Craft An Alternative To Intervention
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Interventions lack empirical support and have mixed reviews in actual practice. People who are confronted in this way often report that interventions are unhelpful. Conversations that are guided by a trusted loved one who provides love, encouragement, and support may be more productive.
There are different types of interventions that might be used depending on the needs of the individual and their loved ones. Regardless of which type is used, it is essential that the process is guided by a trained mental health professional.
Hellum R, Nielsen AS, Bischof G, et al. Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions. BMC Public Health. 2019;19(1):307. doi:10.1186/s12889-019-6632-5
Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. J Consult Clin Psychol. 1999;67(5):688-97. doi:10.1037//0022-006x.67.5.688
A well-thought-out research question helps set up a research project for success. Researchers can use question development frameworks to craft a well-built question. Development frameworks are guides that take the researcher step by step through the different components that go into building a research question. A researcher with a question in mind can run it through a question development framework to hone their question and sharpen its elements. The process is designed to help highlight the main concepts to focus on. There are many different frameworks; each have their strengths and limitations and are suited to different types of research.
The most common question development framework inquiries seen by library staff here at CUIMC relate to PICO (Patient/Population, Intervention, Comparison, and Outcome). The popularity of PICO on this campus likely is due to the clinical focus of much of the research done at CUIMC, as PICO is best suited for clinical questions, comparing interventions, and evidence-based medicine. Clinical research is not the only type of research conducted on the CUIMC campus, however. To help researchers select the most appropriate framework for their own work, this article highlights some alternative frameworks in addition to PICO and links to resources on additional frameworks not covered here.
SPICE is a framework for qualitative research that focuses on evaluating the outcomes of an intervention or project. SPICE represents Setting, Perspective, Intervention/exposure/interest, Comparison, and Evaluation.
Booth, A., Noyes, J., Flemming, K., Moore, G., Tunçalp, Ö., & Shakibazadeh, E. (2019). Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Global Health, 4(1), e001107. -2018-001107
The CRAFT method contrasts with a traditional intervention. In traditional interventions, family and friends will get together and confront someone struggling with substance abuse. These interventions aim to get the person into a rehab program. The CRAFT method encourages close significant others, called CSOs, to reward a loved one when they show self-control or choose sobriety.
While there are different approaches to interventions, older methods are generally based on the idea that your loved one must accept help or you will distance yourself from that person. With CRAFT, rather than distance themselves from someone unwilling to get help, families learn strategies that allow them to support their loved ones and communicate with them.
The ultimate goal of the CRAFT method is to get someone dealing with an addiction to admit they have a problem and then get help. This is what makes it similar to other intervention approaches. There are also other goals, though.
Fortunately, there are alternative intervention approaches to the Johnson Model. Some of the most effective methods to get individuals who are resistant to treatment to get help include Motivational Interviewing (MI), and CRAFT (Community reinforcement and family training) along with the ARISE model of intervention. These more recent and less confrontational approaches also employ professional counselors or interventionists, although in these interventions, the goal is to move the addict into a state in which they themselves are motivated to change their behavior (MI) or focus on teaching behavior change skills to use at home by family members and loved ones (CRAFT).
Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.
CRAFT has, until now, been examined and shown effective in the USA and Germany. To our knowledge, studies on CRAFT have also been initiated in the Netherlands (ClinicalTrials.gov ID: NCT02510508) and Sweden (ISRCTN 38220020), but the results are not yet published. In the Netherlands researchers are performing a three-armed RCT with group, self-directed CRAFT or non-intervention addressed to CSOs to alcohol dependents. In Sweden, the effect of a five-week internet-based CRAFT program is tested versus waiting list (ISRCTN 38220020), in addition to another study on an online self-help program combined with a parent-training program for partners suffering from alcohol use disorder, versus a brief psycho-education program [27]. Moreover, a RCT study on CRAFT for CSOs with problem gamblers (CRAFT vs. treatment as usual) is currently being conducted in Sweden [28]. Earlier studies performed are based on small populations, and no study of CRAFT has been performed in Denmark so far.
Based on the data from Manuel et al. [20], we expect 40% of CSOs receiving self-help material and 60% of the CSOs receiving either Group CRAFT or Individual CRAFT to be able to motivate the drinkers to enter treatment. Furthermore, the effect of CRAFT is one-sided as the intervention of CRAFT cannot make the situation inferior for either the CSO or the drinker [8]. Based on these expectations, 106 participants in each group are needed to be able to detect a 20%-point difference with an α level at 5%, a power of 90% and an ICC of 0.05. As we foresee a dropout rate at approximately 10% and, furthermore, a loss to follow-ups rate at 10%, we need to include at least 135 CSOs in each group. This gives an expected total of 405 CSOs.
Consecutive CSOs, who contact a center randomized to the control condition (self-directed CRAFT), will be offered self-help material, only. After three months, and when the primary outcome has been measured, the CSOs in this intervention format will, however, have the possibility of an individual follow-up session with a therapist to make sure that the CSOs are helping to move on.
Since we expect a higher impact from the face-to-face intervention than from the control condition, all participants in the control condition have the option for a face-to-face session with therapist three months after enrollment in the study, in order to ensure that the participants are feeling sufficiently helped. The additional face-to face session for the control group is for ethical reasons and postponed in time, in order not to disturb the testing of the interventions.
The therapists delivering the CRAFT intervention will be staff from the participating treatment centers. Typically, the therapists are educated nurses or social workers with extensive experience in the treatment of alcohol abuse disorders. Therapists from the participating centers, randomized to deliver either group-based or individual CRAFT, have received three days free training in CRAFT, funded by the present project. To avoid disappointment if a participating center is randomized to deliver self-directed CRAFT, the control intervention, and in order to add to the overall implementation of CRAFT nationwide, therapists will be offered identical training free of charge when the enrollment of participants is completed.
During the study, all therapists, delivering the experimental intervention, will receive feedback on recordings of their intervention performance. All face-to-face intervention sessions will be recorded, and feedback will be given on randomly picked recordings.
In view of the fact that the CRAFT intervention has proven highly effective in the US, and since living close to a problem drinker is such a burden to the individual and, finally, because the Danish National Guidelines strongly recommend the implementation of CRAFT, we find it un-ethical and problematical not to offer CRAFT in some form to all the participants, even to the control condition. However, since we expect less effect of the control condition (CRAFT as self-help material), for ethical reasons, the participants in the control group will be offered an individual CRAFT session three month after enrollment. Training significant others in new communication strategies and new ways of acting, in relation to the problem drinker, may lead to increased tension in the family set-up. Domestic violence is already relatively more frequent in families with problem drinking, thus, an increased risk may be anticipated. It is, therefore, highly important to address the risk of domestic violence in therapy. Addressing this risk is mandatory in the interventions and includes developing safety plans together with the CSO. It is, however, important to bear in mind that the risk of abuse and suffering, on the part of the CSOs, is even higher if the problem drinking continues unaddressed. We expect no risks or side-effects for the participants. 59ce067264
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