Analyzing Components of Community Reinforcement and Family Training (CRAFT): Is Treatment Entry Training Sufficient?
Analyzing Components of Community Reinforcement and Family Training (CRAFT): Is Treatment Entry Training Sufficient?
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DOI：
10.1037/adb0000306
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发表时间：
2017-11-01
影响因子：
3.4
通讯作者：
Meyers, Robert J.
中科院分区：
文献类型：
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作者：
Kirby, Kimberly C.;Benishek, Lois A.;Meyers, Robert J.
社区强化和家庭培训（CRAFT）帮助家庭成员与治疗抵抗的亲人。CRAFT最一致的结果是增加了已确定的治疗耐药者（IP）的治疗入组。这让我们质疑CRAFT的所有6个组件是否都是必要的。在一项随机临床试验中，115名IP的相关重要他人（CSO）接受了12-14次完整的CRAFT干预，4-6次重点关注治疗入门培训（TEnT）的课程，或12-14次Al-Anon/Nar-Anon促进（ANF）。我们监测了IP和CSO的情绪和功能的治疗进入、出勤和物质使用。在基线和基线后4、6和9个月收集数据。我们发现，CRAFT的治疗进入时间显著缩短（卡方2 = 8.89，p = 0.01），治疗进入率更高（62%;比值比[OR] = 2.7，95%置信区间[CI] = 1.1-6.9）和TENT（63%; OR = 2.9，95%CI = 1.2-7.5），但CRAFT和TEnT彼此无显著差异（OR = 1.1，95%CI = 0.4-2.7）。CSO未报告IP药物使用的组间差异，但所有组的药物使用天数均随时间推移而减少（F-（3，F- 277）= 13.47，p < .0001）。同样，CSO情绪和功能在3种情况下没有差异，但随着时间的推移而改善（所有重要指标p <0.0001）。我们复制了先前试验的结果，证明CRAFT产生的治疗进入率高于ANF，并发现CRAFT和TEnT的治疗进入率相似。这表明治疗入组培训足以产生CRAFT的最佳既定结局。
Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12-14 sessions of the full CRAFT intervention, 4-6 sessions focused on Treatment Entry Training (TEnT), or 12-14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO's mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (chi(2)((2)) = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1-6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2-7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4-2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F-(3,F- 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT.