Watching someone you love struggle with alcohol or drugs is exhausting and frightening. Many families feel stuck between two options that both seem wrong: confronting the person and risking a blowup, or stepping back and watching things get worse. You may have heard that nothing can change until they “hit bottom.”
Research points to a third path. Community Reinforcement and Family Training (CRAFT) is an approach developed by researchers Robert Meyers and Jane Ellen Smith at the University of New Mexico that works with family members directly — even when the person using substances is not interested in treatment. It gives you practical skills to improve the odds that your loved one will accept help, and to take better care of yourself along the way.
If anyone is in immediate danger, call 911. If you or your loved one is thinking about suicide, call or text 988. For free, confidential treatment referrals any time, you can call the SAMHSA National Helpline at 1-800-662-4357.
What CRAFT is
CRAFT is a structured, non-confrontational program for “concerned significant others” — partners, parents, adult children, siblings, and close friends. Rather than trying to force change, it helps you change the everyday patterns around substance use so that sober time becomes more rewarding and use becomes less so. It has three goals:
- Reduce your loved one’s substance use.
- Encourage them to enter treatment, with a plan for recognizing and acting on moments when they may be open to it.
- Improve your own wellbeing, whether or not your loved one chooses treatment.
CRAFT is usually delivered one-on-one with a trained clinician, and sometimes alongside group sessions. In research, many loved ones entered treatment within the first four to six sessions.
How it compares with other family approaches
Families have long had other options. Al-Anon and Nar-Anon are free mutual-support groups that focus on the family member’s own wellbeing and many people find them deeply sustaining; they are not designed to bring a loved one into treatment. The Johnson Institute intervention prepares family members to gather, often by surprise, to share their concerns and ask the person to enter treatment right away. Each approach reflects real care, and each was designed with a different goal in mind.
In a 1999 randomized trial by Miller, Meyers, and Tonigan, 130 family members of people with alcohol problems who were resisting treatment were assigned to CRAFT, a Johnson Institute intervention, or Al-Anon facilitation. CRAFT engaged 64% of the loved ones in treatment, compared with 30% for the Johnson approach and 13% for Al-Anon facilitation. In the Johnson group, most families (70%) decided not to go through with the planned confrontation. Family members in all three groups reported similar improvements in their own functioning.
A 2010 systematic review of four high-quality randomized trials (264 family members) found CRAFT engaged roughly three times as many loved ones as Al-Anon/Nar-Anon approaches and about twice as many as the Johnson intervention, typically within four to six sessions. A 2020 meta-analysis of 14 studies again found CRAFT about twice as effective at treatment entry as comparison conditions, with the strongest results when family members received both individual and group support.
The skills CRAFT teaches
Understanding the pattern
You learn to map your loved one’s use: the triggers, the times, the places, and what it seems to do for them. That map shows where small changes can have the most effect.
Positive communication
CRAFT teaches a calmer, more effective way to talk: keeping it brief and specific, asking for what you want rather than what you don’t, naming your own feelings, showing understanding, accepting your share of the situation, and offering to help. Conversations that used to end in arguments become more likely to be heard.
Rewarding sober time
You learn to notice and reinforce moments when your loved one is not using — spending time together, sharing a meal, doing something they enjoy — so that being sober feels more connected and worthwhile.
Allowing natural consequences
Rather than shielding someone from the effects of use, such as covering for missed work or cleaning up after a rough night, you learn when to step back and let those consequences land, while staying kind and connected.
Timing the invitation to treatment
Clinicians help you recognize windows when your loved one may be more open, such as after a painful consequence, and help you have treatment options lined up so you can act quickly when that moment comes.
Safety comes first
CRAFT includes specific attention to domestic violence precautions. Before practicing any new strategy, a trained clinician helps you think through how your loved one might react and builds a plan for staying safe. If there is any history of violence or threats, safety planning takes priority over every other goal. If you feel unsafe at home, the National Domestic Violence Hotline (1-800-799-7233) can help you make a plan.
Caring for yourself, too
Living alongside someone’s substance use takes a real toll: worry, sleep loss, strained finances, isolation. CRAFT treats your wellbeing as a goal in its own right. Sessions help you reconnect with friends, interests, and routines you may have set aside, and research shows family members tend to feel better even when their loved one has not yet entered treatment. Many people also find that peer support groups add to the work they do in CRAFT.
Finding a provider
Look for a licensed mental health provider with training in addiction and in CRAFT specifically. Clinicians trained in CRAFT can explain how the program is structured, how they handle safety, and how they will help you connect your loved one to treatment when the time is right.
Questions worth asking a provider
- “Have you trained in CRAFT? Where, and how much of your work uses it?”
- “Do you work with family members when the person using substances is not in treatment?”
- “How do you assess and plan for safety at home?”
- “What treatment options can you help us line up for when my loved one is ready?”
- “How will we work on my own wellbeing, not just theirs?”
- CRAFT works with family members, even when the person using substances is not ready for treatment.
- In research, CRAFT engaged roughly two-thirds of loved ones in treatment, more than Al-Anon facilitation or the Johnson intervention.
- Core skills include positive communication, rewarding sober time, allowing natural consequences, and planning for safety.
- Your own wellbeing is a goal of CRAFT, whatever your loved one decides.
The specialists listed below are mental health providers whose addiction training Tandem has reviewed. Reaching out for yourself is a meaningful place to start.
References
- Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67(5), 688–697. https://doi.org/10.1037/0022-006X.67.5.688
- Roozen, H. G., de Waart, R., & van der Kroft, P. (2010). Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction, 105(10), 1729–1738. https://doi.org/10.1111/j.1360-0443.2010.03016.x
- Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. Addiction, 115(6), 1024–1037. https://kclpure.kcl.ac.uk/portal/en/publications/community-reinforcement-and-family-training-and-rates-of-treatmen/
- Smith, J. E., & Meyers, R. J. (2023). The CRAFT Treatment Manual for Substance Use Problems: Working with Family Members. Guilford Press. https://www.guilford.com/books/The-CRAFT-Treatment-Manual-for-Substance-Use-Problems/Smith-Meyers/9781462551101
- SAMHSA National Helpline. https://www.samhsa.gov/find-help/helplines/national-helpline