crafting a new life

By Rachel Maurer

Bob Meyers has developed a program that teaches the spouse or family member of an addict to use positive reinforcement. Bob Meyers, senior research scientist at UNM's CASAA, is helping drug and alcohol abusers go straight.Bob Meyers is addicted to addictions. In fact, he has devoted 24 years of his life to encouraging alcoholics and drug abusers to go straight.

This is no easy task, but a promising solution, crafted by Meyers, is yielding dramatic results. It is called CRAFT -- Community Reinforcement and Family Training -- and it teaches spouses or family members of hardcore, treatment-resistant addicts to take charge of their lives. The indirect result is that the addict usually enters treatment.

"Loved ones are crucial in helping addicted persons seek treatment or make changes in their lives," says Meyers, a senior research scientist who has spent 14 years working at UNM's internationally recognized Center on Alcoholism, Substance Abuse, and Addictions (CASAA). "Loved ones know the addict's triggers, antecedents, and behavior. Using this information we build treatment around positive reinforcement and what is fun about life when alcohol or drugs are not involved."

Through one-on-one sessions, CRAFT works with a concerned significant other, or CSO, to recognize and reinforce the clean and sober behaviors of the user. CSOs also learn to let addicts suffer the natural consequences of their actions, as well as effective ways to suggest treatment. CRAFT helps loved ones devise strategies to avoid domestic abuse, improve communication, reconnect with friends and family, and learn how to use and withdraw positive reinforcement.

"We role-play with the CSOs, teaching them how to communicate in a positive way," Meyers explains. "For instance, they learn that they can say, `Honey, I love spending time with you when you're sober, but if you come home drunk I'm going to watch TV by myself in the other room'." CRAFT is rooted in the Unilateral Family Approach, the umbrella term for the first CSO-focused programs.

However, CRAFT differs from other approaches in that it does not advocate confrontation, trains clients face-to-face, and works with any family member, not just a spouse, willing to promote sobriety. Working with William R. Miller, a UNM psychology professor and director of research at CASAA, Meyers tested CRAFT. Together, they received four grants from the National Institutes of Health (NIH) quite an accomplishment considering that funds are usually for the treatment of addicts rather than their families.

The first five-year study focused on alcoholism and involved 130 participants, 91 percent of them women, divided into three protocols. CRAFT was compared against two popular traditional strategies, Al-Anon, a 12-step approach emphasizing the CSO's helplessness to control the problem drinker, and the Johnson Institute technique where family and friends confront the problem drinker using shame or guilt.

The final results were dramatic. Sixty-four percent of the CRAFT participants were successful in getting their family members into treatment, compared to 30 percent of the Johnson intervention and 13 percent for Al-Anon. A later, parallel study with drug addicts reported even better CRAFT statistics, with 74 percent of the users seeking treatment.

"We blew the doors off of them!" Meyers exclaims. "Not only that, but we also found some unexpected results in that the CSOs in CRAFT experienced a dramatic reduction in psycho-social problems. Their depression, physical ailments, anger, and anxiety diminished substantially."

Another surprising result was that 80 percent of the mothers, compared to 60 percent of the spouses, were successful in getting the addict into treatment. Parents and children have a special bond and, Meyers points out, mothers are less afraid of violence from the user. These findings have spurred Meyers to join forces with professor Holly Waldron, an authority in family psychology at UNM's Center for Family and Adolescent Research, to study CRAFT's impact on teenagers.

Another key component is to respond immediately when the user expresses interest in receiving help. Therefore, the intake process for addicts is quick and efficient. "These are 60 percent of the users who wouldn't have come in for treatment so it is important that they are not placed on a waiting list," says Meyers.

With CRAFT, the CSOs do not nag or use coercion to get the addict to stop, and they are not responsible for disposing of alcohol or drugs. CSO's do not warm up meals when the addict returns from a drunken binge, or offer medications to relieve a hangover.

Instead, when the user is sober, the CSO praises them, suggests fun activities, or cooks a favorite meal. Meyers admits that the goal is to improve the CSO's quality of life, but that does not mean they must remain in the relationship. "Some women say `Why am I with this loser' and they leave," says Meyers. "Sometimes those are the best success stories."

To some folks, CRAFT seems like common sense. Parents and child-rearing experts have advocated this kind of positive reinforcement for years. What is special about CRAFT is that it is a 180-degree turnaround from most typical addiction treatments. "The medical model is that addiction is a disease and that addicts can't help themselves," says Meyers.

"You see it all the time where counselors, therapists, and doctors play on the guilt and shame of the addict, and they hit rock bottom. Then the therapy builds them back up again. In CRAFT, therapists empathize with the user, stress their good points, show respect, and don't judge them because of their actions."

Unfortunately, treatment counselors are often unaware of published studies, and it can take years for a new approach to trickle into the system. Meyers lectures and trains therapists, but he acknowledges that it may take time before CRAFT is widely used.

However, he is quick to point out that CRAFT reduces domestic violence and alcohol-related accidents. The health of the CSO also greatly improves, which translates into fewer trips to the doctor. These are the kind of facts that might spark the interest of managed care administrators, especially since Meyers plans to adapt CRAFT to group situations.

"This is a transferable, trainable system," Meyers says. "It has gigantic potential for health care in that it reduces the burden on the general population. It's a cost-effective system that is a win-win situation for everyone." That is a well-crafted plan.

Copyright 2004 Rachel Maurer