Friends and Family

Friends and Family make a difference. This is not an idle statement or empty promise, they are words filled with power to help people we love.

Like many things in life, in the field of mental health and addiction, change comes slow. In some ways that is a good thing because people’s lives are at stake. On the other side, it is unfortunate because lives are at stake.

Back in the 1970s. A group of researchers in Illinois, led by behavioral psychologist Nathan Azrin, developed what is still the most effective behavioral treatment for substance users, and called it the Community Reinforcement Approach, or CRA. In that process, they discovered that family involvement is a crucial factor in bringing about a healthy change in the lives of those we love.

Dr. Robert Meyers, a member of the original team of researchers that created CRA expanded it’s principles further to create an approach that added the component that I hear many people ask about. Can I help my loved one if they do not want to be helped? The answer is yes you can, and in the process, you will be helping yourself.

CRAFT has three goals:

1. to teach you skills to take care of yourself;
2. to teach you skills you can use to help your loved one change; and
3. to reduce substance use, period, whether your loved one gets formal treatment or not.

CRAFT is behavioral in that it employs strategies for real-world, observable change. CRAFT is also motivational, drawing its strength from collaboration and kindness rather than confrontation and conflict. I am sure that as you read the last sentence a question comes to your mind. Is that enabling? The answer is no, CRAFT is not about pretending there are not issues that need to be addressed or releasing our loved one from any and all responsibility for their actions, it is more about “how” we are approaching the issue of addiction or mental health.

Our natural reaction when we discover that our loved one is addicted is to get them in treatment, quick. There are reasons for that. Today’s drug world is very dangerous thanks to fentanyl and car-fentanyl, which shows up in almost everything. The other week I happened to speak with a dad who like myself lost his daughter, she was 26 years old. Slightly different than LaLa (my daughter Lauren) this girl was not a heroin addict. She was an occasional user of oxycodone when she and her friends would go out to party. Many people do not realize that most drugs like oxycodone hitting the streets are made by dealers on the streets, they are counterfeit and they are indistinguishable from the real pills. To the right is an image of how much fentanyl or carfentanil can kill you. Fentanyl and it’s derivatives are the number one drug connected to opiate deaths. Unknown to the girls at this party one of the pills had a little too much fentanyl in it. As a result, a twenty-six-year-old died, and a family was left devastated. The most common treatment offered today is residential and IOP programs. They work, but the should not always be our first choice. The Society of Addiction medication recommends that we start with the least intensive form of treatment that will keep our loved one safe. By safe I mean alive.

CRAFT (Community Reinforcement and Family Training), CRA (Community Reinforcement Approach), and MI (Motivational interviewing) may be the first, and perhaps, most effective steps. Several significant studies have revealed that CRAFT is very effective. Here are some of the facts that have been revealed:

• Two-thirds of people using substances who had been initially resistant to treatment agreed to go to treatment (typically after family members had around five sessions of CRAFT).
• The majority of participating spouses and parents reported being happier, less depressed, less angry, and having more family cohesion and less family conflict than prior to their CRAFT sessions, whether or not their loved one engaged in treatment.
• CRAFT’s effectiveness in engaging substance users and improving family functioning is found across substance types, relationship types, and ethnicities.

One thing to remember in helping our loved one is that people do not use substances in a vacuum. CRAFT may help our loved ones, and us, discover some of the drivers behind substance use. That is why family is so important.

CRAFT treats the problems families face as a deficit of skills rather than as a disease of codependence. These skills can be learned. Second, CRAFT recognizes that “just stopping” is not a sustainable long-term solution. While change depends at first on stopping (or reducing), the $ 64,000 question is what promotes staying stopped.

CRAFT asks you to see what makes substance use rewarding to your loved one so that you can introduce the “competition”— more constructive activities that serve the same needs— into his or her world. To this end, CRAFT will feel strange at first but it is very powerful.

CRAFT is becoming widely used in treatment, that amazes me since the roots of this started 49 years ago. This weekend I have the chance to attend a special training focused on CRAFT, CRA and other evidence-based approaches hosted by The Center for Motivation and Change. The Center for Motivation and Change is possibly the foremost practitioner of CRA and CRAFT in treatment in the USA. They are located in New York State, you can review their website here: https://motivationandchange.com/ . I am looking forward to learning new strategies families can apply to help their loved ones battling addiction and mental health. These types of training are becoming more and more common and several organizations are offering CRAFT Training for families. Here is an inexpensive online offering https://www.cadenceonline.com/ . Amazon also has two extremely helpful books about CRAFT. Beyond Addiction: How Science and Kindness Help People Change , this book is published by the Center for Motivation and Change. Several statistics in today’s blog are from this book as referenced below.  Sober: Alternatives to Nagging, Pleading, and Threatening by Dr. Robert Meyers.

Our family never got the chance to use the CRAFT approach to help LaLa. I did not learn about such approaches to recovery until after Lauren passed away. I deeply regret that because I believe it would have been helpful.

It is easy to feel overwhelmed by a loved one’s addiction and think there is not much we can do to help. That we probably should leave it in the hands of experts. Experts are important, but the evidence is revealing that you can make a big difference in your loved one’s recovery. If you love someone fighting addiction or mental health, you can help. You can make a positive impact. Don’t give up!

Todays featured image is by Brooke Shaden called “Running from Wind”

Foote, Jeffrey; Wilkens, Carrie; Kosanke, Nicole; Higgs, Stephanie. Beyond Addiction: How Science and Kindness Help People Change (pp. 6-8). Scribner. Kindle Edition.