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 GOALSPopulation CRAFT Study Treatment

EngagementReduce Addictive

BehaviourDecrease 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, CONSEQUENCES1. Gambling Behaviour2. Treatment Involvement 3. Inventory of Consequences for the IP and CSO4. University of Rhode Island Change Assessment

Inventory - Gambler version

RELATIONSHIP FUNCTIONING1. 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 motivation2) Functional analysis of the gambling

behaviour3) Improving communication skills4) Positive reinforcements for non-

gambling behaviour5) Use of negative consequences6) Helping the CSO enrich their own lives7) 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 gambled2. Treatment engagement3. 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