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final report CRAFT (german)

 

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Dr. phil. G. Bischof
Universität zu Lübeck
Klinik für Psychiatrie und Psychotherapie
Arbeitsgruppe S:TEP (Substanzmissbrauch: Epidemiologie, Epidemiologie, Prävention)
Ratzeburger Alle 160
23538 Lübeck, 
Fax: 0451-5003480
Tel.: 0451-5004860
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Intervention in family members of alcoholics unwilling to undergo therapy according to Community Reinforcement and Family Training (CRAFT)

Gallus Bischof, Julia Iwen, Christian W. Müller, Hans-Jürgen Rumpf
Universität Lübeck, Klinik für Psychiatrie und Psychotherapie

Family members of untreated alcoholics are frequently emotionally highly burdened. So far, there are no treatment offers for family members which take into account the addiction problem in the home. According to the concepts of work with family members that are widespread in Germany to date, family members are principally considered to be powerless. However, in various US studies, it was shown that the treatment of family members can exert a strong influence on the willingness of persons with alcohol problems to utilise specialist help. The study thus examines whether and how, through a behavioural training program for family members, untreated alcoholics can be motivated to undergo treatment. In addition, the training strives to achieve an improvement in the quality of life of participating family members. The results of the treatment, which take place weekly for twelve weeks, are compared with changes of an initially untreated group. The modules adopted from the USA were adapted to the local conditions.

The study targets adults who have regular contact with an alcoholic without current treatment contacts and without willingness to undergo treatment.

 

Background:

According to the estimate of the German Council Against Addiction, in Germany, 5-7 million family members of alcoholics are directly affected by the addition. The high burden of these persons is reflected in the increased rates of stress-related illnesses and psychosocial impairments (e.g. Orford et al., 1975, 2005). Studies have consistently demonstrated that the inclusion of family members in the treatment of persons suffering from addiction leads to an improvement in short- and long-term therapy success. At the same time, only approximately 10% of alcoholics are reached by the addiction aid system yearly, and family members represent only approximately 6% of users of the outpatient addiction aid system (Sonntag et al., 2007). Family members of those who reject treatment for alcohol problems, compared to those who accept treatment, are often merely advised to separate; those who are unwilling or unable to take this step find it difficult to get support. At the same time, various US studies have shown that the treatment of family members can exert a strong influence on the willingness of persons with alcohol problems to utilise specialist help (e.g. Miller et al., 1999). A tried and tested concept is the Community Reinforcement And Family Training (CRAFT). In this approach, it is assumed that family members can make an essential contribution to the further development of the substance use of the alcohol patient (“Index Patient”; IP) and the utilisation of help. The objective of the training is primarily the imparting of skills deemed to be useful for this aim, supplemented by further modules targeted at an improvement of one’s own quality of life. In this respect, three main goals are pursued: First of all, the substance use of the IP should be reduced in order to achieve an initiation of treatment of the IP in a further step. Independently or these two goals, the quality of life of the family member should be improved.

CRAFT is based on principles of learning theory and covers the following modules in 12 individual sessions:

 

  1. Motivating the family member,
  2. Functional behavioural analysis,
  3. Strategies against violence,
  4. Communication training,
  5. Positive reinforcement,
  6. Utilising negative consequences,
  7. Strategies to improve quality of life, and
  8. Motivating the IP to utilise help (cf. Bischof, 2007).

 

Aims:

To examine the intervention approach for family members of untreated alcoholics with the aim of increasing the utilisation of help on the part of the alcoholic as well as reducing the psychosocial burden on the participating family member.

 

Methods:

Randomised waiting-list design: 120 family members of alcoholics are randomly divided into an immediate treatment group or a 3-month waiting-list group. Follow-up surveys are conducted after 3, 6 and 12 months. In line with the inclusion criteria of US studies, adult family members of IPs with an alcohol-related disorder, who live with the IP or spend at least 20 hours per week with the IP are included in the study. Exclusion criteria are current alcohol-specific treatment of the IP, presence of multiple substance use in the IP, a substance-related addiction of the family member (exception: nicotine dependence) as well as a previous history of violent assaults in the partnership with use of weapons.

Current status: The patient recruitment began in May 2008. So far, 63 study participants have been included. To improve recruitment, first press contacts were made at the end of 2008.

 

Literature available from author




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