ADC 660 Module 4 Engaging Families in Treatment Example

Inviting, Not Ambushing: Engaging a Reluctant Partner Through the Family

Student Name

Psychology and Addiction Studies Program, Aspen University

ADC 660: Addiction and Families

Instructor Name

Month Day, Year

Inviting, Not Ambushing: Engaging a Reluctant Partner Through the Family

When Lisa first called the Omaha family program, she wanted one thing: Glen in treatment. With support for herself and her children under way, the counselor returned to it. Glen still said he had no problem, though he had missed work twice in a month. Lisa had heard of interventions in which family members surprise a relative with letters and an ultimatum and wondered whether to try one. Lisa, Glen and the program are fictional. This paper compares the approaches open to her.

Three Approaches

Families trying to bring a relative into treatment commonly use one of three approaches. A confrontational intervention, associated with the Johnson Institute, prepares family members to meet the relative together, read letters describing the harm caused and present treatment as an immediate choice. Referral to Al-Anon or similar mutual-help groups focuses on the family member's own recovery and on detaching from responsibility for the relative's drinking. The third, Community Reinforcement and Family Training (CRAFT), teaches family members skills to change their interactions with the relative so that sobriety is rewarded and treatment becomes more attractive.

A Head-to-Head Trial

Miller et al. (1999) randomly assigned concerned family members of people who refused alcohol treatment to CRAFT, a Johnson Institute intervention or Al-Anon facilitation therapy. CRAFT engaged about two thirds of the drinkers in treatment, compared with about three in ten for the Johnson Institute approach and about one in eight for Al-Anon facilitation. A notable reason for the Johnson approach's lower rate was that many families who prepared for a confrontation did not go through with it. Family members in all three groups reported improvements in their own well-being, such as reduced depression and anger.

Confirming the Evidence

Roozen et al. (2010) reviewed studies of CRAFT, including trials with families of people using alcohol and other drugs. Across studies, CRAFT engaged substantially more treatment-refusing individuals than comparison approaches, roughly three times more than Al-Anon or Nar-Anon referral and about twice as many as the Johnson Institute intervention. They concluded that CRAFT was an effective option for engaging treatment-resistant individuals and that family members also benefited.

How CRAFT Works

CRAFT rests on the idea that drinking is maintained partly by its consequences, including how others respond. Family members learn to analyze the drinking pattern, recognizing triggers and consequences; to communicate positively, using specific, calm requests rather than criticism; to reward sober behavior with time, attention and activities the relative values; to allow the natural consequences of drinking rather than shielding the relative from them; to look after themselves; and to choose a good moment, such as after a drinking-related problem, to suggest treatment, with a program ready to receive the relative quickly. Safety is assessed at the start and throughout.

A Plan for Lisa

Lisa's sessions began with a safety assessment; Glen had never been violent, but Lisa had a plan in case. She then learned to identify Glen's drinking pattern: weekday evenings after a stressful commute. She planned to reward sober evenings by doing things Glen enjoyed with him, such as watching a game together, and to withdraw her attention when he drank, without arguing. She practiced positive requests: "I'd love it if we could have dinner together tonight without drinking." She stopped covering for him at work. And she rehearsed an invitation to treatment for the next time Glen expressed regret, with the program's intake line ready.

Copello and Colleagues' Framing

Copello et al. (2005) described engagement of the relative as one of three routes to family-focused help, alongside joint treatment and support for family members themselves. CRAFT combines the first and third: it aims to engage the relative while improving the family member's own life. For Lisa, this meant that the work was worthwhile even if Glen did not enter treatment.

Why Confrontation Often Backfires

The confrontational intervention rests on the idea that a person must hit bottom, or be pushed there, before accepting help. Miller et al. (1999) found that many families prepared for a Johnson Institute intervention never carried it out, often because they feared the damage it could do to the relationship. Where confrontations do happen, the relative may feel ambushed and respond with anger, and families who have exhausted their one dramatic move may have nowhere left to go. CRAFT avoids this by changing everyday interactions gradually, so that the invitation to treatment comes within a relationship that has become warmer rather than more strained.

Checking Safety First

Before Lisa changed how she responded to Glen, the counselor asked about any history of violence, threats or controlling behavior, since withdrawing attention or allowing consequences can provoke anger in some relationships. Roozen et al. (2010) note that CRAFT programs build this assessment into the early sessions. Glen had never hurt or threatened Lisa, but she agreed to stop any strategy that raised tension and to leave with the children for her mother's house if he ever became frightening.

If Glen Says No

Lisa asked what would happen if Glen refused even after all this work. The counselor was honest: in the trials, about a third of relatives did not enter treatment. But Lisa would still have gained skills, support and, according to Miller and colleagues, likely improvements in her own mood. She could also repeat the invitation later, since a refusal at one moment often becomes acceptance at another.

Conclusion

Miller, Meyers and Tonigan's trial and Roozen and colleagues' review show that CRAFT engages reluctant relatives in treatment more often than confrontational interventions or Al-Anon referral, while benefiting family members. Copello and colleagues place engagement within a wider set of family routes. Lisa's plan teaches her to reward sobriety, communicate positively and invite Glen at the right moment, while caring for herself.

References

Copello, A. G., Velleman, R. D. B., & Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 24(4), 369-385. https://doi.org/10.1080/09595230500302356

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(5), 688-697. https://doi.org/10.1037/0022-006X.67.5.688

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