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CRAFT for Parents of Kids With Substance Problems (Part II): Parent CRAFT in Action

“Our daughter is 23. She started using when she was 15 – drinking and smoking pot – the summer before she entered high school. A few of her friends’ parents had addictions, and she’d come to us, letting us know things she was learning about drug use. The year before, at age 14, she started cutting. She was experiencing tremendous clinical anxiety and depression about this time. She was hurting an awful lot and just didn’t know what to do with the pain. We undoubtedly made mistakes in the way we communicated with her and lost that openness. We’re not blaming ourselves, but CRAFT helped us see our role and how we needed to change things. CRAFT had a plan.”  – Sandra F.

By the time Tom and Sandra F.’s daughter, Susan, was in her late teens, she began using heroin, which as mentioned in my last column, CRAFT for Parents of Kids with Substance Problems, led the couple to a CRAFT (Community Reinforcement and Family Training) group and then to the new Parent Craft course at Cadence Online. Just recently, Susan went to residential treatment for the second time, this one for a severe alcohol use disorder. Her parents said she realized, “This time, if I don’t make some changes, I’m not going to live.”

“Fortunately, we have a tremendous bond that has carried us through,” said Sandra. Susan is adopted and, during her adolescence, Tom and Sandra said, “She was becoming more aware that her biology is very different from ours.”

Sandra added that Susan has “incredible birth parents who love her” and, from the age of 18, have had strong ties with her.

What Has CRAFT Taught Them?

Tom and Sandra learned many skills for improved parenting and communication. Following are the ones they highlighted:

  • “We learned the importance of setting boundaries.”

    Tom said that their daughter was violating boundaries. For instance, after her first round of treatment, they had a “long list” of behaviors they had mutually agreed upon for her recovery, and one of them was that she would take the medication, Vivitrol. (Vivitrol is an injectable form of naltrexone that blocks the effects of opioids and related feelings of wellbeing that can lead to abuse. It is designed to prevent recurrence of use.) Tom said, “When she stopped taking Vivitrol, it was clear that she had made the decision to use. We were prepared to say, ‘We need to help you move out.’ But she realized she’d reached that point ahead of the conversation and moved into one horrible situation after another. That kind of pushed her to start realizing that she needed help. Before that, I would have probably confronted her and said, “Susan, you’re out of here.” But CRAFT is about having them feel like they’re making the choices.”
  • “It’s about how we communicate.”

    Sandra gave the example of using “I statements” rather than more threatening “you statements.” For instance, instead of telling your loved one, “You’re going to lose your job because you’re always out late with those losers and then hung over in the morning,” a parent might say, “I’m concerned about the job that you like so much. I know that you have it in you to do what it takes to keep it, but being late could get in the way.” Sandra added that they spent a long time trying to figure out when Susan was using. But CRAFT helped them stop that focus and when they felt suspicious, to just say, “I don’t feel comfortable talking to you right now.” She said that with CRAFT, “It’s about knowing what not to say as much as what to say. Respond, don’t react. We are much kinder now. But you have to practice.”
  • “Taking care of yourself is important.”

    For Tom and Sandra, this includes attending a CRAFT support group regularly, which helps them avoid isolation and self-blame. They go on “no drug talk walks” and highly recommend it. They recently took a week-long driving trip along a coastal highway. She said, “It took two days before we settled down enough to really relax and enjoy ourselves, but we were successful! Sometimes our self-care is as simple as getting a good night of sleep. It sure beats dragging all over town at 3:00 a.m. searching for your child… I don’t mean to diminish the urgency, pain, and sorrow drug use brings into the lives of family members, as well as our addicted loved ones. But I have to come up for air! The more I do, the healthier and more in control of my own life I feel and definitely more able to be helpful to Susan.”
  • “We have had to learn to keep it calm.”

    Sandra explained the importance of not seeing everything as a crisis. “We’ve learned to slow down and think things through, which is very difficult for me because I want to service our children the minute I get a request for help. This is a very unhealthy behavior overall and sends the message, ‘You can’t solve your own problems,’ which is not true.” She finds that if she takes a few deep breaths and checks her heart rate her response is usually much smarter, adding, “this applies to the day to day things, not emergencies.” 

Overall, they feel that CRAFT helps them evaluate what they’ve done in the past and anticipate how to respond more appropriately in the future – until they get it right, noting:

“It takes time to learn how to do this. It’s work that’s well worth the effort. We have also learned how much our daughter wants to not only be sober, but also become a healthy, happy adult. So anything that supports that, we are onboard. The CRAFT model is so much more humane and positive in its approach to addiction than other approaches. Who wouldn’t want to get better if they were treated with kindness? An overriding message for the addicted loved one is ‘they don’t just want me to be sober, they want me to be happy.’ It’s pretty powerful stuff.

Evidence Supporting CRAFT for Young People

Parent CRAFT is considered the first evidence-based online approach for parents concerned about changing drug and alcohol behaviors in their children. There’s a long history preceding Parent CRAFT through a program for teens called Adolescent Community Reinforcement Approach or A-CRA (for a description, see Teen Addiction Treatment Programs That Measure Up). A-CRA has a great deal of research supporting its effectiveness and uses many of the same types of approaches as CRAFT.

Research published in the Journal of Substance Abuse Treatment in 2007 showed that 71 percent of parents who took part in a CRAFT intervention were successful in engaging their resistant youth in substance use treatment. Also, parents experienced a significant reduction in negative symptoms such as depression, anxiety, and physical problems. There was not a control group for comparison, so it will be interesting to see how CRAFT measures up with teens and young adults if and how future studies compare CRAFT with other approaches.

I should add that many approaches currently used with teens and young adults in substance use disorder treatment do not have scientific support, and some that do have strong support are not used to any great extent.-Anne Fletcher

Parent CRAFT certainly holds promise for the health and mental health communities. I spoke with Mark Fadool, M.A., clinical director of an outpatient clinic that’s part of Seattle’s Children’s Hospital. He personally took the Parent CRAFT course and is trying to figure out how to best disseminate it, seeing value for primary care physicians, social workers, and school counselors. Right now, his clinic is doing a pilot study using Parent CRAFT with parents of teens.

Fadool said, “It’s well-written and well-acted. You get to see where things go wrong and how they can go better. It’s poignant and can be very effective.”

He added, “How do you get the most information to the most people? With technology.”

* Some names have been changed to protect identity.


Image Courtesy of iStock

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