WORKING WITH FAMILY MEMBERS OF
PEOPLE WITH ADDICTION: EVIDENCE-
BASED METHODS FOR HELPING FAMILY
MEMBERS GET THEIR LOVED ONE INTO
TREATMENT
Christeine Terry, Ph.D., independent practitioner
at Seattle Psychology, PLLC & online at
Soberfamilies.com
Jason Luoma, Ph.D., director of Portland
Psychotherapy Clinic, Research & Training
Center & online at soberfamilies.com
WHAT CAN WE DO? WHAT DO WE DO?
Reflective exercise
2
AGENDA
History & Overview
Research findings
Techniques
Resources
3
HISTORY, OVERVIEW,
& RESEARCH
4
A LIMITED MENU OF OPTIONS
• Al-Anon/Nar-
Anon
• Intervention
• SMART
Recovery
• Supportive
Therapy 5
AL ANON
6
JOHNSON MODEL INTERVENTION
7
A NEW PRODUCT
CRAFT
8
TWO GOALS OF CRAFT
Give the loved one skills to non-confrontationally
encourage loved one to engage in treatment
Increase loved one’s quality of life
9
THE STYLE OF CRAFT
Similar to MI
Non-confrontational
Explore ambivalence
Empowerment
10
THE STYLE OF CRAFT
Similar to SMART Recovery
Alternative to 12-Step
Family & Friends based on CRAFT
11
SOME TERMS TO KNOW
IP = Identified Patient
CSO = Concerned Significant Other
12
How does CRAFT
compare to Al Anon
and Johnson Model
Intervention?
13
AL ANON VS. INTERVENTION VS.
CRAFT
14
CRAFT IS FLEXIBLE
Works across relationships (parents, spouses,
etc.)
Works across substances
15
EMPIRICAL EVIDENCE
CRAFT vs. 12-Step (Kirby et al., 1999; Meyers et al.,
1999; Meyers et al., 2002)
Approximately 70% engagement in CRAFT
< 20% engagement in 12-step
16
EMPIRICAL EVIDENCE
Loved one engaged in treatment (Miller et al, 1999)
CRAFT : 7 of 10
Johnson Intervention: 3 of 10
Al-Anon: 1 of 10
17
EMPIRICAL EVIDENCE
Improves CSO functioning
Decreases in
Depression
Anxiety
Physical symptoms
Health and financial problems
Increases in
Self-esteem
18
CRAFT:
TECHNIQUES AND
CONSIDERATIONS
19
CRAFT TECHNIQUES
Functional Analysis
Communication skills and role plays
Reinforcing Sober Behaviors
Removing Reinforcement for Using Behaviors
Problem Solving
Self-Care
Offering Treatment
20
THE ULTIMATE GOAL: GETTING THE
LOVED ONE INTO TREATMENT
Enter treatment
quickly
Windows of
opportunity
Positive
communication
Motivational hooks
21
FUNCTIONAL WHAT?
Functional Analysis
3 main components
What is going on before the drinking occurs?
What does the drinking actually look like (amount,
frequency, pattern)?
What happens after drinking occurs?
Functional Analysis is like a road map for treatment.
22
FUNCTIONAL ANALYSIS: THE ROAD MAP OF
TREATMENT
External Internal Drinking/ Positive Effects Negative
Triggers Triggers Using Effects
People: Emotions: What: People: Relationships:
Places: Financial:
Times: Health/Physical:
Places: Thoughts: How Much:
Feelings: Job/Career:
Thoughts: Emotional:
Times: Sensations: For How Long:
Sensations: Legal:
Other: 23
Adapted from Functional Analysis form in Smith, J. E. & Meyers, R. J. (2008). Motivating Substance Abusers
to Enter Treatment: Working with Family Members. New York: Guilford Press.
REWARDING SOBER BEHAVIORS
In a gentle way, you can shake the
world. –Mahatma Gandhi
24
WHY SHOULD I REWARD SOBER
BEHAVIOR?
Increases non-using behaviors
Potentially decreases using behaviors
Creates positive experiences for CSO and IP
But isn’t that bribing my loved one?
A bribe comes before the desired behavior occurs and
is a coercive action typically to benefit the person
who is bribing.
A reward comes soon after a desired behavior occurs
and typically benefits the person engaging in the
desired behavior.
25
26
REWARDING SOBER BEHAVIORS
A fundamental difference between 12-step and
CRAFT
“Remember, when taking responsibility for our
own behavior each one of us must find our own
path. Experience teaches us that it is useless to
lay out a path for someone else to follow. We
must each make our own way to our goal”
(http://www.co-anon.org/enable.html).
27
ENABLING VS. REWARDING
What’s the difference between rewarding sober
behaviors and “enabling”?
Enabling – an action by the CSO that unintentionally
increases or allows drinking/drug use to continue
(e.g., shielding IP from negative consequences of
using)
Ex. Calling in sick for IP who is hung over.
Rewarding – an action by the CSO that increases
non-drinking/non-drug behaviors (e.g., intentionally
and mindfully rewarding non-using behavior)
Ex. Offering to make dinner for IP who comes home directly
from work without using.
28
WHAT MAKES A GOOD REWARD?
IP finds it rewarding
Free or inexpensive
Immediate (no or little delay)
Comfortable for CSO
Easiest rewards: positive verbal comments
Potentially more effective rewards: emotional
impact on IP
Ideal reward: competes directly with
drug/alcohol use.
29
NOT REWARDING USING: NATURAL
CONSEQUENCES
How is the CSO unintentionally reinforcing
drinking/drug use?
Examples: calling in sick for loved one who is hung
over, making excuses for loved one’s behavior,
cleaning up after them when they get sick
Explore the natural consequences for use
Identify problems with allowing natural
consequences to occur
Will likely need to use problem solving and
communication skills with CSO
30
NOT REWARDING USE: THE BIG FREEZE
“The Big Freeze”: withdraw
rewards when loved one is using
Technical name extinction
Even negative attention can
unintentionally reward
drinking/drug use
Example: Karen often waits up for
her adult daughter (Susan) on
nights when she goes out drinking
with her friends. As soon as Susan
is in the door, they start to argue.
31
COMMUNICATION SKILLS
What are important elements of effective
communication?
32
COMMUNICATION SKILLS
1. Be brief
2. Be positive
3. Refer to specific behaviors
4. Label your feelings
5. Offer an understanding statement
6. Accept partial responsibility
7. Offer to help
33
ROLE PLAY! ROLE PLAY! ROLE PLAY!
Describe scenario
Do the role play
Debrief
Repeat as necessary
34
COMMUNICATION SKILLS: EXERCISE
Break into groups of 2. We will present a
problematic communication and then you will
have a chance to improve the communication by
using the 7 communication skills. One person
will be the listener and the other will be the
communicator. The communicator will practice
the new (improved) statement and the other will
listen and provide (positive) feedback. You can
switch back and forth between communicator and
listener as often you like for each
scenario/communication.
35
COMMUNICATION SKILLS: EXERCISE
“You’re drunk again! I told you we had a PTA
meeting to go tonight, but of course, you can’t go
now b/c you’re too drunk. You’re a terrible father
and a drunk!”
36
COMMUNICATION SKILLS: EXERCISE
“I hate it when you hang out with those stoners; all
they do is get you into trouble. I guess weed and
your friends are more important than your family!”
37
COMMUNICATION SKILLS: EXERCISE
“Are you high?! I asked you to watch the kids
tonight, but you couldn’t even stay away from weed
long enough to take care of your own kids for 2
hours!”
38
COMMUNICATION SKILLS: EXERCISE
“Honey, I need to talk to you about something, but
maybe it isn’t a good time right now. But I don’t
when there is a good time to talk to you. You’re
always doped up and checked out, so I guess it
doesn’t matter when I talk to you about important
things. In any case, our daughter got in trouble at
school today and the teacher wants to meet with us
to talk about it.”
39
COMMUNICATION SKILLS: EXERCISE
“Do you really have to meet up with your friends
after work tonight? You know that I don’t like you
hang out with them; you always wind up drunk
when you go to happy hour with them.”
40
COMMUNICATION SKILLS: EXERCISE
“I’m tired of bailing you out of trouble. It doesn’t
matter what I do because you’ll just wind up drunk
or high anyway, and then come crying to me to get
you out of whatever shit you get yourself into.”
41
PROBLEM SOLVING
Problem Solving: systematic way of generating
solutions.
42
SELF CARE
Increasing or utilizing social support and
increasing engagement in enjoyable activities
Goal setting
Walking with a friend in the
dark is better than walking
alone in the light. – Helen Keller 43
WHEN CRAFT MAY NOT BE HELPFUL
Current domestic violence or high risk for
domestic violence
CSO has insufficient contact with IP
CSO more interested in individual therapy for
his/her own emotional difficulties (e.g.,
depression)
44
RESOURCES
FAMILIES THERAPISTS
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SOBERFAMILIES.COM
Free ten-week email course
Podcast for families and counselors
Bite-size blog posts, handouts, and exercises
Upcoming online workshops for families
SNIPPET FROM OUR
WEBSITE
46
RESOURCES
Dr. Meyer’s website: http://www.robertjmeyersphd.com/
Our website and contact information: www.soberfamilies.com.
Christeine Terry, Ph.D.: 206-963-6313 or christeineterry@gmail.com
Jason Luoma, Ph.D.: 503-281-4852 ext. 13 or
jbluoma@portlandpsychotherapyclinic.com
Online SMART Recover Friends & Family meeting using CRAFT
principles: http://www.smartrecovery.org/resources/family.htm
Meyers, R. J. & Smith, J. E. (2004). Motivating substance abusers to enter
treatment. New York: The Guilford Press.
Meyers, R. J. & Wolfe, B. L. (2004). Get your loved one sober:
Alternatives to nagging, pleading, and threatening. Center City, MN:
Hazelden.
Foote, J., Wilkens, C., Kosanke, N., & Higgs, S. (2014). Beyond addiction:
How science and kindness help people change. New York, City, NY:
47
Scribner.
REFERENCES
Al-Anon Family Services (2004). Who are the members of Al-Anon and Alateen? 2003 survey
results in the U.S. and Canada. Al-Anon Family Group Headquarters, Inc.
Foote, J., Wilkens, C., Kosanke, N., & Higgs, S. (2014). Beyond addiction: How science and
kindness help people change. New York, City, NY: Scribner
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: A
unilateral intervention to increase treatment entry of drug users. Drug and Alcohol
Dependence, 56, 85 – 96.
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.
Meyers, R. J., Miller, W. R., Smith, J. E., & Tonigan, J. S. (2002). A randomized trial of two
methods for engaging treatment-refusing drug users through concerned significant others.
Journal of Consulting and Clinical Psychology, 70, 1182- 1185.
Meyers, R. J. & Smith, J. E. (2004). Motivating substance abusers to enter treatment. New
York: The Guilford Press.
Meyers, R. J., Villanueva, M., & Smith, J. E. (2005). The Community Reinforcement
Approach: History and new directions. Journal of Cognitive Psychotherapy: An International
Quarterly, 19 (3), 247 – 260.
Meyers, R. J. & Wolfe, B. L. (2004). Get your loved one sober: Alternatives to nagging,
pleading, and threatening. Center City, MN: Hazelden.
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.
Schneider Institute on Health Policy (February 2001). Substance Abuse Chart Book. Retrieved
from: http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf 48
Substance Abuse and Mental Health Administration (January 2012). 2010 National Survey on
Drug Use and Health. Retrieved from:
http://oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.pdf
