community reinforcement and family training (craft) with concerned significant others of problem...
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Community Reinforcement and Family Training (CRAFT) with Concerned Significant Others of Problem Gamblers
Nicole Peden & David C. Hodgins
University of Calgary
Rationale for Working with CSOs
Engaging CSOs is an excellent way to access problem gamblers who are resistant to treatment
Problem gamblers report that family influence was an important reason why they quit gambling
CSOs are in need of help themselves
Traditional Approaches
12 Step Programs
Johnson Institute Intervention
Mental Health Counseling
Nothing
12 Step Programs
Loving detachment
Acceptance of CSOs inability to control IPs behaviour
Group support for CSO
Johnson InstituteIntervention
IP is confronted at a “surprise party”
29% of CSOs complete training and carry out the intervention
Overall success rate: 24% enter treatment
CRAFT Goals
1) Engage addict into treatment
2) Reduce addictive behaviour
3) Decrease CSO distress
CRAFT Theory
Rooted in Behaviour Theory Operant Conditioning
Aspects Problem focused (e.g., problem solving, functional
analysis) Skills based (e.g., communication training, use of
positive reinforcement and time out from pr, natural consequences for using)
Active during sessions (e.g., role plays, exercises) Active between sessions (e.g., assignments,
suggesting treatment)
Empirical Support
Makarchuk, Hodgins, & Peden (2002)
Method 31 CSOs randomly assigned to CRAFT
workbook vs. standard treatment package
3 month follow up
Results Gambling behaviour decreased in
CRAFT workbook group Treatment entry rates similar for both
groups CSO distress improved in both groups
Empirical Support
Hodgins, Toneatto, Makarchuk, Skinner, & Vincent (2004)
Method 186 CSOs randomly assigned to 1) CRAFT
workbook, 2) CRAFT workbook + telephone support, 3) a control package
3, 6 month follow ups
Results Fewer days gambled in CRAFT workbook
groups Treatment entry rates similar for all groups CSO distress improved in all groups
Empirical Support
CRAFT GOALS
Population CRAFT Study Treatment Engagement
Reduce Addictive Behaviour
Decrease CSO Distress
Substance Abuse
Sisson & Azrin (1986)
NA
Miller, Meyers, & Tonigan (1999) NA
=
Kirby, Marlowe, Festinger, Garvey, & LaMonaca
(1999) = =
Meyers, Miller, Hill & Tonigan (1999)
Meyers, Miller, Smith & Tonigan (2002) NA =
Waldron et al., (2003)
NA
Problem Gambling
Makarchuk, Hodgins, & Peden (2002) = =
Hodgins, Toneatto, Makarchuk, Skinner, &
Vincent (2004) = =
CRAFT Study Conclusions
CRAFT is the only therapy that is aimed
at helping both the gambler and the
CSO
AND
Has some empirical evidence to
support its utility
Study Objectives
Phase I Modify and deliver the CRAFT
intervention in an individual face-to-face format to CSOs of problem gamblers
Phase II Compare CRAFT individual
intervention to the CRAFT self-help intervention
Collaboration and Funding
Collaboration with AADAC Counseling Services in Calgary
Funding support fromAlberta Gaming Research Institute
Ethics
Department of Psychology Research Ethics Board (DPREB)
November 2005
Conjoint Faculties Research Ethics Board (CFREB)
January 2006
Development of CRAFT therapist manual, client handouts, and treatment integrity checklist.
Initial telephone contact, screening, and recruitment.
Administration of pre-treatment assessment measures(face-to-face interview).
Assignment to treatment condition.
CRAFT Self-help CRAFT Individual Workbook Intervention
Post-treatment assessment (telephone interview).
Six-month assessment (telephone interview) + gift certificate mail out.
Sample Advertisement
Inclusion Criteria
1) CSO be over the age of 182) CSO have a minimum of 3+days/week of contact
with the gambler 3) Gambler be resistant to suggestion for treatment4) Gambler and the CSO must have not attended
treatment for gambling related problems in the last 2 months
5) Gambler must meet criteria for problem gambling (as reported by the CSO) and the CSO should be free of problems with gambling
6) Record sessions7) Provide follow-up data8) Provide the name of a collateral to help locate them
for the post-assessment and 6-month interviews
Measures
GAMBLING BEHAVIOURS, MOTIVATIONS, CONSEQUENCES
1. Gambling Behaviour
2. Treatment Involvement
3. Inventory of Consequences for the IP and CSO
4. University of Rhode Island Change Assessment Inventory - Gambler version
RELATIONSHIP FUNCTIONING
1. Relationship Happiness Scale
2. Relationship Assessment Scale
CSO PSYCHOLOGICAL FUNCTIONING1. Brief Symptom Inventory2. Depression Anxiety Stress Scales2. State-trait Anger Expression Inventory-II
REACTIONS TO TREATMENT1. Attendance/Workbook adherence2. Working Alliance Inventory3. Satisfaction questions about the program
Measures
CRAFT in 7 Modules(8-12 Sessions)
1) Building and sustaining motivation
2) Functional analysis of the gambling behaviour
3) Improving communication skills
4) Positive reinforcements for non-gambling behaviour
5) Use of negative consequences
6) Helping the CSO enrich their own lives
7) Suggesting treatment/Termination and additional resources
Hypotheses
1) CRAFT individual intervention = less gambling and more gamblers entering treatment
2) CRAFT individual intervention = lower levels of personal distress and better relationship functioning with the gambler
Data Analysis
Hypotheses = group (CI, CW) x time interaction (Pre, Post, 6m)
ANOVA will examine differences between groups for each outcome category
1. Days gambled
2. Treatment engagement
3. CSO functioning
STRENGTHS Unique contribution Random assignment Use of treatment
manual Treatment
adherence check (non-invested rater)
Blind follow-ups
LIMITATIONS CSO report Less experienced
clinicians Sample size Limited
measurements
Questions