
Windows of Opportunity
  • Is IP approachable when feeling remorseful for a
    drug-related crisis?
  • Is IP acting upset upon overhearing a negative
    remark about his substance use?
  • Is IP asking about whats happening in the CSOs
    therapy?
  • Is IP inquiring about why the CSOs behavior has
    changed lately?

36
For further information on CRAFT
  • Email bmeyers_at_unm.edu
  • Web page http//robertjmeyersphd.com
  • Phone 505-925-2361 UNM
  • Phone 505-270-6503 RJM Assoc.
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How To Get Your Loved One Sober: An Evidence Based Intervention

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Developing safer Red Flag responses. Advocacy and referral. Drinking/Using Road Map: ... the IP would enter treatment (for the relationship, kids, to keep his/her job) ... – PowerPoint PPT presentation

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Title: How To Get Your Loved One Sober: An Evidence Based Intervention


1
How To Get Your Loved One Sober An Evidence
Based Intervention
  • Robert J. Meyers, Ph.D.
  • Research Associate Professor in Psychology,
    Clinical Research Branch, Center on Alcoholism,
    Substance Abuse Addictions (CASAA), University
    of N. M.

Important Legal DisclaimerAny reproduction or
modification of all or part of this presentation,
regardless of purpose, is strictly prohibited
unless written authorization has been obtained
beforehand by U.S. Journal Training, Inc. and
Health Communications, Inc.
2
CRAFT
  • Community Reinforcement and Family Training
  • Created Developed by
  • Robert J. Meyers, Ph.D.
  • Jane Ellen Smith, Ph.D.
  • Department of Psychology, University of New
    Mexico Center on Alcoholism Substance Abuse
    and other Addictions (CASAA), University of New
    Mexico

3
(No Transcript)
4
Alphabet Soup
  • CRAFT Community Reinforcement and Family
    Training
  • CRA Community Reinforcement
  • Approach
  • CSO Concerned Significant Other
  • IP Identified Patient
  • (the substance user)
  • Engagement Entering Treatment

5
Rationale for Working with CSOs
  • Substance abusers often report that family
    pressure prompted treatment seeking
  • CSOs can influence substance abusers behavior
    due to extensive contact
  • CRA has always viewed CSOs as crucial
    collaborators
  • CSOs also need help (victims of violence, verbal
    assaults, problems, marital conflict, etc. etc.
    etc.)

6
130 CSOs randomly assigned to 1 of 3 interventions
  • Al-Anon Facilitation Therapy (AFT)
  • Johnson Institute Intervention (JII)
  • Community Reinforcement and Family Training
    (CRAFT)

7
Al-Anon Facilitation Therapy
  • 12 sessions (1 hr each)
  • Purpose
  • -get CSO to attend Al-Anon mtgs
  • -help CSO accept powerlessness
  • -emphasize detachment self-care
  • Supervisor Joseph Nowinski, Ph.D.

8
Johnson Institute Intervention
  • 6 sessions (2 hrs each)
  • 4 sessions of preparation and training
  • 1 family confrontation meeting
  • 1 post-intervention evaluation
  • Supervisor A. Lane Leekman, M.D.

9
CRAFT
  • 12-sessions (1 hr each)
  • Purpose
  • Empower CSO to influence change
  • Train CSO in behavior change skills
  • Improve CSOs quality of life
  • Prepare CSO for treatment engagement
  • Supervisor Robert J. Meyers, Ph.D.

10
Characteristics of CSOs
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
CRAFT D1
  • The Demonstration Project
  • Meyers, Miller, Hill,
  • Tonigan (1999)

16
Engagement 74 (46/62) of the resistant drug
abusers entered treatment.
17
CRAFT - D2Treatment Engagement
  • CRAFT 59
  • CRAFT aftercare 77 combined 67
  • Al-Nar/FT 29
  • 3 group comparison p lt.0006
  • no difference between 2 CRAFT conditions

18
CRAFT STUDIES
19
Conclusions
  • You can raise the bottom!
  • Initially unmotivated/resistant problem
    drinkers/drug users can be engaged in treatment
    through CRAFT-trained CSOs

20
More Conclusions
  • CSO functioning improves regardless of engagement
    status
  • Primary reason for failure of the Johnson
    Institute approach Unwillingness of the family
    to proceed with the confrontation

21
(No Transcript)
22
CRAFT Procedures
  • Motivational Focus
  • Domestic Violence Precautions
  • Functional Analysis of IPs Using Behavior
  • Communication Training
  • Use of Positive Reinforcement

23
CRAFT Procedures
  • Time Out from Positive Reinforcement
  • Natural Consequences for Using
  • Reinforcers for the CSO
  • Suggestion of Treatment to the User
  • Rapid Intake

24
CRAFT Program Description for CSO
  • 3 Major Goals
  • reduce loved ones harmful drinking
  • engage loved one into treatment
  • improve the functioning of CSO
  • (emotional, physical, relationship)

25
CRAFT Induction
  • Client focused
  • Positive reinforcement
  • Clarify assessment information
  • Begin to establish reinforcers
  • Describe the Program What is expected

26
Initial Meeting Motivational Strategies
  • Let the CSO express frustration with IPs
    substance abuse
  • Have CSO describe problems created by the
    drinking/drug use
  • Show empathy and support build rapport
  • Demonstrate an understanding of the problem

27
Initial Meeting Motivational Strategies
  • Explore CSOs past attempts to help stop the
    substance abuse
  • Begin to identify problem areas
  • Present positive expectations - build hope
  • Place responsibility where it belongs
  • Discuss confidentiality and safety
  • Review the assessment material

28
CRAFT Treatment
  • Domestic Violence PrecautionsAssess the
    Presence of Violence
  • Assess Level of Social Support
  • Develop a Protection Plan
  • Open expression of feelings in session
  • Recognition of triggers or Red Flags to
  • violence
  • Developing safer Red Flag responses
  • Advocacy and referral

29
Drinking/Using Road Map The Functional Analysis
  • CSOs wealth of information
  • CSOs behavior is worth examining
  • Identify triggers for the drinking/using
  • Describe the drinking/using behavior
  • List the consequences the IP experiences for
    alcohol/drug use

30
CRAFT Treatment
  • Communication Training
  • Role-Playing
  • Use of Positive Reinforcement
  • Enabling vs. Positive Reinforcement
  • Time Out from Positive Reinforcement The Big
    Chill
  • Problem Solving

31
CRAFT Treatment
  • Identifying the Natural Consequences for Using
  • Allowing the Natural Consequences for Using
  • Increasing the CSOs Quality of Life Finding CSO
    Reinforcers
  • get by with a little help from my friends

32
Suggestion of Treatment Overview
  • Prepare for Rapid Intake (for IP to be seen
    within 24-48 hrs.)
  • Role-play the conversation (use positive
    communication)
  • Include important motivational hooks
  • Discuss windows of opportunity

33
Basic Questions to Consider
  • CSOs past engagement attempts that have been the
    most successful?
  • Time, place, day the IP is most approachable
    about requests in general?
  • Most likely reason the IP would enter treatment
    (for the relationship, kids, to keep his/her
    job)?
  • Most influential person to talk with IP about
    treatment?

34
Motivational Hooks
  • Ask IP to informally meet CSOs therapist
  • Mention having ones own (a different) therapist
  • Invite IP to sample treatment
  • State that the IP wont have to do anything
    he/she doesnt want to
  • Explain that theres no confrontation/judgment
  • Mention that IP can focus on topics besides just
    alcohol/drugs (e.g., job, depression)
  • Tie in IPs reinforcers

35
Windows of Opportunity
  • Is IP approachable when feeling remorseful for a
    drug-related crisis?
  • Is IP acting upset upon overhearing a negative
    remark about his substance use?
  • Is IP asking about whats happening in the CSOs
    therapy?
  • Is IP inquiring about why the CSOs behavior has
    changed lately?

36
For further information on CRAFT
  • Email bmeyers_at_unm.edu
  • Web page http//robertjmeyersphd.com
  • Phone 505-925-2361 UNM
  • Phone 505-270-6503 RJM Assoc.
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