CRAFT: A Compassion-Based Approach to Family Addiction Treatment

While we take a client-centered approach to addictions at Ellenhorn, we are also keenly aware that we are treating an individual who is part of a system and community. Often the community that is most fraught for the client struggling with substance use is their family and loved ones. As those who have been in its grip can attest to, substance abuse has a way of radiating its negative influences out towards family members, loved ones and those with whom the client may live. In fact, it can affect those in the user’s community in a way that is just as significant as the effects on the user herself. This can result in a scenario in which the family’s attempts to curtail substance use and/or get the user into treatment only drives the user deeper into their dependence and the family into more chaos.

To address this dynamic we employ the Community Reinforcement And Family Training (CRAFT) approach, which is an evidence-based motivational family therapy model developed by Robert Meyers, Ph.D.

It is at this point that you may be bracing yourself for an onslaught of jargon, statistics and clinical rationale for this method. However, the best thing about CRAFT is that it is not that complicated. It is also non-confrontational. It is simply a positivity-based approach that relies on love and compassion for both the substance user and their concerned family. This is also in line with our view of addiction as an attachment issue. Rather than “detach with love” as other programs suggest, we prefer for clients to stay attached to their loved one. But this must be done in an intentional way if things are to change.

In the CRAFT model, the “client” is the Concerned Significant Other (CSO) of the Identified Patient (IP), who is the substance user. Okay, you got me. There is a little bit of jargon! The CSO can be a parent, sibling, friend, teacher, co-worker, or anyone in the IP’s community whose life is being negatively affected by the IP’s substance use. At Ellenhorn, the CSO’s typically tend to be family members.

The goals of CRAFT are as follows:

  • To increase the CSO’s well-being
  • To encourage the IP towards treatment and/or change

Relieving the anxiety, anger and worries of the CSO is a vital part of this process. Many family members have seen the quality of their lives plunge due to the substance use of a loved one. Often this is directly related to the behaviors they have been employing to get the user to change. These are the classic techniques of nagging, expressing anger and/or ignoring the person. While we can all identify with these behaviors, they do nothing for the CSO’s well-being nor do they encourage the IP towards treatment. In fact, they do the exact opposite of that. They frustrate the CSO as well as the IP and this keeps the pinwheel of use twirling.

The first step towards love and compassion for the IP is for the CSO to start to take care of themselves. Understanding that the IP is much further from change, the CSO learns that the best way to start is changing their own behaviors for their own benefit. CRAFT offers many tools for the CSO in this process that they and the counselor can choose as they move along. The concept of “Community Reinforcement’ refers to the steps that a CSO can then take to create a loving environment that not only makes sobriety more attractive for the IP but also reinforces any steps the IP takes in that direction.

For example, rather than nagging or detaching, a CSO can learn to say to a loved one who is abusing substances things like, “while I love you, I’m not interested in spending any time with you when you’re drunk but I’ll be here for you when your sober.” In this situation, we can see that the CSO is setting a healthy boundary for themselves in not allowing the IP’s substance use to affect their well-being. At the same time, the CSO is using the power of attachment, a.k.a. the loving relationship, to create an environment in which sobriety is more attractive. If this IP wishes to spend time with the CSO, they will have to start to consider some change.

This quick and simple example is just one slice of how the CRAFT dynamic works within families. One thing that needs to be emphasized in this process is the power of positivity and the avoidance of the negative. Many users are especially attuned to insults or any attempt to control them and respond in a highly negative way. In CRAFT work the clinician and CSO must take special care to express things in a positive way. This includes validating an IP’s experience even if you don’t agree or understand, using the language of love while holding one’s boundaries and treating the IP with respect and compassion rather than as “an addict.” This takes practice, for both clinician and CSO, and CRAFT provides tools and trainings to address this specific task.

In the brief example given above, think about the things the CSO didn’t do. They didn’t use harsh language, throw down ultimatums or threaten to kick the user out of the house. Ponder for a moment:  would the IP living on the street increase or decrease the CSO’s anxiety? What would living on the street do for an IP’s dependency problem? If the answer to both is “it would make it worse,” then these are not effective love and compassion-based methods.

CRAFT takes the stance that love and compassion are what anyone caught in the grips of substance abuse needs to heal. No matter what part of that system you are, either a user or loved one, IP or CSO, there is a healing power one can access through loving and attachment. CRAFT merely provides space and tools for people to express these in an intentional way with the hopes of increasing their own well-being and gently encouraging their loved one towards change.