CRA & CRAFT Flashcards
What are the two effective behavior treatments that help people build rewarding lives without substances?
Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). Both recognize that for someone to choose a substance-free life, life needs to feel satisfying and offer rewards that outweigh those from substance use.
What are the differences between CRA and CRAFT?
CRA focuses on the individual struggling with substance abuse and is designed to work even if they are not initially motivated for change. CRAFT, on the other hand, is for concerned significant others (CSOs) who are supporting individuals refusing substance abuse treatment.
What is a functional analysis (FA) in CRA?
Functional analysis (FA) is a foundational component in CRA. It aims to understand both external and internal triggers that lead to substance use. Looks at the short-term positive consequences of using (that help sustain the behavior) as well as triggers and reinforcements for healthy behaviors. It is used to identify alternative, rewarding activities to replace substance use.
What is sobriety sampling in CRA?
Sobriety sampling is a technique used to gently introduce the idea of change by encouraging individuals to try a limited period of abstinence. Helps reduce resistance, allows for experimentation with new coping strategies, and builds self-confidence. The length of the trial is collaboratively decided based on the individual’s motivations, and during this time, clients work with their therapist to develop coping strategies and alternative activities for high-risk situations.
What is the Happiness Scale procedure in CRA?
The Happiness Scale is a 10-item questionnaire used to assess an individual’s satisfaction across various life areas. It is used in therapy to identify areas for goal setting and track progress throughout treatment.
What is the purpose of the Goals of Counseling form in CRA?
The Goals of Counseling form mirrors the 10 areas on the Happiness Scale. It helps set specific, measurable, realistic, and personally meaningful goals that are under the individual’s control. Each goal is broken down into actionable steps that serve as homework between sessions. This process enhances the satisfaction gained from a substance-free lifestyle.
How does CRA use communication skills training?
CRA emphasizes teaching positive communication skills to reduce relapse triggers like arguments or misunderstandings. Clients learn three key strategies for difficult conversations: offer an understanding statement, take some responsibility, and propose a solution. These skills are practiced through role-playing.
What is the problem-solving approach in CRA?
CRA includes training in a 7-step problem-solving process: 1) Clearly define the problem, 2) Brainstorm possible solutions, 3) Eliminate unrealistic or undesirable options, 4) Choose the best solution, 5) Anticipate obstacles, 6) Plan for dealing with obstacles, and 7) Assign the task. The solution is attempted between sessions and reviewed in therapy for refinement or alternative strategies.
How does CRA prepare people for relapse risk?
CRA teaches drink and drug refusal skills, focusing on seeking social support, identifying high-risk situations, and practicing assertive refusal. Clients role-play scenarios, build support networks, and use FA to anticipate challenges.
How does CRA incorporate employment support into treatment?
CRA recognizes employment as a powerful source of positive reinforcement. It enhances self-esteem, provides financial stability, and supports sober social connections. CRA uses a structured job-finding method which includes identifying relapse-safe job options that match the client’s skills, setting up systems to track job applications, providing resume and interview preparation, and anticipating workplace challenges to manage them proactively.
How does CRA help clients rebuild a sober social life?
By helping clients rediscover old interests or try new activities that are genuinely appealing. Includes identifying high-risk time slots for substance use and planning sober activities during those periods. Systematic encouragement and in-session planning help clients overcome hesitations and follow through.
How does CRA handle relapse when it happens?
It uses a new FA focused on the relapse episode to understand triggers and consequences, and a chain analysis to examine the sequence of decisions leading up to it. Turns relapse into a learning opportunity. Clients also create early warning plans to identify and respond to relapse risk, including notifying a trusted support person.
What is medication monitoring in CRA?
Medication monitoring is a support technique used for clients prescribed disulfiram or other meds. A designated support person is trained to remind and encourage medication adherence. This person may attend a therapy session to learn the process, and there is a plan in place for what happens if the client refuses medication. It also acts as a relapse warning system.
What does CRA relationship therapy involve?
CRA relationship therapy focuses on improving romantic relationships as a source of reinforcement and stability. Relationship Happiness Scale assesses satisfaction in key areas, teaches partners to make specific, positive requests, and uses structured exercises. It also emphasizes joint problem-solving and collaborative goal-setting.
What does the adolescent version of CRA (A-CRA) include?
A-CRA includes adapted questionnaires and interventions for teens. It involves separate sessions for caregivers and joint sessions with also the adolescent. The approach includes teaching communication skills, effective parenting strategies, and goal negotiation. These sessions parallel adult CRA.
How effective is CRA according to research?
Alcohol: Studies consistently show it outperforms traditional treatments like hospital-based AA groups in reducing drinking days, increasing employment, and improving treatment retention. CRA combined with disulfiram monitoring showed higher abstinence rates.
It has also shown effectiveness with other substances like cocaine, tobacco, and opioids. Computerized CRA versions and combinations with contingency management (e.g., voucher rewards) further improve outcomes.
What does the research say about A-CRA’s effectiveness?
Effective. The Cannabis Youth Treatment study showed significant improvements in abstinence and recovery days. A-CRA was also found to be cost-effective. Other studies with homeless youth showed better outcomes in substance use, depression, and social stability compared to standard services. Has also demonstrated effectiveness across different ethnic groups.
What is the purpose of chain analysis in CRA?
Chain analysis is used to understand the sequence of seemingly minor decisions that led to a relapse. Rather than focusing on the relapse as a single event, it helps clients see earlier ‘choice points’ where alternative actions could have changed the outcome. This gives clients more insight into their behavior patterns and highlights that opportunities for change often arise well before the moment of use.
What is the early warning system in CRA?
The early warning system is a proactive relapse prevention strategy. It involves identifying signs that a relapse may be coming and developing a plan in advance for how to respond. This includes selecting a trusted support person and defining what they should do if the client signals risk or stops following through with their plan. It helps catch a potential relapse before it escalates.
How does CRA differ from purely abstinence-based programs?
CRA is flexible and non-confrontational. It doesn’t require immediate commitment to total abstinence. Techniques like sobriety sampling help clients try short-term sobriety, which can lead to longer-term change through increased self-efficacy and improved quality of life.
It is designed to work even if clients are not ready to commit. It uses motivational strategies, focuses on enhancing rewards in everyday life, and introduces change gradually through low-pressure techniques like sobriety sampling and FA. So it is highly accessible and client-centered.
It has been adapted internationally with success. It’s used in Spain’s public health system, the Netherlands, Mexico, Ireland, and Germany, among others. Studies have shown its effectiveness across cultural groups, especially in adolescents.
What is the purpose of CRAFT and who is it designed for?
CRAFT is designed for Concerned Significant Others (CSOs) when the identified person (IP) struggling with substance use refuses treatment. Its goal is to empower CSOs to influence the IP’s environment and behavior in subtle but effective ways.
What are the three main goals of CRAFT?
1) Decrease the IP’s substance use. 2) Get the IP into treatment. 3) Improve the CSO’s happiness and wellbeing regardless of the IP’s actions.
How does CRAFT use Functional Analysis (FA)?
CRAFT uses FA to gather information from the CSO about the IP’s substance use, including triggers, and positive and negative consequences. This helps tailor strategies to influence the IP’s environment and behavior.
How does CRAFT assess and address safety risks, particularly domestic violence?
CRAFT includes an assessment for domestic violence before any behavior change is recommended. If significant risk is found, CSOs are referred to specialized safety programs. FA can also help identify aggression triggers and develop safety plans.
What communication skills are taught in CRAFT?
CRAFT teaches positive communication based on three components: understanding statements, taking partial responsibility, and offering to help. These skills are practiced through role-plays and help reduce defensiveness from the IP, especially when making requests or setting boundaries.
How does CRAFT distinguish between positive reinforcement and enabling?
CRAFT explicitly teaches CSOs to reward behaviors they want more of using simple, inexpensive rewards the IP values. Enabling is avoided by ensuring rewards are not given when the IP is using, and by not shielding them from natural consequences of their behavior.
How does CRAFT recommend CSOs respond when the IP is using substances?
CSOs are taught to withdraw rewards and privileges and use positive communication to explain clear boundaries. They also avoid enabling behaviors like covering for the IP’s responsibilities and discuss the potential consequences of stopping such behaviors.
How is the CSO’s personal wellbeing addressed in CRAFT?
CRAFT uses the Happiness Scale to identify areas for personal improvement and helps CSOs set individual goals. Obstacles are anticipated and addressed, and support is provided even if the IP doesn’t enter treatment. The CSO’s wellbeing is treated as equally important.
How does CRAFT help CSOs invite IPs into treatment?
CRAFT encourages CSOs to wait for a ‘window of opportunity’ when the IP may be more receptive. They use motivational hooks and frame the invitation in non-threatening ways (e.g., trial sessions, personal goals). They are taught not to argue if the IP initially refuses and to continue CRAFT strategies consistently.
What makes CRAFT effective compared to other family support approaches?
CRAFT has strong research support showing higher success rates (often ~70%) for getting IPs into treatment compared to Al-Anon/Nar-Anon or confrontational methods like the Johnson Intervention. It also improves CSO wellbeing regardless of the IP’s treatment status and works across various relationships, cultures, and substances.
What does research say about CRAFT’s effectiveness with different substances and populations?
CRAFT has been effective for alcohol and illicit drug use, and works with parents of treatment-refusing teens. It also performs well in group formats and real-world settings, not just in clinical trials, making it widely applicable.
CRAFT consistently outperformed Al-Anon and the Johnson Intervention at getting treatment-refusing individuals into treatment. CSOs in all approaches reported improved well-being, even if the IP didn’t engage. Adding aftercare (support for the IP once they engaged) didn’t boost CRAFT’s effectiveness, showing the basic model is strong on its own.
How has CRAFT been implemented internationally?
CRAFT has been adopted in multiple countries, with its manual translated into German, Korean, Finnish, and Japanese. Therapists have been trained in Ireland, the UK, Netherlands, Scandinavia, Germany, and Canada. A self-help book is also available in Finnish and Spanish.
