I’m honored to introduce Robert J. Meyers, Ph.D., founder of the Community Reinforcement and Family Training or CRAFT approach. In this interview, Dr. Meyers explains the CRAFT approach, why CRAFT can make a difference for families, and introduces the new Parent CRAFT online program.
Please welcome Bob Meyers!
To listen to the audio version of the interview, click here.
1. What inspired you to work with families struggling with substance abuse?
There are two things that really inspired me and they’re both from my family history.
The first one was that my father was a drinker. He had a serious problem, and my mother obviously was frustrated, depressed, and angry. She had a lot of psychological problems, some of which were caused by my dad not coming home for days at a time.
I grew up in this household where my mother took out her anger and anxiety on me and my brother. She pounded on us and beat us and we just thought that was the way kids grew up. Your dad drinks and your mother beats the hell out of you all the time. We didn’t think much of it at the time.
The second was that I joined the military at seventeen to get out of the trouble at home. I joined during the Vietnam conflict and ended up in Vietnam.
When I came home, I was addicted to several different drugs and my parents wouldn’t let me stay in their home. I was on the street for a while until I ran into a fellow veteran who told me, “You can go to school on the GI bill. They give you money to just to go to school,” so I did.
I finally got myself straight and eventually ended up working in alcohol and drug treatment programs. I was using the community reinforcement approach which I learned in Southern Illinois. There was a marital component to that. As I was doing therapy over the years, I started seeing the influence that the wives had over the husbands—even though sometimes they were a little bit scared and weren’t sure of themselves.
I started thinking about this, and I talked to one or two of my colleagues about it. I said maybe we should have a program for the wives, just to try to help them figure the deal out.
That’s actually how I came to the Craft mode. I started a pilot project back in 1977 or 1978 that I did for several years. It was quite good. It was working well, but at the time I was in a small mental health alcohol treatment division and I really wasn’t able to do any research. I wasn’t even a Ph.D. at that time.
When I moved to New Mexico and started working at the university, they recruited me, so I went back and got my Ph.D. and some research grants with my good friend Bill Miller. We did some CRAFT studies and that is how it all came about. It took me a long time to get the program out to the public, but it’s my baby. I love it. I think it’s magical.
Anywhere I have been, it works: Finland, Sweden, Denmark, Australia, South Africa, Chile. I have been all over the world. I just want to let you know that this Community Reinforcement approach is based on behavioral treatment and some operant conditioning.
My first degree was as a social worker. I used those social worker skills and melted them together with some of the psychological stuff. By luck, I came up with a protocol that I think is amazing. I think if you take a good look at it, you will see the benefits.
2. Please briefly describe Community Reinforcement and Family Training (CRAFT) for people who know nothing about it?
Going back to my mother, I remember watching her sitting. I remember the chair. I remember what she wore. I remember her tears. She went to Al-Anon and she did okay in Al-Anon. She had a lot of friends.
The CRAFT approach is the first program that is specially designed to help family members engage a resistant substance user to go to treatment. The way we have done that is we turned the paradigm upside down. We have a whole program within the book that’s like a self-care program for the woman or the wife that comes in to get help, or the mother that comes in to get help for her kids.
We start trying to help them work on their depression, or maybe some anxiety. They may have other physical symptoms. Then what we try to do is instead of having the family member focus on the substance use all the time, we try to focus on something that the individual is doing right.
We try to teach them when to talk to the user and when to back away from people by trying to help them pick a time when the person may be likely to sit and talk to them about a difficult situation. We try to avoid them on times that you know they are using.
We try to teach them to walk away and say, “Well I love you, but it hurts me to see you coming in this intoxicated, so I think I will just go upstairs and read a book. I will talk to you later.”
One thing you have to remember with CRAFT is that job number one is “do no harm.” We have to make sure that if there is domestic violence in the household, we don’t want to ask the CSO, the concerned significant other, the mother or the wife, to put themselves in jeopardy of getting hurt. That’s a big thing.
We also talk a lot about enabling behaviors, where they come from, and why it’s not such a bad thing to use them right now because they are trying to kind of keep an equilibrium in the house.
Eventually we have to get them to drop those enabling behaviors and let the drinker or the drug user suffer what I call natural consequences for his or her behavior, so they need to stop the enabling. Letting them suffer a natural consequence would be, for example, if they vomit, let them clean it up in the morning. If they have other problems, try to move away from being that kind of a caretaker.
One of the biggest pieces of CRAFT that helps the most is that we teach them how to re-communicate in a very positive way. We talk about giving them understanding statements or statements of empathy, like saying, “I know it’s been hard on you, and I know this is really difficult, but I really would appreciate it if you could spend a little more time with your kids, or a little more time with working on your homework, or whatever it might be.”
Instead of going in and calling them names saying, “You never get your homework done,” or “You are a horrible kid,” you go in and say, “I know this is difficult for you. Would you like me to help you? Would you like me to help you get a tutor? What can I do to support you in getting good grades and working on your homework?”
We also teach precise communication skills and some problem solving techniques for the CSO and for the family members. If the mother has a daughter who is really out of control, who does horrible things and screams and acts out at the house, we can do problem solving around what those behaviors are and where they started, and we can help to kind of minimize some of the negativity of those particular behaviors.
CRAFT is really for the family members. They are the client. We get to build the program around what they want to work on and when they want to work on things. We actually have them fill out scales on what they would like to work on first.
Whatever it is, they are the client, so we take their goals and we work those into a change program for the user.
I learned to talk in social work about who is the change agent: it’s the parent.
Here’s the deal: if the parent or spouse starts acting differently, the other person is going to think, “What the heck is going on? Why is she acting like this? Why did she walk away when I came home? Why did she not leave my food out on the counter?”
When the individual asks, “what the heck is going on?” we try to teach the family members to say, “Look, I’m just trying to help the family, so I’m going to treatment to get some ideas on what I can do to help the family.” At that point in time, maybe they’re ready to invite them treatment. Inviting them into treatment can take three to six weeks for some people.
During that time, we’re looking at what would be the reward for him to stop using drugs. What would be the reason for them to stop using alcohol? There has to be some kind of give and take. If we take away the alcohol, what are we going to give them in return? We look for what I would call positive reinforcement or rewards for the drinker or the drug user.
What is nice about the Cadence Online program and with CRAFT is you can do it right from your home. This is cool because there are so many rural areas and people don’t have a lot of money. It is extremely cheap. This program will teach you all the skills that would be helpful for you to change your behavior and to try to influence the drinker or the drug user’s behavior.
I can’t change anyone’s behavior, but I can influence that behavior by my actions. That’s the whole idea of CRAFT. How can I change who I am to make myself a better person and to get what I want out of my life, and at the same time bring my family along with me?
To me that’s why it’s magical. When we did the studies, we found that every woman that came through the CRAFT program was less anxious. They had less depression. They had less anger. They had less physical and medical complications. By six months, you could hardly tell it was the same person after they had gone through the program. So whether you do it online or you do it in person, I really believe that it is magical.
The people who come in for treatment are about 90% women. They come in to help somebody else and they always do a wonderful job.
The key is that the family member has so much information about how this drinker drinks or this drug user acts, when they come in, or where they go, or who they are with. That’s the information therapists need. When we have that information and we work with the family member, then we become a powerful team to try to figure out where to start to try and help this person to sit down and talk about maybe going to treatment. We say, “Just look. Maybe just come one time. If you don’t like it, don’t come back.”
The key is to get them through the door, treat them with respect and dignity and without judgment, and there’s no confrontation whatsoever. He’s in there and you’re supporting him in what he’s doing. And I ask, “What would you like to work on?”
It makes a whole world of difference. That’s how we get people in treatment—by finding positive things about them and getting back to the fact that we love and care about one another.
3. What motivated you to put the Cadence Online program together? What do you want parents to take away from the program?
The nice thing about the program is that we teach them new skills to be able to navigate their environment. We teach them positive communication skills that can be used on the job, that you can use with friends and with your family.
We teach them problem solving. We teach them when is the right time to talk to somebody, when it’s the right time to tell if it’s okay to move forward in a certain conversation. We also try to help them to learn how to take care of themselves to make sure that they don’t get sick. That’s very, very important.
I’ve been in the addiction field for 40 years. It seems whether it’s the family or the drinker or drug user, they always talk about things they don’t want to do. “I don’t want to go to jail, I don’t want to get into trouble; I don’t want to upset my son; I don’t want to make my daughter mad at me.”
They don’t say what they want to do. “I want to spend more time with my daughter because I love her. I want to again go places with my husband and feel good about it and not have to get worried that he’s going to get drunk.”
Instead of saying what you don’t want to do, let’s start saying what you want to do and spin it in a positive way. Let’s talk about things that are positive, even if you have to go back four or five years to get back to some of those positive things, that’s okay.
One of the strategies that I’ve come up with over the years is having mothers bring in scrapbooks of their children. They start looking at the pictures and say what was going on in each picture. They’ll say things like, “Oh, she was so beautiful back then. She was so wonderful. She did so well.” Everything is in the past tense.
I say, “Wait a minute, this is the same girl that we’re talking about right now, right? Do you remember when she was little and you taught her how to walk and go potty? You helped her to the first day in kindergarten.”
“Now she’s at a different stage in her life, but you can still help her get into the treatment she needs. You can help her and support her by being a caring individual who knows and loves this person and only wants to help them. That’s what you have to do because yelling, screaming, confrontation, being negative, all that stuff, it just doesn’t work at all. It just pushes kids out the door.
The more you yell at them, scream at them, you take away this or that, all that does is make them more and more angry, and more and more likely to go out the door and get into more trouble and more difficulty.
I’ve been watching this for 40 years, and I’ve watched some of the other strategies they call intervention. I don’t know what the heck they’re intervening, because they really don’t teach anybody the skills to take care of themselves and to help the family get into treatment. That’s the key: to get those adolescents into treatment before it gets too difficult.
The longer someone uses drugs or drinks alcohol, the more they are using, the more likely they are to get into more trouble with the police, hurt themselves or others with car accidents, overdose, or have other problems.
I’ve been on six continents, and America is the only country where people talk about how you’ve got to hit rock bottom.
That’s a bunch on bologna. The bottom line is that you can help somebody at any stage. The key for me is to get them before the pathology is so terrible and they’ve got such a horrible addiction problem that it’s much more difficult to treat. It may take years and years then as opposed to getting them into treatment earlier so you can help them.
I’ve seen it. I’ve had parents come up to me crying and hugging me saying, “you saved my son’s life.”
My comment always is, “No I didn’t; you did because you changed the way you interacted with him so that you can be friends again.”
That’s what CRAFT is all about. It’s getting your family back, getting your children back and being friends with them again. Help them move through life in a positive way, but try to keep everything positive—even relapses.
When they relapse, okay, let’s not condemn them. Let’s not put them to death because they had one or two days where they went backwards. Let’s start all over again and keep that positive attitude.
The whole idea with CRAFT is that you’re here because you want to help somebody you love. If you love and care about your kids, this is the program to go to. We have an unbelievable success rate. About 70% of the people who came into our clinical trial entered treatment.
People have replicated my study in Oregon with adolescent treatment, in TRI they’ve done it. In inner city Philadelphia they’ve done it. It works with African-Americans, Hispanics, and Anglos. Everywhere I go, it works very well.
I just really want to get kids into treatment before they end up going to some party and taking the wrong type of drug and really doing serious damage to themselves or someone else.
4. What are your top three messages for parents just learning about CRAFT who want to communicate better with their child?
The number one thing is that you’re not alone. You’re among millions of other parents in dozens of other countries that are having the same kind of problem. You’re not alone. We want to normalize the fact that some teenagers have problems.
One of the reason they have problems is their frontal cortex, the part of their brain that makes decisions, is not fully developed in adolescence. Give them a little bit more space. You’re not alone. Get the treatment and you will find lots and lots of people who’re in the same boat that you’re in.
The second thing is this is something that has been around from the beginning of time, and “You catch more flies with honey than vinegar.” If you’re going to be mean to your kid and yelling at them, and too structured for a teenager or young person, it’s going to be more difficult to get them to hang out with you, spend time with you, or even have a conversation with you.
I think the big thing is let’s talk positively. Catch your loved one doing something positive instead of catching them always doing something negative.
Let’s look at the positive stuff. You also have as much time and as many chances as you want to get into treatment and to get help. Sometimes you might need to go twice, but the nice thing about the online program is once you get it, it’s yours and you can go back over it.
Go back and find out a different way to do things. Talk to other women or other people that have been through the program and you can help one another.
And the bottom line, the last thing is that I want people to help themselves first. Listen: you’re fried, you’re depressed, you’re anxious, and you should be. You’re angry; you should be. Things aren’t going well and all of a sudden this adolescent turns into this kind of monster.
I have teenagers. I have raised kids too. I understand it. It’s everywhere. The idea is to take care of your anxiety issue or your depression issue or your isolation, because sometimes women isolate themselves because they’re embarrassed about what’s going on in their family.
Don’t isolate yourself. Stay in contact with friends and family. Get your life back. Get your power back so you’re more capable of handling a child who is having some difficulties. You’ll be stronger. You’ll feel better about yourself. Your self-esteem will go up. Your ability to handle difficult situations in a positive way is more likely to happen.
5. Going forward, what would you like to see as some of the next big trends for substance use treatment and recovery?
What I would like to see is for people who run the states and governments; the state alcohol and drug substance abuse directors and co-directors and CEOs, whoever they are, to start using evidence-based treatment.
There are several treatments for alcohol and drug problems, whether it’s for the CSO or the drinkers, so let’s say the CSO gets her son into treatment. Where is he going to go for treatment?
If he goes to certain programs, they are using a bunch of stuff that’s garbage, so he may not get himself together. If the adolescent goes on to a program like adolescent CRA or a motivational interviewing or positive behavioral program that have shown efficacy in those particular areas, they have a much better chance of recovering and staying away from trouble.
You know it’s really a shame that there are several countries in the world, like Sweden, Denmark, and Canada where they mandate CRAFT. Anybody who works with family members in an addiction program must by law use CRAFT.
Here in America, we are still using techniques that were developed 60 to 80 years ago! If your son or daughter had cancer, would you want them to get the same treatment that they used in 1940? Why would you use alcohol and drug treatment? I don’t understand that.
Everybody talks about evidence-based programs, but very few programs fill their inpatient, out-patient, and their family programs with evidence-based treatment. That would be the trend that I would love to see happen.
Click here to learn more about the Cadence Online Program.
Learn more about Dr. Meyers at his website.
Dr. Meyers has been in the addiction field for 40 years with 23 of those years being at the University of New Mexico. He is currently the director of Robert J. Meyers, Ph.D. & Associates and a Research Associate Professor Emeritus in Psychology at the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addiction. He has been involved in over a dozen clinical trials funded by the National Institutes of Health, including Project Match and the Clinical Trials Network.
Dr. Meyers began his work with the Community Reinforcement Approach (CRA) in 1976. At that time he helped develop the first CRA outpatient procedures, which were used in the seminal study published by Dr. Nathan Azrin and colleagues in 1982. In the late 1990’s Dr. Meyers helped design and evaluate the adolescent version of CRA (A-CRA). Dr. Meyers also developed the new innovative “intervention” program used to engage resistant substance abusers to enter treatment. This new intervention called Community Reinforcement and Family Training (CRAFT), an evidence-based protocol, has been shown to be superior to more traditional interventions in several randomized clinical trials. His CRAFT work has led Dr. Meyers and CRAFT to be one of the 14 featured segments of the Emmy Award-winning HBO Addiction series. Dr. Meyers has also been featured in Oprah magazine for his outstanding work using the Community Reinforcement Approach.
Dr. Meyers is an internationally known speaker and trainer who has delivered trainings in 31 states in the USA and in 14 countries around the world. Dr. Meyers has delivered trainings in 6 of the worlds 7 continents. He has published over 100 scientific articles or chapters and co-authored 5 books and one manual on addiction treatment, including “Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening” and “Motivating Substance Abusers to Enter Treatment: Working with Family Members”. Several of his books are also available in Dutch, Finnish, German and Korean. The book “Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening” is currently being published in Dutch, Finnish, Japanese and Spanish. Dr. Meyers along with Dr. William Miller have published 2 interactive Journals through the Change Companies for returning war veterans called the Coming Home series.