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Alcohol & Sub. Dep.: Family Struggling with Sobriety
The Definition of Alcoholism and Chemical Dependency and The Evaluation of the Abuser
Evaluation of the abuser
The TWEAK screen has been recommended for white females, and a score of 3 or higher indicates an alcohol problem. The TWEAK involves the following questions:
Frequent injury and injury while drinking also should prompt screening for alcohol abuse.
A family intervention program developed by researchers in New Mexico is proving successful in engaging addicts and getting them into treatment. Recent studies have shown that the Community Reinforcement and Family Training (CRAFT) approach to reaching addicts proved far more successful than other traditional approaches.
CRAFT focuses on helping family members persuade their addicted loved ones to start treatment. Recent federally supported randomized studies of the approach found a much higher rate of engagement into treatment than was the case for both the approach used by Al-Anon and a Johnson Institute intervention.
The CRAFT approach contrasts sharply with that of Al-Anon by emphasizing positive reinforcement rather than Al-Anon's detachment philosophy. Family members are taught when and how to communicate with their addicted loved one. They are advised to engage the addict into a discussion of what is important in his or her life and to use this as a motivation to enter treatment.
In a recent study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 130 family members of alcoholics were randomly assigned to either CRAFT, the Al-Anon approach or the Johnson Institute intervention.
Another study, using family members of drug addicts, found similar results for CRAFT. The study found that of 62 family members using the CRAFT approach, 74 percent were successful in engaging their family members into treatment, Meyers told O&A.
Meyers said that a second randomized study in progress, using family members of drug addicts, is yielding results that are almost identical to those in the randomized study of families of alcoholics.
Results of the randomized study using family members of alcoholics were published in the September issue of the Journal of Consulting and Clinical Psychology, while the completed study of family members of drug addicts was published in the August issue of the Journal of Substance Abuse.
CRAFT was developed in the late 1980s by Meyers and Bill Miller, a professor at the University of New Mexico and director of research at the university's Center on Alcoholism, Substance Abuse and Addictions. Despite the program's success, the approach has not been replicated on a widespread basis.
Meyers is in the process of writing a training grant that would allow him to travel around the country to train other therapists in the approach. While Meyers has spoken at conferences, he is aware of only one replication of the approach (in Philadelphia), though researchers in Canada are attempting to use the approach on families of gambling addicts.
Meyers has taught the approach to about 14 therapists. He said that a positive aspect of disseminating the approach is that the skill level of the therapist does not seem to alter the approach's effectiveness.
The CRAFT approach emphasizes activities involving the addict and family members in which an addict remains sober. "We want to increase their positive times together," said Meyers. "For instance, if an alcoholic never drinks at his in-laws' house, we schedule more time over there."
Family members are advised to ignore loved ones when they are under the influence.
Therapists typically meet with family members for about 12 hours of sessions before the addicted loved one is persuaded to enter treatment. Family members also benefit from receiving their own mental health treatment in the sessions. Depression and anxiety levels among family members usually drop considerably after the sessions.
A different therapist treats the addict. This can be appealing to addicts because they won't feel that a family member's therapist is coercing them, said Meyers.
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