Dr. Meyers has been has been invited to give the B. F. Skinner Lecture at
the 2010 convention of the Association for Behavior Analysis
International (ABAI). The 36th annual convention takes place May 28 - June
1 in
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TWO NEW
ARTICLES JUST RELEASED
A new article on CRAFT has
just been published, Smith, J.E., & Meyers, R.J. (2009) Working
with family members of treatment-resistant substance abusers: What independent
practitioners should know. It
can be found in the APA journal The Independent Practitioner, Summer 2009,
Volume 29, Number 3.
A new 90 page chapter on A-CRA has just been published, Godley, S.H., Smith, J.E. Meyers, R.J., & Godley,
M.D. (2009). Adolescent community reinforcement approach
(A-CRA). This chapter can be found in D.W. Springer, & A. Rubin (Eds.),
Substance abuse treatment for youth and adults. John Wiley &
Sons, Inc
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NEW REVIEW: From the Family Journal, Volume, 17, No.2,
April 2009
Motivating Substance Abusers to Enter Treatment:
Working with Family Members (2008). Jane Ellen Smith & Robert J. Meyers,
At some point in their careers, all counselors encounter
families who are struggling with a loved one’s refusal to get help for
substance abuse or dependence.
Typically, responses available to clinicians have included only two
options: either a confrontational intervention by family and friends or
encouragement not to enable their loved one, and learning to detach with love,
by attending a support group such as
Al-Anon. This book presents a different way: an
empirically based, non-confrontational therapy program designed for the
concerned significant other (CSO) who wants to motivate a partner or family
member to get help.
I found the Community Reinforcement and Family Training
(CRAFT) approach, presented by authors Smith and Meyers, to be progressive in
its basic premises, practical, and generally applicable to counselors working
in a variety of settings. The text
begins with a general description and overview of the CRAFT Intervention
Program, including a fine discussion of the requirements for being a competent
practitioner of this approach. The
inclusion of sample of conversations with CSOs as well as a review of some
family therapy spouse inventories were particularly useful.
The heart of the book is chapter4, in which the authors
conduct a functional analysis of a problem behavior, with the main goal being
to alter the identified patient’s (IP) substance use by changing how the CSO
interacts with the IP. This may sound
like an oversimplification of a complex process, but the text addresses not only
how the CSO can reward sober behavior but also the importance of problem
solving and self-care. For those
clinicians who may not be confident in their knowledge of drinking or using
behavior, the text provides vivid examples and a step-by-step process for
getting started, guiding the CSO, identifying short term- and long-term
consequences for both the IP and the CSO, and ultimately how to help get the
substance abuser into treatment.
Edward P. Cannon,
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The
following is a recent review by the European publication Addiction Today of the book Motivating
Substance Abusers to Enter Treatment: Working with Family Members by Jane
Ellen Smith and Robert J. Meyers.
“Excellent”…Gives
therapist comprehensive, clear, and detailed steps to lead concerned
significant others (CSOs) into specific behavioral interventions with
identified patients. The authors’
respectful, careful approach in working with CSOs to encourage the substance
misuser into treatment or reduce misuse and improve their own lives is
impressive and evidenced-based…This book offers meaningful support and
interventions to people living with substance misuers.
In
the June 2008 issue of the Journal, Irish Psychologist there is a very useful
article on how to introduce the Community Reinforcement Approach (CRA) into a
traditional addiction treatment unit. You can get a copy of this insightful
article by Muhammand Tahir Khalily by emailing him at Khalily64@yahoo.com
10/25/08 – New Testimonial
Bob
Meyers is an inspiration, both because he has written an effective therapeutic
approach, which is backed by acres of clinical research evidence, but also
because he has a ‘joie de vive’ that pervades all that he does. He is personable and engaging and when teaching
he brings the detail of CRAFT to life with anecdotes from practice and a warm
humour that was appealing to our audience of Substance Misuse workers in Wales,
UK. From the 2 ˝ days CRAFT training
staff were able to take an understanding of the ethos, the theory, the
practical elements, the materials and start practicing with families
immediately. I would have no reservation in recommending this training to
anyone who works with family members who are supporting a loved one with a
substance misuse problem.
Strengthening Families Programme,
Congratulations goes to Jane Ellen
Smith, Ph.D., who becomes the
first female chair of the Department of Psychology at the
A review of the book, Motivating Substance
Abusers to Enter Treatment: Working with Family Members, by Jane Ellen Smith
& Robert J. Meyers. By “The
Journal Critical Psychology, Counselling, and Psychotherapy” Vol. 8, No.1,
March 2008.
This
program must be recommended for its emphasis on empowering family members, used
to experiencing high levels of helplessness, as well as the strong evidence for
the effectiveness of this program in motivating substance abusers to engage in
treatment. Overall this book is
effective in providing a clear and detailed guide to initiating and delivering
this program for practitioners in a range of clinical settings.
There
is a great article on addiction treatment at MSN here is the link http://health.msn.com/health-topics/addiction/articlepage.aspx?cp-documentid=100202307&page=1
A
study by Knudsen, et al., in the Journal of Psychoactive Drugs points out that
over 49% of private substance abuse centers in both rural and urban areas claim
they use the Community Reinforcement Approach (CRA) as part of their overall
treatment program.
As
of April 1, 2008 Robert J. Meyers, Ph.D. has been awarded a new title by the
A new CRAFT article has been published in
the Journal Alcoholism Treatment Quarterly, Volume 26, Numbers 1/2, 2008. You can find it on pages 169-193. The title is Working with Family members to
Engage Treatment-Refusing Drinkers: The CRAFT Program. By Jane Ellen Smith, Ph.D., Robert J. Meyers,
Ph.D., & Julia L. Austin, MS. It
is available online at http://atq.haworthpress.com
Testimonial,
The substance of the ACRA
training has added value to the clinical structure of my agency as a whole, by
providing a way to define and organize clinical interventions and facilitating
clinical communication.
There is an added benefit to the ACRA model in its time-limited,
curriculum-oriented format which I think can do much to lower the barrier of
treatment acceptance by non-Western
populations. This is a problem that has troubled the addiction
treatment field for a long time.
Brandon Nguyen, LCSW,
Supervisor
Asian American Recovery Services Inc.
WHY USE A COMPREHENSIVE TRAINING MODEL
According to a recent national survey, 4.8 million adults
are in need of substance abuse services, but less than 1.5 million receive them
(Substance Abuse and Mental Health Services Administration, 2001). Alarmingly,
for those who do receive treatment,
all too often the interventions are not scientifically based (Miller, Sorensen,
Selzer, & Brigham, in press). In his most recent summary of “What works?”
in the alcohol treatment field, Miller again reported on the striking
negative correlation between empirically-supported treatments and those
treatments typically being used in the community (Miller, Wilbourne, &
Hettema, 2003 & 2005). Although there are numerous illustrations of
these overlooked evidence-based treatments, prime examples include behavioral
couples therapy (Fals-Stewart & Birchler, 2001), naltrexone, contingency
management (Carroll & Rounsaville, 2003), and the Community Reinforcement
Approach (Miller et al., 2003).
What are the reasons why practitioners do not commonly use the substance abuse
treatments with empirical backing? The range of obstacles varies widely,
beginning with clinicians simply being unaware of the effective treatments
(Fals-Stewart & Birchler, 2001), or thinking they actually are using scientifically-supported
treatments when, in fact, they are not (Erickson-Pritchard, 1999; Miller &
Meyers, 2001). Some clinicians are aware of the research findings, but question
the fact that the interventions were tested on carefully-screened non-diverse
samples (McLellan, 2002; Morgenstern, 2000), and while using unrealistically
standardized deliveries (Morgenstern, 2000). Another salient barrier is the
perceived clash in ideologies between scientists and many clinicians, with the
two “sides” differing in their fundamental tenets about the etiology of
substance abuse and the most basic components of treatment (McCrady, 1994;
Morgenstern, 2000). Practical obstacles to the adoption of empirically-based
interventions include the treatments being too difficult to learn or too boring
(Hayes, 2002), or the issue of counselors being too overworked and underpaid to
shoulder the responsibility of converting science into practice (Backer,
Liberman, & Kuehnel, 1986). Finally, despite many clinicians being open to
learning novel models, practice behavior that has been established for many
years is notoriously difficult to modify (Chapman & Chapman, 1967). What
does this suggest? We should examine the shortcomings in our standard training
of therapists, and develop approaches that would be more likely to yield and
maintain the desired behavior change.
Research
shows that dissemination efforts fall short if they focus exclusively on the
clinicians’ behavior and do not take organizational (agency) factors into
consideration (Martin, Herie, Turner, & Cunningham, 1998; Simpson, 2002;
Stirman, Crits-Christoph, & DeRubeis, 2004). Models examining
organizational change suggest (on the basis of uncontrolled and case studies
mostly) that leadership attributes (e.g., risk tolerance), institutional
resources, level of work stress, clinical autonomy (Judge, Thoreson, Pucik,
& Welbourne, 1999; Simpson, 2002), compatibility between treatment
philosophies (Thomas, Wallack, Lee, McCarty, & Swift, 2003), affordability
of programs for agencies and insurance companies (Carroll & Rounsaville,
2003; McLellan, 2002; Thomas et al., 2003), and a host of other factors have a
non-trivial impact on adoption practices. Consequently, in developing training
programs in which eventual adoption is truly an objective, we must be mindful
of numerous critical factors at both the individual and agency levels.
Given the limitations of the commonly used
one-time workshop to support the training and maintenance of new therapy
skills (Miller et al., 2004; Najavits et al., 2000), tape reviews and
supervision post-workshop is highly recommended.
Because
one would hope that an effective training strategy could be used there are
several things to consider. Thus, issues of affordability and availability
(e.g., to rural populations, to the disabled) must be examined. Although
offering the training via books/manuals satisfies these criteria, research does
not support the exclusive reliance on manuals as being an effective or
clinician-preferred method for either skills
acquisition (Levinson, Schaefer, Sylvester, Meland, & Haugen, 1982;
Miller et al., 2004; Sholomskas et al., 2005) or adoption (Sorensen et al., 1988). Importantly, the data further
suggest that one group of therapist, “recovering” counselors, performed better
in face-to-face trainings than when simply provided with CBT manuals (Sholomskas
et al., 2005). At the same time, the
most common format for continuing education training, a one-time workshop or
conference, has been shown to be problematic as well, particularly for maintaining training effects (Davis et
al., 1999; Godley, White et al., 2001; Miller et al., 2004; Najavits et al.,
2000; VandeCreek, Knapp, & Brace, 1990).
Ongoing consultation during any transfer of
technology is considered critical
(Backer et al., 1986; McCarty et al., 2004; Simpson, 2002). Staying true to the
learning principle that gave rise to CRA, reinforcement appears to hold great
promise as far as the foundation of the supervision. Positive reinforcement for successive approximations
is a well-established principle of learning. Interestingly, Andrzejewski et al.
(2001) discovered that therapists’ practice behavior was highly responsive to
reinforcement, and thus he determined that the maintenance of new skills and
their use in the workplace appeared to be a motivational issue. For instance, one of the most consistent
findings in motivational psychology is that systematic feedback, when combined
and compared with behavioral goals, enhances performance (Locke & Latham,
1990). When a recent study evaluated the effect of supplying therapists with
objective feedback about their patients’
progress throughout therapy, it discovered that the clients of these
therapists showed twice the improvement rate of the clients of therapists who
received no such feedback (Lambert et al., 2001). Although the exact mechanism
of operation is unknown, one would assume that the therapists who received feedback modified their behavior in a
positive way. The same should apply to feedback about therapists’ own behavior.
In sum, we are left with the notion of supplying therapists with feedback about
their performance, thereby enhancing learning and reinforcing their behavior in
the process.
How can supervision that involves
feedback/reinforcement for new practice behavior best be offered? On a
practical note, the extremely high turnover rates of substance abuse staff
(including administrators) calls into question whether many agencies’
infrastructures could support some type of ongoing training themselves
(Fals-Stewart et al., 2004; McLellan, Carise, & Kleber, 2003).
Consequently, the supervision would likely need to occur with experts outside
of the agencies. The predicament of having to find therapist
training/supervision that is affordable, readily available regardless of
location, and of high quality leads one naturally to computers as the solution
(Weingardt, 2004).