When someone you love struggles with alcohol or other drugs, what can you do? How can you help them when you feel like you’ve tried it all?
Sometimes you have to start by helping yourself.
That’s the philosophy at the heart of CRAFT, a behavioral health therapy now available in Anchorage and Unalaska.
“CRAFT is Community Reinforcement and Family Training,” said Stacy Kelley, who manages the CRAFT program for the Aleutian Pribilof Islands Association. “It’s an approach for helping family members to change the way they interact with someone who is using alcohol too much or using drugs. The aim of CRAFT is really to help the person get into treatment and get on the road to recovery.”
Launched last year by APIA in partnership with the Alaska Native Tribal Health Consortium, this unique approach to substance abuse was developed in the late 1970s but is new to Alaska. Developed by University of New Mexico researchers in the late 1970s and early ’80s, CRAFT is a form of therapy that’s offered not to the person with a substance use disorder but to their loved ones.
“That’s what’s really unique about it,” said Maria Crouch, the CRAFT program manager at ANTHC. “It’s a family-based approach.”
A loved one engaged in CRAFT therapy will learn coping skills and ways to offer positive reinforcement and motivation, as well as when to allow the natural consequences to occur -- for example, deciding to stop covering for a spouse whose substance use interferes with their work. It’s not the only family therapy for substance use disorders, but Crouch said it is unique in its approach, which is centered around the spouse, relative or friend affected by someone else’s addiction.
“When you have a loved one who’s struggling, you don’t feel good either,” she said.
Both Crouch and Kelley said stigmatization of mental and behavioral health conditions has a tendency to deter people from seeking help for their loved ones. That’s one thing they’re trying to combat with this new program, which they say is designed to encourage help without judgment.
“CRAFT comes from more of a compassion-based therapy and is really taking that shift away from criminalizing addiction (to) accepting and treating substance abuse as a chronic medical condition,” Kelley said.
CRAFT helps participants learn to approach their loved ones with compassion, Crouch and Kelley said. More importantly, it begins by addressing addiction’s impact on the CRAFT patient themselves.
And it’s an effective, evidence-based practice. Studies have found that CRAFT is significantly more successful than other family support programs; about 70 percent of CRAFT patients’ loved ones end up entering treatment.
“That’s huge,” Crouch said. In general, the federal Substance Abuse and Mental Health Services Administration estimates that less than 20 percent of Americans who require treatment for a substance abuse disorder actually get it.
Even if the patient’s loved one doesn’t go into treatment, CRAFT helps improve their own quality of life, Crouch said.
“The reality is that when you’re living with or interacting daily with an individual who is struggling, you struggle as well,” Crouch said. “If I were to come in your space and push on you, you’re not going to fall down. You’re going to right yourself and push back at me. That’s what people are doing; they can be constantly engaged in this power struggle. Part of what CRAFT does is take that away.”
CRAFT patients, she added, learn a new approach to those power struggles: “I’m not going to engage. I’m going to take care of me.”
“CRAFT does not teach confrontation,” Kelley said. “It’s more about invitation.”
Essentially, she said, it provides patients with tools so they can understand how to recognize windows of opportunity to have difficult conversations, and how to regroup and respond if those conversations don’t go well.
Unlike a self-help program, CRAFT is treated as a behavioral health service, administered by licensed professionals.
“At APIA, we have clinicians who are specifically trained in CRAFT and offering this type of therapy and program to people,” Kelley said. “They’re embedded in our behavioral health clinic.”
The CRAFT process starts with an initial assessment conducted by one of the APIA clinical psychologists who has been trained in the therapy.
“It’s going to be compassionate and confidential,” Crouch said. “They are very kind, very compassionate, very skilled individuals. That first meeting is in a very nice environment. It’s a very beautiful setting.”
Together, the clinician and the patient identify a treatment plan that takes into consideration the culture, values and beliefs of their loved one and their family. A typical course of treatment is six to eight sessions, sometimes more.
“In the therapy sessions, the family member or friend is able to kind of navigate which topic areas they want to focus on,” Kelley said; this may include learning to break patterns, improve communication skills, or support family members. “They could also learn or relearn ways to take care of themselves and reconnect with their own values.”
There’s also an open invitation extended to the person experiencing the substance use disorder: They’re welcome to join the sessions at any time and be part of the conversation.
“No one gets left behind,” Crouch said.
Both Kelley and Crouch said CRAFT’s approach fits in well with the culturally informed care provided by Tribal organizations like APIA and ANTHC.
“For me personally, CRAFT is exciting because it aligns with our Alaska Native values,” Crouch said. “We are family-oriented. Focusing in on the strength-based approach is so integral to values and belief systems that go across cultures in Alaska. It’s quite beautiful.”
While CRAFT is administered by Tribal health care providers, it’s available to anyone, whether or not they are Alaska Native. Crouch stressed that APIA accepts multiple insurance plans, and the organizations want to make sure cost doesn’t deter anyone who thinks they might benefit from the program.
“Absolutely no one will be turned away, whether you’re underinsured or you’re uninsured,” Crouch said.
And like other chronic health conditions, its impact is felt not only by the person who has the disease but by the people who care about them. You can’t force a loved one to seek treatment for addiction, but Kelley and Crouch said CRAFT may provide the tools you need to encourage them to get help.
“You might feel like you’ve tried everything, but here’s hope,” Crouch said.
If you have a loved one who experiences a substance use disorder, CRAFT is currently providing services in Anchorage and Unalaska. Learn more at www.anthc.org/craft or call 844-375-2742 to schedule an appointment.
This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.
This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.