Worried about someone’s drinking or drug use, but not sure what to say? The CRAFT approach can help!
by K Michelle Peavy via PSYCHE
Need to know
Has someone in your family started drinking more heavily? Or maybe you suspect your teenager is using drugs. Or you see your friend’s occasional cocaine use escalate. You wonder: Should I say something? If so, what? Perhaps you have already had conversations with someone in your life about their substance use, and those conversations might have ended in arguments and bad feelings. No single conversation is likely to change another person’s behaviour but, if you are a family member or close friend of someone who could be struggling with a drug or alcohol problem, you might be in the best position to support that person and encourage them to pursue change.
Many people who want to talk with someone about their drinking or drug use approach the situation in one of two ways – they ‘come in swinging’ with advice, information and mandates, or they don’t say anything at all. Neither of these approaches is likely to help the other person. But both are understandable given that: people are not taught skilful ways to have these conversations; we might worry about miscalculating someone’s substance use, risking offending or pushing the person away; substance use disorders are highly stigmatised, making the topic even more sensitive; these conversations can be awkward and negative; and the stakes feel especially high for family members and loved ones.
What you can do instead, if you see evidence that substance use is hurting someone you care about, is approach with kindness and curiosity. You can start a conversation, get the person thinking. You can provide a safe space for the other person to explore change.
In this Guide, we will take some cues from a form of specialised counselling for the loved ones of people who misuse alcohol and drugs, called Community Reinforcement Approach and Family Training (CRAFT). Studies on CRAFT show that family members who undergo this training are more likely to see their loved one seek addiction treatment or reduce their substance use than are those who don’t do CRAFT. What follows are some key ideas from CRAFT, as well as other guidance drawn from research on what actually motivates people to seek treatment or change their use. First, let’s take a more detailed look at what doesn’t work:
- Silence and secrecy. ‘It’s none of my business.’ ‘I didn’t want to start another fight.’ ‘I wasn’t sure if it was really a problem or not.’ People stay silent about others’ drug or alcohol use for all kinds of reasons. But if you are genuinely concerned about another’s behaviour, speaking up is a loving way to respond. Not saying anything (or repeatedly covering for a person’s substance use) will, at best, limit how impactful you could be. At worst, silence provides tacit approval for behaviour that could be unhealthy for the person you care about.
- Cutting the person out of your life. Like silence, avoiding or ignoring a person who has a problem with drinking or drug use means that you’ve given away your own ability to have any influence on that person. But, perhaps more importantly, cutting the person out of your life might leave them without the support they need when they want to make difficult changes.
- Nagging. Many parents have goaded their kids since toddlerdom about whether they’ve brushed their teeth, have a warm enough jacket, or packed their water bottles. Needling people about their substance use may be just an extension of relationship patterns established over many years. Instead of ‘You’ve got to do your homework! Don’t you care about your grades?’ it’s ‘You can’t keep drinking like this. Don’t you care about your kids/health/job etc?’ Seems like a logical approach to take, but it doesn’t work. That is, nagging doesn’t compel kids to want to do their homework, nor does it motivate people to want to change a complex behaviour such as substance use.
- Yelling. Watching someone make repeated, illogical decisions is frustrating. Not only can you get caught in your own emotional heat, but you might also think that yelling will scare the person into changing, or at least demonstrate how much damage their behaviour is doing. We want people to reflect on their drinking or drug use. But yelling at them creates an environment that makes self-reflection near impossible.
- Shaming. Trying to make someone feel ashamed of themselves can really backfire. When people feel shame, what do they want to do? Hide. How do people who have a substance problem like to hide? Substance use.
- Punishment. If your focus is to increase the other person’s suffering in order to ‘teach them a lesson’ or ‘make them change’, you have adopted a punitive stance. It’s common and even understandable to reach for punishment as an option. Nevertheless, decades of research have shown that, while punishment may decrease unwanted behaviour in the short term, it usually does not get people to make long-term changes. Worse, it could backfire and have serious consequences for your relationship.
- Intervention-style ambushes. The US reality TV series Intervention (2005-) popularised one approach to dealing with a loved one who has a substance use problem. The show used a variation on the Johnson Model of intervention, which involves gathering a team of concerned family members, planning a confrontation with the person whose drug use or drinking is a concern, and providing the person with a forced choice of seeking treatment for their problem. Research indicates that this method often does not result in change. It’s empathy that creates an environment in which people can explore their situation and move towards change. Research aside, we can ask ourselves what our own response to coercion is. Resentment? Hostility? Avoidance? Most of us don’t respond well to being told what to do in a confrontational way.
- Simply providing information about the harms of substance use. It’s natural to want to pull back the curtain and reveal why drug use and drinking can be unhealthy or harmful. Here, the assumption is that people are making decisions without the proper information. But many people who struggle with a substance use disorder are intimately aware of the problems associated with their use. In fact, using drugs or alcohol despite negative consequences is a symptom of a substance use disorder. And it’s an experience that people feel a great deal of confusion, fear and shame around. In my clinical practice, people who misuse drugs or alcohol often express painfully: ‘I know using is bad for me, but I do it anyway.
As a clinical psychologist, I’ve worked with family members who desperately want to change their loved one’s alcohol or drug use and, upon learning what doesn’t work, I often get the question: ‘What else can I do?’ The answer is: a lot! Sometimes our habits of negative communication and non-communication get so ingrained that we fail to see all the ways that we can engage and be there for someone with a substance problem.
Before we get to that, it’s important to consider expectations. What do you hope to get out of a conversation? What’s even possible? If you expect that one conversation will get the person to ‘realise’ that they have a problem and stop using, you’ll probably be disappointed. It is certainly possible for people to develop awareness about their substance use and to approach change, but it could take many conversations and possibly other actions on your part. For the initial conversations, it’s reasonable to think that you might better understand the person’s desires and motivations related to their drinking or drug use, and to plant the seed of change. To begin this process, consider the following strategies.