By Darlene Lancer, JD, LMFT
How to Help Addicts Get Treatment
Community Reinforcement and Family Training (CRAFT) is a program developed in the 70s that has been effective in helping a loved one of an addict (“Concerned Significant Other” – CSO) with a substance use disorder who refuses treatment to motivate them to start treatment. The program has been more than twice as effective as interventions, Al-Anon, and Nar-Anon in helping CSOs get their loved ones to treatment.1 CRAFT has been helpful for parents and developed a screening program to use with adolescents. CSOs reported a sizeable reduction in their own physical symptoms, depression, anger, and anxiety as well.2
The CRAFT Program
CRAFT requires CSOs attend coaching sessions with CRAFT-trained professionals over 10-14 sessions. They learn to:
- Care for themselves and take back control of their lives.
- Reward themselves when they improve their circumstances.
- Understand triggers that lead to a loved one’s substance use.
- Reward a loved one for abstinence and pro-social behavior.
- Withdraw reinforcement and set boundaries for unhealthy behavior or substance abuse.
- Use positive assertive communication to improve interactions and to maximize their impact.
- Encourage a substance user to seek treatment.
- Spot signs that things might escalate to domestic violence.
- Support the addict and be patient during relapses.
Compared to 12-Steps Programs
Although we’re powerless over an addict’s ultimate behavior, we can create circumstances that influence someone’s choices. Unlike 12-Step programs, it uses behavioral modification and operant conditioning to motivate addicts. Rather than just stand by, CRAFT requires CSOs assertively communicate to addicts the consequences of their behavior. CSO’s are taught to praise and reward addicts and themselves for positive behavior. This approach is also helpful with narcissists.
Similar to 12-Step programs, CRAFT advocates CSOs:
- Have compassion and support for the addict.
- Do not pressure the addict to get treatment.
- Do not enable. It teaches what is enabling.
- Set boundaries for unwanted behavior more specifically than 12-Step programs, including for substance use.
- Practice detachment – not ignore the addict, but communicate in an assertive, non-reactive manner.
- Pursue their own goals and increase their individual happiness.
Drawbacks of the CRAFT Approach
Although CRAFT is effective in getting addicts to begin and participate in treatment, long-term abstinence as a result has not been validated. In the end it’s really up to the addict to maintain abstinence. The reinforcement of ongoing attendance in a 12-Step program can help addicts maintain sobriety. Most treatment programs incorporate 12-Step programs into their treatment plans.
Other problems with CRAFT are that it isn’t widely available and can be expensive. It requires effort and is laborious for CSOs.
Drawbacks of the 12-Step Approach for CSO’s
Al-Anon and Nar-Anon’s concepts of powerlessness and detachment can be taken to an extreme and interpreted to totally disengage from the addict. I don’t believe this is the original intention of the founders. Boundaries are recommended for self-protection. They can also be used to shape an addict’s behavior; not just, “I’ll take my own car to the party,” but, “I won’t be accompanying you to the party if you’re not sober.” Additionally, “I won’t watch TV with you if you’ve been drinking.” These might be viewed as “control” by 12-Steppers, but they’re boundaries only over the CSOs behavior. Also, CRAFT advocates rewarding positive behavior.
Detachment can also be misinterpreted as coldness or to mean no contact or no communication. Detaching is an emotional concept, meaning to not react. This is helpful. However, cutting off communication is not an effective boundary, except in extreme circumstances, such as violence. It’s far better to state what and why certain behavior won’t be tolerated. Doing so and then leaving an abusive conversation is more effective than stonewalling or silently withdrawing.
© 2022 Darlene Lancer
This article was originally published here, and is reprinted with the author’s kind permission.
Darlene Lancer is a Licensed Marriage and Family Therapist and expert on relationships and codependency. She’s the author Conquering Shame and Codependency: 8 Steps to Freeing the True You and Codependency for Dummies and six ebooks, including: 10 Steps to Self-Esteem, How To Speak Your Mind – Become Assertive and Set Limits, Dealing with a Narcissist: 8 Steps to Raise Self-Esteem and Set Boundaries with Difficult People and Freedom from Guilt and Blame – Finding Self-Forgiveness, also available on Amazon. Ms. Lancer has counseled individuals and couples for 30 years and coaches internationally. She’s a sought after speaker in media and at professional conferences. Her articles appear in professional journals and Internet mental health websites, including on her own, www.whatiscodependency.com, where you can get a free copy of “14 Tips for Letting Go.”