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 Institute
Intervention
 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 GOALS
Population
CRAFT Study
Substance
Abuse
Sisson & Azrin (1986)
Miller, Meyers, & Tonigan
(1999)
Kirby, Marlowe, Festinger,
Garvey, & LaMonaca
(1999)
Meyers, Miller, Hill &
Tonigan (1999)
Meyers, Miller, Smith &
Tonigan (2002)
Waldron et al., (2003)
Problem
Gambling
Makarchuk, Hodgins, &
Peden (2002)
Hodgins, Toneatto,
Makarchuk, Skinner, &
Vincent (2004)
Treatment
Engagement
Reduce Addictive
Behaviour
Decrease CSO
Distress
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NA
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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 from
Alberta 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
Workbook
CRAFT Individual
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 18
2) CSO have a minimum of 3+days/week of
3)
4)
5)
6)
7)
8)
contact with the gambler
Gambler be resistant to suggestion for
treatment
Gambler and the CSO must have not attended
treatment for gambling related problems in the
last 2 months
Gambler must meet criteria for problem
gambling (as reported by the CSO) and the
CSO should be free of problems with gambling
Record sessions
Provide follow-up data
Provide the name of a collateral to help locate
them for the post-assessment and 6-month
interviews
Measures
GAMBLING BEHAVIOURS, MOTIVATIONS,
CONSEQUENCES
1. Gambling Behaviour
2. Treatment Involvement
3. Inventory of Consequences for the IP and CSO
4. University of Rhode Island Change Assessment
Inventory - Gambler version
RELATIONSHIP FUNCTIONING
1. Relationship Happiness Scale
2. Relationship Assessment Scale
Measures
CSO PSYCHOLOGICAL FUNCTIONING
1. Brief Symptom Inventory
2. Depression Anxiety Stress Scales
2. State-trait Anger Expression Inventory-II
REACTIONS TO TREATMENT
1. Attendance/Workbook adherence
2. Working Alliance Inventory
3. Satisfaction questions about the program
CRAFT in 7 Modules
(8-12 Sessions)
1) Building and sustaining motivation
2) Functional analysis of the gambling
3)
4)
5)
6)
7)
behaviour
Improving communication skills
Positive reinforcements for nongambling behaviour
Use of negative consequences
Helping the CSO enrich their own lives
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 gambled
2. Treatment engagement
3. 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