Background 5 & Community Reinforcement and Family Training

Question 1

concerned significant others (CSOs) and treatment

Answer 1

addicts often have a detrimental impact on the lives of their concerned significant others. these problems include marital distress, social problems, financial troubles, aggression and interpersonal issues. as well as depression, anxiety, low selfesteem and physical problems. not only the addict, but also their loved ones need help with coping and support.

Question 2

3 traditional CSOs treatments

Answer 2

1. Al-Anon/Nar-Anon: instructs CSOs to accept that they are powerless and helps them detach with love from the substance abusers and to resist any effort to influence their behavior
2. Johnson intervention: promotes an active CSOs role in attempting to set up a group confrontation, with the goal of getting the addict to enter treatment through new insights into the negative impact of the substance related behaviour
3. behavioural couple therapy: actively involves the addicts partner in treatment and aims to teach a) the couple to cope, b) the partner to support/reinforce behavioural change, c) improve relationship satisfaction and to reduce stress (prevent relapse). has a large effect on satisfaction but a weak effect on the sud.

Question 3

newer treatment with CSOs

Answer 3

community reinforcement and family training

Question 4

community reinforcement and family training CRAFT

Answer 4

treatment in which close relatives are supported by a practitioner to adjust their behavior in order to motivate the patient to start treatment. improving the QOL of the relatives is also an important goal. CRAFT is based on CBT and MI.

Question 5

elements of CRAFT

Answer 5

• functional analysis: involving the CSOs in FA and devising strategies to discourage the behaviour
• emergency plan: discussing an emergency plan for aggression/domestic violence
• communication training: communicate in a positive way
• reinforcement: letting the CSOs reward abstinence or other good behaviour while they do not reward unwanted behaviour. they do not try to protect their loved one from natural negative consequences of abuse

Question 6

dus verschillen tussen deze treatments wat betreft de rol van CSOs:

Answer 6

• Al-Anon/Nar-Anon: CSOs should detach, are powerless.
• Johnson intervention: very confrontational role for CSOs
• BCT: active role of partner
• CRAFT: CSOs can actively motivate the patient

Question 7

the majority of sud patients are opposed to seeking treatment, which often leads to disruptions in relationships with CSOs. only 6%-16% users enter treatment

Answer 7

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Question 8

which method encouraged more patient engagement

Answer 8

CRAFT:
- 3 times more than al/nar-anon
- 2 times more than Johnson internvetion

-> CRAFT encouraged 2/3 of treatment-resistnat patients to attend treatment.

Question 9

which method lead to better CSOs functioning

Answer 9

CSOs showed improvements regardless of the intervention

Question 10

evidence is not as strong yet for superiority over the johnson intervention due to a limited number of available studies.

Answer 10

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