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Community Reinforcement and Family Training (CRAFT) is an evidence-based approach designed to help family members support their loved ones with substance use disorder (SUD). It focuses on positive reinforcement, behavioral change, and healthy communication to engage the individual in treatment without placing further strain on relationships. CRAFT has been shown to increase treatment entry and completion rates, making it a powerful tool for families seeking to improve their loved one’s recovery journey.
Family Support for Substance Use
Motivating and supporting your loved one’s journey through substance abuse and sobriety often feels confusing, hopeless, and stressful. That is why having a roadmap to guide concerned loved ones of individuals who abuse substances is such a powerful and necessary tool for families who are impacted by substance use disorder.
Community Reinforcement and Family Training (CRAFT) is an effective and evidence-based approach to helping family members get their loved one’s sober without placing further strain on relationships or allowing drugs and/or alcohol to further damage or consume their own lives. Given that family involvement significantly improves outcomes for people with substance use disorder, family members deserve to be equipped with the tools to motivate, communicate with, and cope with their loved one’s addiction.
What is CRAFT?
Due to the prevalence of substance use disorders in the United States (approximately 17.1% of the population) (SAMHSA: Substance Abuse and Mental Health Services Administration, 2023), it is a common experience to have a loved one who struggles with addiction. Because over 94% of adults with substance use disorder do not seek treatment (SAMHSA, 2023), it is also a common experience to feel burdened with improving your loved one’s relationship with drugs and/or alcohol.
Community Reinforcement and Family Training (CRAFT) is an evidence-based approach designed for those family members to assist them in engaging their alcohol-or-drug-abusing loved ones in treatment while simultaneously improving their relationship with them. So, not only does this program benefit people with addiction, but also their concerned significant others (CSOs).
CRAFT is a group therapy model that uses both psychoeducation, skill acquisition, and principles of behaviorism. The key strategies of CRAFT aim to change the CSO’s approach to their loved one’s drinking. All strategies are based in behavioral principles and key strategies include:
- Take domestic violence precautions during the transition to new ways of responding
- Develop an understanding of what leads to substance abuse episodes (personal functional analysis)
- Learn behavioral skills including communication skills
- Use positive reinforcement for nondrinking/using behavior
- Use time out from positive reinforcement for drinking/using behavior
- Allow natural consequences for drinking/using
- Develop reinforcers for themselves and their partners
- Learn how to give effective suggestions of treatment/self-help group involvement for the user if they relapse
- Cope with relapse by accessing rapid intake procedures when motivation for treatment emerges
How Reinforcement Works in Behavior Change
You may be familiar with the term “Classical Conditioning” or “Operant Conditioning”, which are methods of shaping behavior made famous by research with animals like dogs, rats, and pigeons. However, we as humans are not immune to the principles of behavior change either. In fact, our behavior can be shaped by rewards and punishment as well. Here’s how it works. Let’s say someone does something that we don’t like, and, in response, we do one of the following:
- Do something, they don’t like
- Take something away that they do like
- Ignore it.
Doing any of these things in response will make it less likely that the first person behaves that way again.
Now, let’s say someone does something that we like, and we want them to do it again, so we respond by dong one of the following:
- Reward them
- Take away something that is unpleasant for them
Either of these responses will feel good to the other person and increase the likelihood the person will behave that way again.
What is happening in both situations is the first person behaving is learning consequences for their actions. Naturally, they want positive consequences to result from their actions which is where our response being rewarding or punishing plays a massive role.
Behaviorism (as explained above) is the method with which we can influence our loved one’s behavior toward or away from drinking or using simply by our response to their use. Ignoring or “punishing” substance abuse and substance-abuse-related behaviors decreases the likelihood the likelihood those behaviors will occur again. Rewarding sobriety increases the likelihood the behavior will occur again. These are the assumptions that the CRAFT model operates from and the logistics of using these skills are not much more complicated than they seem – meaning anyone can do it! At its core CRAFT teaches CSOs how to reward sobriety and ignore intoxication.
How Does CRAFT Benefit Family Members?
No one wins when you spend a lot of time complaining about your loved one’s use, argue with them about their use, or try to bargain with them to stop. This takes significant energy, and those efforts often feel fruitless, as your loved one continues to use or engage in damaging behaviors. You do win when you take a step back and get to continue living your life despite their use. Family members can do this by ignoring using behaviors, withdrawing attention from loved ones when they use, or simply going about their daily schedule without letting loved one’s use impact them. To sum it up – CRAFT teaches CSOs how to stay focused on their life and allow bad consequences to happen to the person that uses. If your loved one choses sobriety, give praise, attention, and quality time to them to show them being sober comes with positive benefits and makes them more likely to do it again. This is another win for you and a win for your loved one!
Impact of CRAFT Model
The CRAFT approach gives CSOs the specific skills needed to support their loved one’s recovery efforts. Research demonstrates this approach benefits CSOs by reducing frustration, feeling more successful in supporting their loved one’s sobriety, and improving their relationship with their loved one (Hellum et al., 2021). And, although it may seem paradoxical, a major aspect of CRAFT is empowering COS’s to working on their own life rather than focusing on their loved one with substance use disorder. When CSOs prioritize their own happiness, seek their own support, and resist the urge to let their loved one’s addiction hijack their lives, the person with addiction can see firsthand how their behavior is preventing them from living a happy and healthy life. The more we see that our behavior is damaging us in various ways, the more motivated we may feel to change that behavior.
Research on the CRAFT approach indicates it is twice as effective of other methods of interventions or no family intervention at all (Archer et al., 2020). Further individuals with substance use disorder are 77% to 86% more likely to enter treatment (Archer et al., 2020). Aside from treatment engagement, data investigating individuals six months after beginning treatment shows CRAFT-users have higher completion rates than other interventions (APA).
Statistics consistently back that CRAFT is both an effective and long-lasting intervention for families navigating loved ones with substance abuse. Finally, research on CSOs who participate in CRAFT feel relief, educated on substance use disorder, and more equipped to communicate with loved ones and respond to their drinking or using (Hellum et al., 2024). Regardless of the outcome of their loved one’s CSOs indicated that their own outcome had been positive after participating in CRAFT (Hellum et al., 2024). CSO outcomes are incredibly important given the model aims to promote the wellbeing of family members of people with substance use disorder, not just the wellbeing of the user.
Practical Steps for Family
If you are ready to learn more about CRAFT, here are some key skills to home in on as you explore approaching your loved one’s use in a different way: identify triggers, improve communication, focus on positive reinforcement, employ natural consequences, identify emotional barriers, work with a therapist, and continue offering support. Additionally, “Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening” by Robert J. Meyers and Brenda L. Wolfe is a self-help book written using the CRAFT model that can give you tools for practically applying the approach to your life.
A final practical way to begin enacting positive change in your own and your loved one’s life is to enroll in a CRAFT group or find a provider who is trained in CRAFT and can provide an individual CRAFT intervention.
Advaita Integrative Medicine offers a free virtual family support group that meets weekly and is based in an Invitation to Change Model that integrates CRAFT and Motivational Interviewing techniques. If you want to get support and training on how to help a loved one with his/her substance use, then you can complete a form below and let us know.
Written By: Meaghan Brackin, MS, LCAS-A, LCMHC-A, CRC
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References:
Archer M, Harwood H, Stevelink S, Rafferty L, Greenberg N. Community reinforcement and family training and rates of treatment entry: a systematic review. Addiction. 2020;115(6):1024-1037. doi:10.1111/add.14901 Available Here
Hellum, R., Bilberg, R., Mejldal, A., & Nielsen, A. S. (2024). Potential factors affecting the impact of community reinforcement and family training. Secondary analysis of an RCT. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-17656-1. Available Here
Roozen, H. G., De Waart, R., & Van Der Kroft, P. (2010). Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction, 105(10), 1729–1738. https://doi.org/10.1111/j.1360-0443.2010.03016.x. Available Here
Substance Abuse and Mental Health Services Administration. (2023). National Survey on Drug Use and Health (NSDUH). https://www.samhsa.gov/substance-use/learn. Available Here
