Secondary analysis of an RCT

BACKGROUND

In addition to increasing the quality of life among concerned significant others (CSOs), Community Reinforcement and Family training (CRAFT) aim at helping CSOs motivate treatment-refusing identified patients (IPs) into treatment through a positive reinforcement process. The aim of the present study was to investigate if the following factors, measured at baseline, have an influence on IP future treatment engagement (1) Type of relation between CSO and the IP (2) The amount of time the CSO spend with the IP (3) if the IP knows that the CSOs seeks help, and (4) The CSO's own alcohol use.

METHODS

A secondary analysis from the Danish CRAFT study. CSOs completed a self-administered questionnaire at baseline, after three months, and six months. To investigate the relationship between the four variables and treatment engagement, logistic regression was used.

RESULTS

CSO's relation to the IP, the frequency of contact between the CSO and the IP, and the CSO's AUDIT score at the time of the baseline interview were not associated with the IP's treatment engagement. If CSO at baseline had informed the IP that the CSO participated in CRAFT, odds for IP treatment engagement were significantly higher (adjusted OR [(CI)] = 2.29 [1.13; 4.63] (p < 0.05), relative to if IP not being informed.

CONCLUSIONS

CRAFT has a higher impact on the likelihood for treatment seeking, if the CSOs inform the IP about his or her own help seeking in order to change the situation. The underlying mechanism behind this is needs further investigations.

Study protocol for the family empowerment program: a randomized waitlist-controlled trial to evaluate the effectiveness of online Community Reinforcement and Family Training (CRAFT) on the wellbeing of family members with a relative experiencing substance dependence and mental illness

BACKGROUND

Systematic reviews consistently show that family-focused interventions are effective at improving substance treatment engagement and outcomes across the lifespan. Yet, Australian substance use treatment services rarely incorporate family members and concerned significant others. Testing of family focussed interventions in the Australian context is required.

METHODS

The trial is a randomized wait-list control trial assessing the effectiveness, feasibility and acceptability of online CRAFT with a parallel group. Participants will be randomised to receive either online CRAFT or to a wait-list control group who are provided with CRAFT related reading material during the waiting period. Outcomes will be assessed at baseline and then at 6- and 15-weeks post baseline. The primary outcome will be improved wellbeing of participating family members. The trial reporting will comply with SPIRIT guidelines.

DISCUSSION

This study will focus on people living in rural areas. Substance treatment programs are limited in rural Australia. The provision of the Family Empowerment Program (CRAFT) online should make family focused substance treatment support accessible and attainable for the first time in rural areas. The outcomes of this trial could have meaningful implications for the future funding and support of family focused substance treatment services that are inclusive of people with mental health conditions.

TRIAL REGISTRATION

ANZCTR, ACTRN12623000796684p, Registered 26 July 2023. Prospectively registered with protocol version 3.

How concerned significant others experience Community Reinforcement and Family Training (CRAFT) - a qualitative study

Introduction

Heavy drinking causes serious harm, not only to the drinker but also to relationships and concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) is an intervention developed to help the CSOs of substance users. The aim of this study was to investigate the drivers and aims underlying CSO participation in CRAFT, as well as their experience of the intervention itself and their module preferences.

Method

This is a qualitative study based on data from semi-structured interviews with 11 female help-seeking CSOs of individuals with alcohol problems. The participants were recruited from an RCT study of a variety of CRAFT delivery formats (group sessions + written material, individual sessions + written material or self-delivered CRAFT with written material only). The interviews were audio-recorded, transcribed, and analyzed by Interpretative Phenomenological Analysis.

Results

CSOs reported CRAFT helpful when both delivered by means of individual sessions or group sessions. The “Communication Element” in CRAFT, the module focusing on positive reinforcement and acquiring a clearer understanding of AUD, appeared to be particularly helpful elements of CRAFT. Furthermore, being met with acceptance and non-judgmental attitudes seemed to count highly for the CSOs. The written material a helpful supplement to the face-to-face interventions. The written material a helpful supplement to the face-to-face interventions.

Conclusion

CSOs who participated in the CRAFT intervention felt helped by its components, irrespective of delivery format.

Building on shared experiences: The evaluation of a phone-based parent-to-parent support program for helping parents with their child's substance misuse

AIMS

To evaluate the feasibility and acceptability of a phone-based parent-to-parent support program, in which parents who have had children with substance use problems provided support and guidance to other parents seeking help about their child's substance misuse.

METHOD

228 parents completed a 2.5-day coach workshop and 6-months of ongoing training and support in the Invitation to Change Approach (ITC), a program blending evidence-based strategies for addressing substance use disorders. Trained parent coaches provided support and guidance to 278 parents for up to 8 weeks. We evaluated the coach trainees' satisfaction with the training program and pre-post differences in self-care and the use of communication and behavior management strategies among parents who called the helpline.

RESULTS

The coach training program was rated as very satisfying, useful, and coaches would recommend the training to other parents. Among parents enrolled in the coaching program, a significantly greater proportion reported improvements on a majority of the survey items (e.g. a decrease in depression and better communication with child).

CONCLUSIONS

Remote parent-to-parent coaching appears promising for providing emotional and evidence-based informational support to family members parenting a child with substance use problems.

Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions

BACKGROUND

Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.

METHODS

The study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.

DISCUSSION

We expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.

TRIAL REGISTRATION

Clinical trials.gov ID: NCT03281057 . Registration date: September 13th, 2017.