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As of 2009, CRAFT and CRA programs were not widespread amongst addiction counselors. The adoption of evidence-based treatments have been slow. Instead, many addiction counselors were tied to a twelve-step model with less research support. The National Institute on Drug Abuse (NIDA), a federally funded organisation aiding scientific research into addiction has supported CRAFT intervention techniques among others. In 2007, CRAFT was being used in 25 clinics in the United States.However CRAFT has been adopted by a number of commercial and self-help organisations in the United States. Meyers and the Treatment Research Institute (TRI) worked with Cadence Online to create a ParentCRAFT course where parents pay a one-off fee for a series of videos presenting the CRAFT process, aimed at teaching them skills to meet the risks of substance use in their adolescent children. An undisclosed “major share” of the revenues goes to TRI. Meyer’s work was partially funded with a grant from NIDA Allies in Recovery provides a series of videos, eBook, blog, live calls and other services to families of addicts based on CRAFT methods for an annual fee. As of 2020, the State of Massachusetts is providing free access for all its residents to the AIR service. Based in Rhode Island, Resources Education Support Together (REST) is a peer-led mutual aid group that uses CRAFT and the Allies in Recovery service for its members. |
Research and outcomes |
CRAFT compared with other approaches |
An offshoot of the community reinforcement approach is the community reinforcement approach and family training. This program is designed to help family members of people who use substances feel empowered to engage in treatment. Community reinforcement approach and family training (CRAFT) has helped family members to get their loved ones into treatment. The rates of success have varied somewhat by study but seem to cluster around 70%. CRAFT is one of the only family-aimed treatments with proven results for getting people with drug or alcohol problems into treatment. 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. |
Intervention for Alcohol Use |
From an article on the American Psychological Association (APA) website about the success of CRAFT in substance use treatment and intervention, these are the success outcomes for engaging drinkers into treatment: |
64% – CRAFT |
23% – Johnson Intervention |
13% – Twelve-Step Facilitation (TSF)Elsewhere Robert Meyers has clarified that Twelve-Step Facilitation used in the Miller et al’s comparative study of 130 caretakers of problem drinkers was a control group structured to “simulate the kind of care and guidance CSO’s would traditionally receive from attending Al-Anon meetings... treatments were delivered one-on-one and included up to 12 hours of therapy.” |
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). |
Comparisons |
One experiment compared the two psychotherapy approaches of CRAFT and Twelve-step facilitation therapies (TFT), (not to be confused with the 12-Step programs such as Al-Anon since TFT is a time-limited program intended to "simulate the type of support and guidance... traditionally receive[d] from attending Al-Anon meetings" ) for their impacts on addicts seeking to enter treatment. The finding was that concerned significant others who participated in facilitation therapy engaged 29.0% of addicts into treatment, whereas those who went through CRAFT engaged 67.2%. Another study compared CRAFT, Al-Anon facilitation therapy and a Johnson intervention. The study found that all of these approaches were associated with similar improvements in the functioning of concerned significant others and improvements in their relationship quality with the addicts. However, the CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the facilitation therapy (13%) and Johnson interventions (30%). |
Intervention for Substance use |
From the same article on the American Psychological Association (APA) website about the success of CRAFT in substance use treatment and intervention, these are the success outcomes for persons abusing drugs to enter treatment (the success outcomes were nearly the same as the alcohol use disorder outcomes): |
64% – CRAFT |
17% – Caregivers' Twelve-step 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. |
Note: When the articles states "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. |
Parallel study |
"In a parallel study sponsored by the National Institute on Drug Abuse that focused on people who use other substances, family members receiving CRAFT successfully engaged 74 percent of initially unmotivated drug users in treatment (Meyers et al. 1999)." |
Professional organizations |
CRAFT is a model of clinical behavior analysis which is of interest to the following professional organisations. |
The Association for Behavior Analysis International (ABAI) has a special interest group in clinical behavior analysis. |
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. |
See also |
Al-Anon/Alateen |
American Psychological Association |
Behaviorism |
Clinical behavior analysis |
Cognitive behavioral therapy |
Communal reinforcement |
Domestic violence |
Intervention (counseling) |
National Institute on Alcohol Abuse and Alcoholism |
National Institute on Drug Abuse |
SMART Recovery |
References |
External links |
Adapting the CRAFT approach for use in group therapy |
Parent CRAFT – Online Video Course developed by Robert J. Meyers, PhD |
Community Reinforcement Approach at Drug & Alcohol Rehab Asia (DARA), Thailand |
Community Reinforcement Approach and Family Training (CRAFT) at the American Psychological Association |
The Community Reinforcement Approach: An Update of the Evidence at the NIAAA |
Robert J. Meyers personal website |
SMART Recovery Family & Friends Archived December 26, 2013, at the Wayback Machine |
Step Facilitation Therapy Manual |
Concreteness training |
Concreteness training (CNT) is the repeated practice of cognitive skills to create habitual behaviors in order to help reduce anxiety and depressive symptoms for those suffering from the disorder of depression. People suffering from depression have a tendency towards unhelpful abstract thinking and negative thoughts, such as viewing a single mistake as evidence that they are useless at everything. As such, CNT involves switching cognitive focus from negative thoughts to positive thoughts so as to cut down on rumination—focused attention on the symptoms of one's distress—and self-criticism, which can cause feelings of inadequacy and raise anxiety.This technique was developed at the University of Exeter, located in Exeter, England, by Professor Edward Watkins and his team of researchers after they conducted a study to see if the CNT approach could reduce symptoms of depression and anxiety. In the 2009 study, twenty-one men and thirty-nine women were randomly assigned to one of three groups. The first group received CNT, the second group received bogus concreteness training (BGT), and the third group was a wait-list (WL) control condition that received no treatment. The concreteness training involved practicing thinking about the specific details of recent mild negative events: how the event happened, where it happened, who was there, what they did. The goal was to try to get a mental picture of the event, its circumstances, and then focus on the sequence of how it happened. Participants received the specific treatment every day for a week based on their assigned group. At the end of the week, participants were again assessed for depression levels and symptoms. Results indicated that CNT showed a trend toward a greater decrease in depressive symptoms than BGT or WL. Accordingly, Professor Watkins noted: “This is the first demonstration that just targeting thinking style can be an effective means of tackling depression. Concreteness training can be delivered with minimal face-to-face contact with a therapist and training could be accessed online, through CDs or through smartphone apps. This has the advantage of making it a relatively cheap form of treatment.”However, in a study published by Springer Nature in 2013, it was concluded that the effectiveness of CNT may be limited, claiming that while concreteness of thinking increased, results did not support that CNT was effective "as a standalone treatment for depression". In addition, contrary to previous findings, the study also did not find a significant effect on rumination. The potential reasoning behind this lack of effect was "because the sample did not exhibit a significant decrease in depression". Yet, CNT has been proven to be effective when delivered in a specific manner, like therapeutic context, with the rationale that the participant knows he or she is being treated for depressive symptoms by a credible authority. Moreover, results have also demonstrated that CNT is a valid technique in the reduction of self-criticism, especially where the use of self-relevant events (autobiographical materials) has been prevalent. |
See also |
Cognitive psychology |
Management of depression |
References |
Cultural competency training |
Cultural competency training is an instruction to achieve cultural competence and the ability to appreciate and interpret accurately other cultures. In an increasingly globalised world, training in cultural sensitivity to others' cultural identities (which may include race, sexuality, religion and other factors) and how to achieve cultural competence is being practised in the workplace, particularly in healthcare, schools and in other settings. |
Cultural competence |
Cultural competence refers to an ability to interact effectively with people of different cultures. Cultural competence comprises four components: (a) awareness of one's own cultural worldview, (b) attitude towards cultural differences, (c) knowledge of different cultural practices and worldviews, and (d) cross-cultural skills. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures and leads to a 15% decrease in miscommunication. Cultural competence has a fundamental importance in every aspect of a work field and that includes school and government setting. With the amalgamation of different cultures in American society, it has become imperative for teachers and government employees to have some form of cultural competency training. |
To attain the goal of cultural competence, cultural sensitivity must be understood. Cultural sensitivity is the knowledge, awareness, and acceptance of other cultures, and includes "the willingness, ability and sensitivity required to understand people with different backgrounds", and acceptance of diversity. Crucially, it "refers to being aware that cultural differences and similarities between people exist without assigning them a value", |
Background |
To cater to an increasingly globalized society, many hospitals, organizations, and employers may choose to implement forms of cultural competency training methods to enhance transparency between language, values, beliefs, and cultural differences. Training in cultural competence often includes careful consideration of how best to approach people's various forms of diversity. This new-found awareness helps military members, educators, medical practitioners, other workers and citizens to establish equity in their environments, and enhances interrelationships between one another for increased productivity levels. There are numerous theories as to how best to conduct cultural competency training, which are often dependent on the specific environment and type of work. |
Cultural identity |
Subsets and Splits