When Jen and Aaron came to see me they were nearing the end of their rope. Their 19 year-old daughter had barely completed her first year of college. In the last few months things had deteriorated. She was living at home, sleeping odd hours, unemployed and not attending classes. Her parents were pretty sure that drug use was the cause of the downturn in her behavior, but she denied it.
Things at home were tense.
How many times had they threatened to kick her out of the house if she was using? Yet, here she was, living at home clearly getting high.-Lara Okoloko
They felt that they were doing all they could to get her back on track – out of the house and back in college. Jen found herself constantly nagging and lately doing quite a bit of yelling too. Aaron’s frustration was leading him to adopt a cold shoulder towards his daughter. What could he say that would make any difference anyway? They had tried ultimatums but somehow it just felt easier to let matters drop than figure out how to enforce their rules. How many times had they threatened to kick her out of the house if she was using? Yet, here she was, living at home clearly getting high.
For decades the leading advice for the family members of addicted people has been a mashup of Al-Anon’s focus on self-care, co-dependency literature about detachment, and the ultimatums of interventions and tough love.
Jen and Aaron had heard this kind of advice from countless well-meaning people. “Just kick her out,” friends and extended family would say. “You have to detach from her and let her hit bottom.” Yet they couldn’t bring themselves to do something that felt so harsh and dangerous. Jen sought support from Al-Anon and appreciated the community of understanding people, but she couldn’t grasp the idea of “letting go” of her daughter when she so clearly needed help.
What most people don’t know is that there is an alternative approach for families who want to help an addicted loved one and themselves.
CRAFT: There is Another Way
I first learned about Community Reinforcement and Family Training (CRAFT) when I was facilitating a support group for parents of adolescents with drug and alcohol problems. The positive, relationship-based approach felt intuitive to me. Using CRAFT, I watched family members establish new boundaries and ways of communicating that allowed them to improve their home environment and family relationships without abandoning the person with the addiction. CRAFT helps families answer the primary question they ask me when they first walk into my office, “How do I stay in a relationship with this person I love without losing my sanity or enabling their addiction?”
How do I stay in a relationship with this person I love without losing my sanity or enabling their addiction?
Over a period of months, Jen and Aaron came regularly to my office to learn how to talk to their daughter again, using positive communication to empathize with her as well discuss the drug use openly. They gained insight into the ways that they were facilitating the drug use and stopped giving her rides to meet up with using friends, allowing valuables to disappear from the home without consequence, or giving her cash when they knew that she was buying drugs. They learned to watch for something positive and were always ready to encourage a healthy behavior like looking for work, agreeing to see a doctor, or staying in for the evening. They re-engaged her with the family, with the clear expectation that plans would be cancelled if she showed up intoxicated. They examined their own well-being and prioritized their own self-care. They researched treatment options and found ways to invite her to consider getting help that called on her motivations rather than her parent’s fears.
They didn’t have control over her or her addiction, but they found all the ways that they could influence change in their home and in their relationship with their daughter.-Lara Okoloko
Jen and Aaron were surprised to find how much influence they appeared to still have with their daughter. They didn’t have control over her or her addiction, but they found all the ways that they could influence change in their home and in their relationship with their daughter. They had replaced nagging and yelling with clear communication. They found that they were confident about their boundaries and more able to say “no” when they were feeling manipulated. They were done enabling but still ready to help. Something was shifting.
The Power of CRAFT
Soon the day came when their daughter said that she was willing to try treatment. Jen and Aaron were ready. They knew that helping their daughter get into treatment was a healthy way to be involved in her recovery efforts. They already had a treatment agency in mind and had checked their insurance benefits. She had her intake appointment a couple of days later.
...studies show that CRAFT 'successfully engaged approximately two-thirds of the treatment refusing individuals into treatment,' regardless of type of substance use...-Lara Okoloko
Loving, involved family members are a protective factor for people who have substance use problems. CRAFT values the role of the concerned family and respects their input. A review of the evidence on CRAFT shows that, “studies have consistently demonstrated that CRAFT is 2 to 3 times more successful at engaging treatment resistant individuals in substance abuse treatment than the traditional Al-Anon model and the Johnson Intervention. More specifically, studies show that CRAFT "successfully engaged approximately two-thirds of the treatment refusing individuals into treatment,” regardless of type of substance use, ethnicity of the family, or types of relationship, including spouses, siblings, or parent-child.
One of the most satisfying parts of using CRAFT to help families is the efficiency with which it initiates change. The research shows that generally, “substance users engaged in treatment after only 4 to 6 sessions [with the concerned family member]. Irrespective of whether the substance user engaged in treatment, the [family member] reported a sizeable reduction in their own physical symptoms, depression, anger and anxiety.”
A Support Network for Parents
When Denise Mariano’s son was in the height of his addiction to heroin at 19 years-old, she was fighting insurance companies and trying to make sense of the maze of rehabs to find treatment for him. “People told me that I was the biggest part of the problem. They told me to use tough love with my son. They told me don’t let him back home, if he calls, don’t help him: only they can help themselves and they must hit their bottom.”
In my heart, letting go and giving up hope on my son was not an option. Such options would never be acceptable if our son was suffering from another medical disease.-Denise Mariano
Denise is one of 55 volunteer peer parent coaches through the Parent Support Network, a free program of the Partnership for Drug-Free Kids. Each of the volunteers have been trained in CRAFT to coach other parents through their concerns about their children’s substance use problems.
“In my heart, letting go and giving up hope on my son was not an option,” says Denise. “Such options would never be acceptable if our son was suffering from another medical disease. We chose to not give up hope, to set healthy boundaries and continue to stay engaged.”
Today, Denise’s son is in recovery and Denise volunteers a few hours a week providing CRAFT-oriented coaching to other parents through the Parent Support Network. “CRAFT has allowed me to support that journey rather than control it.”
Recommended CRAFT Resources for Family Members
- Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening: The CRAFT primer written by CRAFT researcher Dr. Robert J Meyers, Get Your Loved One Sober is easy to read and provides concrete advice to the family members of people in addiction.
- Beyond Addiction: How Science and Kindness Help People Change: A much welcomed second book using CRAFT methods for caring family members wanting to lead positive change in their family and help a loved one find recovery from addiction. Beyond Addiction was written by the psychology team at the Center for Motivation and Change in New York.
- CRAFT Support Groups and Certified Therapists: CRAFT certified therapists are not easy to come by but you can find a listing online on Dr. Meyer’s website. Therapists wanting to become trained can also find upcoming workshops on the site.
- SMART Recovery Friends and Family: SMART Recovery offers in-person and online meetings using Cognitive-Behavioral Therapy to help people change their substance use and find recovery. SMART Recovery Friends and Family has online and in-person support groups for the loved ones of addicted people and uses CRAFT principles.
- Parent Support Network Phone Coaches: Parent Support Network volunteer coaches are CRAFT trained to provide peer support over the phone to parents struggling with their child’s substance use problems.
Author Note: The family in this article is actually a compilation of a few similar families I have worked with in my private practice.