Community reinforcement and family training and rates of treatment entry: a systematic review

Abstract

Background and Aims Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry.Method Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe.Results A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP-CSO relationship, CRAFT modality and integration of treatment for IP. Meta-analysis found CRAFT to be twice as effective as controls/comparison groups. Multi-modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5-71%), group (60%) and self-directed workbook (13.3-40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5-23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. Conclusions Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success.

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment

“…CRAFT is an intervention to educate concerned significant others of those with potential substance abuse or mental health problems on how best to encourage that person to seek mental health support, as well as to monitor and improve their own well-being. Versions of CRAFT developed for military veteran populations are currently being developed and trialled in both the US (Erbes et al, 2015 ) and the UK (Archer, Rafferty, Harwood, Stevelink, & Greenberg, 2019 ).…”

Youth OUD treatment during and after COVID: Increasing family involvement across the services continuum

“…Family-focused recovery maintenance strategies can promote youth retention in ongoing services during OUD remission, formulate and monitor long-term recovery management plans, and encourage family members to enlist direct-to-family supports ( Archer et al, 2020 ; Ventura & Bagley, 2017 ). BG was a 21-year-old in treatment with extended-release naltrexone.…”

CRAFT: Treatment integrity is imperative for understanding research findings

“…Archer et al . [1] address an interesting and challenging perspective on the cumulating CRAFT literature to target treatment components and participant characteristics. During the late 1970s, CRAFT was originally created by R.J. Meyers in the United States and initially tested by Sisson and Azrin [2].…”

“…In several included original CRAFT papers [1], it is stated that treatment adherence was secured by e.g. providing CRAFT literature and clinically experienced or certified (behavioral) therapists.…”

“…Finally, the authors [1] suggest that in countries such as Japan, CRAFT has not been subjected to evaluation and research. These findings are frequently submitted to Japanese journals and therefore easily overlooked by Western researchers.…”