This is a work in progress… I’ll continue to add more research, and more details, as I can. but for now:

Summaries & Collections

• The APA Intervention synopsis offers a brief summary of CRAFT related research.   

• There is an extensive listing of Dr. Robert Meyers CRAFT related research from his website.   

• For more information discussing the empirical base, check out chapter 10 of Motivating Substance Abusers to Enter Treatment.
  

  Individual articles

• Brigham, G. S., Slesnick, N., Winhusen, T. M., Lewis, D. F., Guo, X., & Somoza, E. (2014). A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification. Drug and alcohol dependence, 138, 240–243. Link to full article on PubMed

  • Abstract: Background: Detoxification with psychosocial counseling remains a standard opioid-use disorder treatment practice but is associated with poor outcomes. This study tested the efficacy of a newly developed psychosocial intervention, Community Reinforcement Approach and Family Training for Treatment Retention (CRAFT-T), relative to psychosocial treatment as usual (TAU), for improving treatment outcomes.

    Methods: A randomized, 14-week trial with follow-up visits at 6 and 9 months post-randomization conducted at two substance use disorder (SUD) treatment programs. Opioid-dependent adults (i.e., identified patient - IP) enrolled in a residential buprenorphine-detoxification program and their identified concerned significant other (CSO) was randomized to CRAFT-T (n=28 dyads) or TAU (n=24 dyads). CRAFT-T consisted of two sessions with the IP and CSO together and 10 with the CSO alone, over 14 weeks. TAU for the CSOs was primarily educational and referral to self-help. All IPs received treatment as usually provided by the SUD program in which they were enrolled. The primary outcome was time to first IP drop from treatment lasting 30 days or more. Opioid and other drug use were key secondary outcomes.

    Results: CRAFT-T resulted in a moderate but non-significant effect on treatment retention (p=0.058, hazard ratio=0.57). When the CSO was parental family, CRAFT-T had a large and significant effect on treatment retention (p<0.01, hazard ratio=.040). CRAFT-T had a significant positive effect on IP opioid and other drug use (p<0.0001).

    Conclusion: CRAFT-T is a promising treatment for opioid use disorder but replication is needed to confirm these results.

  • Note: This is an article I often use in trainings to illustrate parental effect on treatment retention and reduction of substance use.

• Marlowe, D. B., Kirby, K. C., Bonieskie, L. M., Glass, D. J., Dodds, L. D., Husband, S. D., Platt, J. J., & Festinger, D. S. (1996). Assessment of coercive and noncoercive pressures to enter drug abuse treatment. Drug and alcohol dependence, 42(2), 77–84. Link to abstract on PubMed

  • Abstract: This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, 'coercion' is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.

  • Note: While not specifically about CRAFT, this paper is cited in other CRAFT articles for its finding that people who entered into treatment for substance use concerns named their family members as the top reason for engaging in treatment, significantly above any other points of potential influence.

• 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. Link to abstract on PubMed

  • Abstract: In a randomized clinical trial, 130 concerned significant others (CSOs) were offered 1 of 3 different counseling approaches: (a) an Al-Anon facilitation therapy designed to encourage involvement in the 12-step program, (b) a Johnson Institute intervention to prepare for a confrontational family meeting, or (c) a community reinforcement and family training (CRAFT) approach teaching behavior change skills to use at home. All were manual-guided, with 12 hr of contact. Follow-up interviews continued for 12 months, with 94% completed. The CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the more commonly practiced Al-Anon (13%) and Johnson interventions (30%). Two previously reported aspects of the Johnson intervention were replicated: that most CSOs decide not to go through with the family confrontation (70% in this study) and that among those who do, most (75%) succeed in getting the drinker into treatment. All 3 approaches were associated with similar improvement in CSO functioning and relationship quality. Overall treatment engagement rates were higher for CSOs who were parents than for spouses. On average, treatment engagement occurred after 4 to 6 sessions.

  • Note: This is an article I often use in trainings to illustrate the three major approaches offered to families (Al-Anon, Johnson Institute Intervention, and CRAFT) and their effectiveness on influencing a loved one towards treatment.

• Kirby, K. C., Versek, B., Kerwin, M. E., Meyers, K., Benishek, L. A., Bresani, E., Washio, Y., Arria, A., & Meyers, R. J. (2015). Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents. Journal of child & adolescent substance abuse, 24(3), 155–165. Link to full article on PubMed

  • Abstract: We describe a project focused on training parents to facilitate their treatment-resistant adolescent’s treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however, there are no controlled trials for parents with a substance-abusing child. We examined the behavioral parent training literature to guide us in tailoring CRAFT for parents of adolescents. We discuss adaptations to CRAFT, outcomes and experiences gained from a brief pilot of the revised CRAFT program, and the future directions of this work.

  • Note: This is, itself, not a study but a description of a study that they would like to do. I have included this here as I appreciate the Introduction section, specifically this paragraph:

    • The failure to involve parents meaningfully into their child’s treatment is unfortunate for several reasons. In addition to family-based models having good empirical support and being more likely to benefit the adolescents, research suggests that providing parents with guidance on managing their child may have direct benefits to the parents (e.g., Serketich & Dumas, 1996; also see Kirby, Marlowe, Festinger, Garvey, & LaMonaca, 1999; Meyers, Miller, Smith, & Tonigan, 2002; Miller et al., 1999, which included parents of adult children). Furthermore, parents may provide an active role in encouraging treatment retention, involvement in aftercare, and treatment re-entry after relapse; activities that have been found to predict better long-term outcomes. In a study that followed 315 youth for up to 5.5 years, Winters et al. (2007) found that greater involvement in any of wide variety of aftercare activities (e.g., offered via the treatment program, AA/NA, individual and family counseling, or via treatment re-entry) was significantly and positively related to the trajectory of improvement over 1, 4, and 5.5 years post-treatment. Continuing care or aftercare is generally recognized as a key element of effective adolescent treatment (Brannigan et al., 2004; Olmstead & Sindelar, 2004); however most community-based treatment programs have difficulty providing this. Parents, however, often can more easily monitor their child and probably will receive greater benefits for doing so. They also are usually available to their child for decades into the future.

• Waldron, H. B., Kern-Jones, S., Turner, C. W., Peterson, T. R., & Ozechowski, T. J. (2007). Engaging resistant adolescents in drug abuse treatment. Journal of substance abuse treatment, 32(2), 133–142. Link to full article on PubMed

  • Abstract: In the first phase of a two-part treatment development study, families with a treatment-resistant, drug-abusing adolescent (n=42) were offered 12 sessions of Community Reinforcement and Family Training (CRAFT). This parent-focused intervention was designed to help parents facilitate their adolescents' entry in treatment and support adolescents' subsequent behavior change and to improve parent and family functioning. In the second phase, successfully engaged adolescents (n=30) were offered 12 sessions of a multicomponent individual cognitive behavioral therapy (CBT) targeting substance use and related problem behaviors. Measures were collected at pre- and post-treatment for parents and adolescents, with an additional follow-up assessment for parents at 3-months post-treatment. Parents in the CRAFT intervention experienced a significant reduction in negative symptoms and 71% of parents were successful in engaging their resistant youth in treatment. The CBT intervention for the engaged youth was associated with a statistically significant, but not clinically significant, reduction in marijuana use.

  • Note: Most of the research around CRAFT has been done with adults, and so this research is especially helpful in demonstrating similar success rates for adolescents as adults regarding entry into treatment . That said, I personally have difficulties with the viewpoint of the writers in places, specifically around their take on (and excessive judgment of) parents, including using the term “enmeshment.”

Last updated 3/11/23.

Accessing articles can be tricky due to the paywall that they are often behind. I have indicated, as accurately as possible, which articles are available for free in full and which are abstract only.

Know of other articles or summaries that you think should be included? Let me know!

Want to participate in CRAFT-based research as a family member? Check out the opportunities for involvement on our Family Events Page!