Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment.
OBJECTIVE
Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs.


METHODS
The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model.


RESULTS
CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11-5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28-3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically after [corrected] four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window.


CONCLUSIONS
CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.
Roozen
Hendrik G
HG
Erasmus University Medical Centre, Department of Forensic Psychiatry, Rotterdam, the Netherlands. h.roozen@erasmusmc.nl
de Waart
Ranne
R
van der Kroft
Petra
P
D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000534:rehabilitation; D017028:Caregivers / Q000193:education* / Q000523:psychology / Q000706:statistics & numerical data; D003142:Communication; D016206:Databases, Bibliographic; D054541:Family Conflict / Q000523:psychology; D005192:Family Health; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011209:Power, Psychological; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D055815:Young Adult