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Episode 239
Community Reinforcement and Family Training (aka CRAFT) is a system for helping friends and family members change the way that they interact with someone they love who has an unhealthy and/or dangerous relationship with substances.
CRAFT teaches family members how to stay connected, increase communication, and effectively encourage their loved one toward treatment, while taking care of themselves in the process.
This episode centers around what parents need to know about CRAFT to have the best possible chance at having their child accept help for their substance misuse. It’s one where you may want a notebook to capture the steps and actions involved in this very important process.
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We got in the car and he said, okay, let’s go. Let’s go, let’s just drive to the airport. And I was so shocked and happy. And then I realized how unrealistic this whole thing was, but I was determined to make something happen. So we started driving and he was texting with his girlfriend and I was so confused if I should really drive to the airport.
Or if we should go home first and get some stuff, maybe pack a bag. And then he was telling his girlfriend, it wouldn’t be too long that he would be gone. And then it was all over because she was begging him not to leave her. And so my son said, nevermind, I can’t go just bring me to the bus stop.
I felt crushed and so deflated. We had been really close and he had been willing to get help, but instead I drove him to the bus stop.
And he hugged me. And told me he loved me and he got out of the car and that was that
Intro
Welcome to Hopestream, a podcast where you’ll hear interviews, conversations, and encouraging words for parents of teens and young adults who struggle with substance misuse and mental health. I’m Brenda Zane, your host and a fellow parent whose child struggled. I’m so glad you’re here. Take a deep breath and know you’re not doing this alone anymore.
Hello friend. How are you really though? How are you? I am glad it’s just us today because we have time to exhale, breathe, obviously very important. And also because I have been wanting to share about this topic of inviting your child to accept help for their substance use, which by the way, is often the first step in treating mental health issues, which are Probably the root of the problem.
It’s good to know that this information is applicable even if your child is in treatment right now or if they’re in recovery because it is something that you can use. If down the road they need some additional support, maybe even just engaging with a therapist or a coach or a mentor, you’ll be prepared and confident about discussing that with them.
This topic is so important. And while I’ve done lots of other episodes about CRAFT and about the invitation to change or ITC, I’ve never covered this as explicitly as I will today.
And I want to start off with a story from my personal experience that will highlight just how important this is.
Personal Story
At some point along our journey, I can’t recall exactly when, but my son was 17, it was after wilderness therapy, and he had had three months of residential treatment after which he ran away.
So we were well into our roller coaster ride. By this point, I had taken my son to see a therapist who had been recommended by one of my friend’s husbands, who’s a local middle school counselor. I do not remember what prompted this therapy visit, but regardless, there we were. My son was in active use, had not been going to school, super skinny, highly agitated, but he went with me willingly.
Or maybe begrudgingly, I don’t remember to see this therapist. I had managed to sneak out of the office again in between meetings. And I was hoping that everything on this day would go smoothly so that I could get back to work in time for a client call in the afternoon. Of course by then people were pretty used to me being in and out and I had missed so much work that I was a little surprised I hadn’t lost my job.
I can see and even smell the little waiting room where my son filled out the paperwork, and I remember sitting there when he went back with the therapist to talk, just praying that something would change. I didn’t even know what specifically I wanted. I just knew I couldn’t go on like we had been for the past couple of years.
I did not know about CRAFT at this point. So I was winging it on my own
About 30 minutes after my son had gone back with the therapist, uh, the therapist showed back up and asked if I would come back with him to the room. So I did. And when I went into his office, my son was. He was literally curled up in a ball in the corner of a long couch, and he looked really sad and scared.
I was not expecting this because normally if I got him to any kind of an appointment, he was pissed off and offensive. So this was different. And I wondered what kind of therapist this guy was to have this effect on my son.
The therapist looked at us both like we were from another planet, which I get because the two of us were just a wreck. And he said that my son had given him permission to talk with me about something. In Washington state, our age of consent is 13. Meaning, the day your child turns 13, you as their parent can no longer get medical information from their doctor, from a therapist, or No one, unless your child gives written permission, it is insane, but that’s what we deal with.
Anyway, the therapist asked me if I was aware of my son’s current legal issue. I didn’t know anything about anything. So I just dumbly looked at him and then at my son who was still crumpled up in the corner of the couch. The therapist looked a little shocked that I was not aware of this issue.
And said that my son had court for a misdemeanor theft charge and that given what was going on, he would most likely be arrested and taken to juvenile jail. He said that if my son were willing to come and see him regularly for the next 60 days, he would write a letter to the court stating that my son was participating in outpatient treatment, which would hopefully avoid the arrest.
I remember thinking maybe this guy was an angel or something because he had only just met my son a half an hour before and he was willing to do this for us.
We talked for a little bit and then my son agreed to this idea. The therapist told us to wait in the lobby while he typed up a letter to take with us. I remember my head swirling and all hope of getting back to work flew right out the window. How did I not even know about all of this? Any of this that was going on, the therapist came out, he handed my son a thick envelope and we scheduled him to come back in a few days to start this 60 day thing that I did not even understand.
We went to the elevator and I could tell them my son was getting more and more agitated and jumpy, which at the time I didn’t know was probably because he was feeling withdrawals. But also I think the arrest thing was staring him in the face at this point. I have no recollection of where this next idea came from, but I remember looking at him.
He was so skinny, so unhealthy and unhappy. I hadn’t seen a smile on his face since he’d been in residential treatment. And I said, Let’s drive to the airport right now and get on a plane and go somewhere to get help. He looked at me like I was losing my mind, which granted I was, but he actually didn’t say anything.
And I could tell that he was tumbling the idea around in his head. So I kept it up. I said, let’s go. Let’s literally drive to the airport, buy a ticket to somewhere. Maybe California and we’ll just go we can get a hotel somewhere and figure things out or we could go to Utah We could call Derek who had been his therapist and on the way there you can call and see if he’ll take you back in the program I was starting to get excited about this idea because I knew I had to get him out of the city and preferably had to get him out of our state.
And while I’d been in the office, the therapist had been able to give me an idea of my son’s drug use and said it was alarming. So I knew things were worse than I understood, and that they were potentially about to get even worse if we didn’t get some help. All the way down in the elevator and in the parking garage, I was selling hard this idea of getting on a plane and my son was not rejecting it, but he was increasingly getting more upset and wanted to call his girlfriend, which I did not want him to do because I knew she wouldn’t want him to leave.
We got in the car and he said, okay, let’s go. Let’s go, let’s just drive to the airport. And I was so shocked and happy. And then I realized how unrealistic this whole thing was, but I was determined to make something happen. So we started driving and he was texting with his girlfriend and I was so confused if I should really drive to the airport.
Or if we should go home first and get some stuff, maybe pack a bag. And then he was telling his girlfriend, it wouldn’t be too long that he would be gone. And then it was all over because she was begging him not to leave her. Side note, she was also using and living an unhealthy lifestyle. And so my son said, nevermind, I can’t go just bring me to the bus stop.
I felt so crushed and so deflated. We had been really close and he had been willing to go to get help, but instead I drove him to the bus stop. He asked if he could take the change in my car console, which was about a dollar 25. So I said, yes.
And he hugged me. And told me he loved me and he got out of the car and that was that.
My friend, I did not know anything about motivation. I did not know how to use positive communication. I didn’t understand how to recognize a window of opportunity. Even though I’d been standing right in front of one.
So now looking back and knowing that you may find yourself in a similar situation, or maybe you haven’t gotten there yet. I feel like it is so important to share information about using all the tools that I talk about here on the podcast to help stack the odds in your favor, that your child will accept help if you offer it in the right way enough times.
With the right intention and planning and quick note, I will be talking about the CRAFT approach to inviting treatment, which is covered in chapter 13 of the book beyond addiction. So if you have that book, you can find additional information there. We also cover CRAFT topics in depth every week in our private online community for parents Hopestream Community.
CRAFT Overview
So for a quick overview of CRAFT, if you’re new to the podcast, this is a behavioral approach designed specifically for family members to use when there is someone in their life who misuses substances and is resistant to accepting help. Instead of coming from a place of helplessness and tough love, it focuses on positive reinforcement.
Self care for you boundaries and natural consequences, which go hand in hand and effective communication.
All of that with the intent to improve your relationship and to invite your person to get help. What I’m going to talk about today will outline CRAFT’s core strategies for inviting treatment. This is a very structured step by step approach to inviting your child to accept help. It is not theoretical.
It is not vague, which is why it is so important and also effective. It is probably worth sharing at this point that there are numerous studies that show CRAFT’s high success rate, which is around 64 to 75 percent in getting individuals into treatment. I will add those in the show notes in case you want to read them, but this is an evidence based approach that has been proven effective with adults.
With adolescents, which is encouraging because teens and young adults have some unique challenges around substance use disorder, things like treatment resistance, their developmental factors, the fact that their brain is not fully developed and the peer influence factor. Let me quickly put this concept in place to help you understand where it fits into the world of CRAFT.
All of the work you do when you learn these skills are really building to a situation where your child is more likely to accept your offer of help. One aspect of that being an increase in your confidence level. And the other is a reduction over time in their substance use. This is typical when parents start really implementing these skills, even if your child is still using, if you are being consistent in your behavior and mindset, their use will continue, often, not always, but often reduce over time.
Core Principals for inviting treatment
So let’s talk about CRAFT’s core principles for inviting treatment.
One is positive communication. This is powerful, non confrontational and calm communication that can influence behavior. Number two is the reinforcement of positive behavior. So we’ve talked about this quite a bit. You are going to reward any positive non using behavior and that helps shift the dynamics in the relationships and it helps keeping them doing the thing that you want them to do.
You are going to understand motivational hooks, you’re going to tap into what motivates the individual that you’re working with your child or someone else, that is going to help lead them to want to seek help. And then patience and timing. So you’re going to be looking for those windows of opportunity, like I was standing in front of and did not see with my son.
it’s really important to wait for the right moment and to avoid pushing too hard, which can often trigger resistance. So those are the principles involved. Now I will give you an overview of the process or the procedure, which is that step by step structured way to approach talking to and inviting your child to accept
Step One – Positive Communication/SURF
Just like with everything CRAFTy, you will start from a positive, supportive stance. This means you’re approaching your child from a nonjudgmental place. This is not a, if you don’t go, if you don’t accept this today, We’re kicking you out. It’s not that type of a confrontational intervention. And I’m going to talk a little bit about how the CRAFT protocol.
It differs from traditional interventions here in a little bit. You may have listened to episode 73, where I talk about the surf communication tool. If you don’t know how to use surf, that’s an acronym, by the way, you’re going to want to rewind your podcast machine and take a listen, episode 73, practice it, get comfortable with it because you’re going to be using it.
Step Two – Plan Ahead for Treatment/Help Options
You’re also going to provide treatment options. So in advance of this conversation, you are going to have done research into different options. That could be a therapist, an IOP, a PHP. A residential program, detox, it could be a mentor. It could look like a lot of different things. Just like I was sitting in a therapist office with my son.
I had the opportunity and he had the opportunity to take advantage of a 60 day outpatient program. Was that ideally what I wanted for him? No, I would have loved to have, you know, shipped him off to Iceland and barricaded him and been safe for the rest of his life. But that’s not what I had. I had an opportunity right in front of me.
Ideally, the person or the program that you are going to be talking with will have a CBT oriented lens, or better yet, they would be CRAFT certified so that you know that they are going to get a consistent approach in the treatment program or from the therapist. Also think of inviting your child to accept.
Use the word help because treatment can be a scary word. And sometimes the only thing people think about when they hear the word treatment is detox and inpatient. You’ll already have checked out availability, insurance, finances, all of the details that can trip you up and delay getting started. If you have to figure that stuff out after they accept your offer for help,
Step Three – Windows of Opportunity
Then you’re going to work on noticing those windows of opportunity, which are times when your child is more likely to be willing to accept your invitation. The creators of CRAFT and the experts in this approach have outlined four general windows of opportunity to are especially pertinent with young people, which are when your child is remorseful about something that has happened or something maybe that they didn’t get to have happen as a result of their substance use.
Like they got caught with drugs or drug paraphernalia at school and they’re facing being expelled or the other common window of opportunity. It could be when they’re upset about a substance related remark or treatment from somebody that they respect.
For example, they learn that someone has talked to their boss about smelling alcohol or marijuana on them and they don’t want to lose that job or they lose a boyfriend or a girlfriend who doesn’t support their substance use. So paying attention to those windows of opportunity is a very important part of the process.
Step Four – Motivational Hooks
The next element of the invitation is finding a motivational hook, a reason why your child would engage with help. There are six tried and true motivational hooks that the CRAFT experts have identified, and they range in applicability depending on the age of your child. If your child is a young adult.
They have to buy into accepting help versus if you have a teen, you usually have a little more authority to enforce help. The important part about motivational hooks is that they have to be appealing to your child, not to you. The thing you think is the most important reason for them to get help may be very different from theirs.
This is where we refer back to the behavior roadmap that is part of the invitation to change and CRAFT where you observe your child for a period of time. to understand what kinds of rewards they enjoy and what naturally motivates them. If you’ve done that work, it’ll be easier to find the motivational hook that you’ll use in your invitation to help.
A couple of examples of motivational hooks are one, the ability for your child to choose between two programs or therapists that you have already vetted and feel good about.
That way they don’t feel trapped and it also relieves some of the burden from you to make a decision. Another common motivational hook is to let them know that the help you’re offering is going to allow them to focus on things other than their substance use, and that they’ll be focusing on their anxiety or depression or dealing with trauma they’ve experienced, which means that you need to make sure you’re asking the right questions about dual diagnosis programs when you’re doing your research, where they will, in fact, address the mental health issues as well as the substance use. This hook can be appealing to someone because they don’t necessarily have to admit they have a substance use problem that needs to be addressed right away.
For adolescents in particular, finding a program that utilizes the seven challenges can be a good place to start, and you can learn more about the seven challenges in episode 211, where I spoke with Robert Schwebel, who’s the founder of that approach, which was specifically created for adolescents.
Practice
Then, of course, there’s practice because none of this stuff comes naturally. So we recommend writing out what you think are the one or two most promising windows of opportunity, construct your positive communication or your surf statement. Write out the motivational hook that you are planning to use and double and triple check the resources that you researched and lined up.
Also, know, it doesn’t necessarily have to be you who has this conversation. If your child has a good relationship with an uncle or an aunt or a brother in law or sister in law or a cousin, somebody else who isn’t mom or dad, you can also teach them this process. So here’s an example of what this could sound like.
This is a conversation that someone is having with a 24 year old treatment resistant male. The parent says, “Hey, I was hoping you had a few minutes to talk. I’m worried about you. You seem a little lost. You don’t really seem happy anymore. I should probably have suggested this a while ago. What do you think about getting some professional help?
I imagine the idea of talking to a stranger might seem odd at first, but I promise it gets easier each time. my own therapist said that he could help find somebody who’d let you work on whatever you want to work on. It wouldn’t be all left up to your therapist to decide and you wouldn’t have to make a big commitment upfront. You could just try a few sessions To see if you like it, if you don’t, you can stop going and maybe try to find something else. What do you think? Is there something else that I could do to make this happen?”
So there’s all kinds of different, tools in there. There was the positive communication statement. There was taking a little bit of responsibility where the person’s, the parents said, I probably should have suggested this a while ago. and then they used a motivational hook, which was that you could try it first, try a couple of sessions. So that works well, obviously, if you have a young adult, if they’re working with a therapist or a coach or a mentor, probably not the best, if you have a teenager who needs to get into a residential program, but that’s where this approach is so flexible and it allows you to really Adjust it to work for your situation.
Plan for a refusal
I’ll also say that it is a good idea to plan for your own response to a refusal of help. It can be devastating to hear no and planning in advance how you’ll take care of yourself and your heart is critical. It’s also good to know that typically your first invitation isn’t likely to be accepted. So consider that practice and know that you’ll probably have another chance.
If your child refuses treatment, you’ll go back to observing for windows of opportunity, figure out if you had the right motivational hook. Maybe you didn’t. You can think about whether or not you use positive communication during the conversation and you can keep checking back in on your resources for availability and adjustments that need to happen there.
You’re going to be strategic at this point about scanning and observing what is going on to know when the next right opportunity might be. One of the clues that I could have taken in my example that I gave was that my son was fairly receptive to seeing a therapist in an outpatient setting.
Again, not necessarily the ideal that I would have liked, but But it was a step in the right direction and he was not actively refusing it until the girlfriend got involved. So that was a clue for me that maybe I need to use that as the motivational hook that we could go back to an outpatient therapist setting.
Now I mentioned earlier that I would talk about how CRAFT is different from a traditional intervention. There are a few reasons, and these are from Lara Okoloko, who is a therapist and CRAFT professional trainer, who talked with me on episode 225 about adolescent treatment resistance. It is so good. If you have not listened, be sure to go back episode two 25, because Lara is truly a master at the practical application of CRAFT.
How is CRAFT different from interventions?
Here are four ways that this conversation, this invitation to help is different from a traditional intervention. First is a process, not an event. Like I said a minute ago, this is likely a conversation that you are going to have several times. You’re going to be tweaking and adjusting based on the motivational hook based on the window of opportunity.
This is not a one time one hit wonder in and out event. Second, you are the one having the conversation with your person, whether that’s a child or a partner or somebody else that you love. You don’t bring a third party into the conversation necessarily all the time. You could, but traditionally this is you having the conversation.
The third way that this is different than a traditional intervention is that as part of the process, you over time are changing your behavior as you seek to influence your child’s behavior. Again, it’s not a one and done. It’s not, we’re going to bring somebody in, have a conversation and they’re out.
This is a process over time. And then fourth, in a CRAFT invitation or treatment, many paths. of getting help are recognized. It is not rigid about what treatment the person must do to begin recovery. Again, it could range from anything from, we want you to start seeing a mentor once a month all the way to we’re recommending detox and residential.
Summary & key takeaway
I know it’s a lot. I tried to keep it a little high level because this is a procedure that we teach over two complete hours, go into a ton of detail, but I wanted to introduce it and to get you thinking about how and when you might have this conversation with your young person.
The key takeaway is that you as the parent. has the most intimate knowledge of what is rewarding and motivating for your child. Even if those things seem to have faded in the recent past, you are still massively influential in helping use that knowledge that often only a parent has to start to create.
Positive change. And if you use the CRAFT and invitation to change skills and procedures as they are intended, you can have a conversation with your child that is proven by research to be effective about 74 percent of the time over the course of 12 ish weeks in having them accept help in one form or another.
Again, help can look like a lot of different things. And it is most likely going to take more than one of these conversations. If this is the kind of material that you think would help you to start to build confidence and to get some sanity and control in your home or in your relationship, I would highly encourage you to take advantage of the free two week trial in our private parent community.
We do this kind of work regularly. This is what we’re about. And you’re able to get live coaching around the issues that you’re struggling with. Go to HopeStreamCommunity. org forward slash communities to learn more about the membership options there.
Download the Worried Sick e-book
And while you’re there, you can download a free ebook. I wrote called worried to sick, a compassionate guide for parents of teens and young adults struggling with substance misuse. It’ll give you additional information about CRAFT about this approach and guide you through some of the difficulties that you might be facing right now.
My friend, it’s a lot. I know, take a deep breath, know that you’re working on it. You’re here. You are here. I just want to say. You are truly an elite level parent. I can’t say that enough. You are an elite level parent. You are dealing with things that most parents will never, ever be able to comprehend. So take it easy, be ridiculously good to yourself , and I will meet you right back here next week.
Or if we should go home first and get some stuff, maybe pack a bag. And then he was telling his girlfriend, it wouldn’t be too long that he would be gone. And then it was all over because she was begging him not to leave her. And so my son said, nevermind, I can’t go just bring me to the bus stop.
I felt crushed and so deflated. We had been really close and he had been willing to get help, but instead I drove him to the bus stop.
And he hugged me. And told me he loved me and he got out of the car and that was that
Intro
Welcome to Hopestream, a podcast where you’ll hear interviews, conversations, and encouraging words for parents of teens and young adults who struggle with substance misuse and mental health. I’m Brenda Zane, your host and a fellow parent whose child struggled. I’m so glad you’re here. Take a deep breath and know you’re not doing this alone anymore.
Hello friend. How are you really though? How are you? I am glad it’s just us today because we have time to exhale, breathe, obviously very important. And also because I have been wanting to share about this topic of inviting your child to accept help for their substance use, which by the way, is often the first step in treating mental health issues, which are Probably the root of the problem.
It’s good to know that this information is applicable even if your child is in treatment right now or if they’re in recovery because it is something that you can use. If down the road they need some additional support, maybe even just engaging with a therapist or a coach or a mentor, you’ll be prepared and confident about discussing that with them.
This topic is so important. And while I’ve done lots of other episodes about CRAFT and about the invitation to change or ITC, I’ve never covered this as explicitly as I will today.
And I want to start off with a story from my personal experience that will highlight just how important this is.
Personal Story
At some point along our journey, I can’t recall exactly when, but my son was 17, it was after wilderness therapy, and he had had three months of residential treatment after which he ran away.
So we were well into our roller coaster ride. By this point, I had taken my son to see a therapist who had been recommended by one of my friend’s husbands, who’s a local middle school counselor. I do not remember what prompted this therapy visit, but regardless, there we were. My son was in active use, had not been going to school, super skinny, highly agitated, but he went with me willingly.
Or maybe begrudgingly, I don’t remember to see this therapist. I had managed to sneak out of the office again in between meetings. And I was hoping that everything on this day would go smoothly so that I could get back to work in time for a client call in the afternoon. Of course by then people were pretty used to me being in and out and I had missed so much work that I was a little surprised I hadn’t lost my job.
I can see and even smell the little waiting room where my son filled out the paperwork, and I remember sitting there when he went back with the therapist to talk, just praying that something would change. I didn’t even know what specifically I wanted. I just knew I couldn’t go on like we had been for the past couple of years.
I did not know about CRAFT at this point. So I was winging it on my own
About 30 minutes after my son had gone back with the therapist, uh, the therapist showed back up and asked if I would come back with him to the room. So I did. And when I went into his office, my son was. He was literally curled up in a ball in the corner of a long couch, and he looked really sad and scared.
I was not expecting this because normally if I got him to any kind of an appointment, he was pissed off and offensive. So this was different. And I wondered what kind of therapist this guy was to have this effect on my son.
The therapist looked at us both like we were from another planet, which I get because the two of us were just a wreck. And he said that my son had given him permission to talk with me about something. In Washington state, our age of consent is 13. Meaning, the day your child turns 13, you as their parent can no longer get medical information from their doctor, from a therapist, or No one, unless your child gives written permission, it is insane, but that’s what we deal with.
Anyway, the therapist asked me if I was aware of my son’s current legal issue. I didn’t know anything about anything. So I just dumbly looked at him and then at my son who was still crumpled up in the corner of the couch. The therapist looked a little shocked that I was not aware of this issue.
And said that my son had court for a misdemeanor theft charge and that given what was going on, he would most likely be arrested and taken to juvenile jail. He said that if my son were willing to come and see him regularly for the next 60 days, he would write a letter to the court stating that my son was participating in outpatient treatment, which would hopefully avoid the arrest.
I remember thinking maybe this guy was an angel or something because he had only just met my son a half an hour before and he was willing to do this for us.
We talked for a little bit and then my son agreed to this idea. The therapist told us to wait in the lobby while he typed up a letter to take with us. I remember my head swirling and all hope of getting back to work flew right out the window. How did I not even know about all of this? Any of this that was going on, the therapist came out, he handed my son a thick envelope and we scheduled him to come back in a few days to start this 60 day thing that I did not even understand.
We went to the elevator and I could tell them my son was getting more and more agitated and jumpy, which at the time I didn’t know was probably because he was feeling withdrawals. But also I think the arrest thing was staring him in the face at this point. I have no recollection of where this next idea came from, but I remember looking at him.
He was so skinny, so unhealthy and unhappy. I hadn’t seen a smile on his face since he’d been in residential treatment. And I said, Let’s drive to the airport right now and get on a plane and go somewhere to get help. He looked at me like I was losing my mind, which granted I was, but he actually didn’t say anything.
And I could tell that he was tumbling the idea around in his head. So I kept it up. I said, let’s go. Let’s literally drive to the airport, buy a ticket to somewhere. Maybe California and we’ll just go we can get a hotel somewhere and figure things out or we could go to Utah We could call Derek who had been his therapist and on the way there you can call and see if he’ll take you back in the program I was starting to get excited about this idea because I knew I had to get him out of the city and preferably had to get him out of our state.
And while I’d been in the office, the therapist had been able to give me an idea of my son’s drug use and said it was alarming. So I knew things were worse than I understood, and that they were potentially about to get even worse if we didn’t get some help. All the way down in the elevator and in the parking garage, I was selling hard this idea of getting on a plane and my son was not rejecting it, but he was increasingly getting more upset and wanted to call his girlfriend, which I did not want him to do because I knew she wouldn’t want him to leave.
We got in the car and he said, okay, let’s go. Let’s go, let’s just drive to the airport. And I was so shocked and happy. And then I realized how unrealistic this whole thing was, but I was determined to make something happen. So we started driving and he was texting with his girlfriend and I was so confused if I should really drive to the airport.
Or if we should go home first and get some stuff, maybe pack a bag. And then he was telling his girlfriend, it wouldn’t be too long that he would be gone. And then it was all over because she was begging him not to leave her. Side note, she was also using and living an unhealthy lifestyle. And so my son said, nevermind, I can’t go just bring me to the bus stop.
I felt so crushed and so deflated. We had been really close and he had been willing to go to get help, but instead I drove him to the bus stop. He asked if he could take the change in my car console, which was about a dollar 25. So I said, yes.
And he hugged me. And told me he loved me and he got out of the car and that was that.
My friend, I did not know anything about motivation. I did not know how to use positive communication. I didn’t understand how to recognize a window of opportunity. Even though I’d been standing right in front of one.
So now looking back and knowing that you may find yourself in a similar situation, or maybe you haven’t gotten there yet. I feel like it is so important to share information about using all the tools that I talk about here on the podcast to help stack the odds in your favor, that your child will accept help if you offer it in the right way enough times.
With the right intention and planning and quick note, I will be talking about the CRAFT approach to inviting treatment, which is covered in chapter 13 of the book beyond addiction. So if you have that book, you can find additional information there. We also cover CRAFT topics in depth every week in our private online community for parents Hopestream Community.
CRAFT Overview
So for a quick overview of CRAFT, if you’re new to the podcast, this is a behavioral approach designed specifically for family members to use when there is someone in their life who misuses substances and is resistant to accepting help. Instead of coming from a place of helplessness and tough love, it focuses on positive reinforcement.
Self care for you boundaries and natural consequences, which go hand in hand and effective communication.
All of that with the intent to improve your relationship and to invite your person to get help. What I’m going to talk about today will outline CRAFT’s core strategies for inviting treatment. This is a very structured step by step approach to inviting your child to accept help. It is not theoretical.
It is not vague, which is why it is so important and also effective. It is probably worth sharing at this point that there are numerous studies that show CRAFT’s high success rate, which is around 64 to 75 percent in getting individuals into treatment. I will add those in the show notes in case you want to read them, but this is an evidence based approach that has been proven effective with adults.
With adolescents, which is encouraging because teens and young adults have some unique challenges around substance use disorder, things like treatment resistance, their developmental factors, the fact that their brain is not fully developed and the peer influence factor. Let me quickly put this concept in place to help you understand where it fits into the world of CRAFT.
All of the work you do when you learn these skills are really building to a situation where your child is more likely to accept your offer of help. One aspect of that being an increase in your confidence level. And the other is a reduction over time in their substance use. This is typical when parents start really implementing these skills, even if your child is still using, if you are being consistent in your behavior and mindset, their use will continue, often, not always, but often reduce over time.
Core Principals for inviting treatment
So let’s talk about CRAFT’s core principles for inviting treatment.
One is positive communication. This is powerful, non confrontational and calm communication that can influence behavior. Number two is the reinforcement of positive behavior. So we’ve talked about this quite a bit. You are going to reward any positive non using behavior and that helps shift the dynamics in the relationships and it helps keeping them doing the thing that you want them to do.
You are going to understand motivational hooks, you’re going to tap into what motivates the individual that you’re working with your child or someone else, that is going to help lead them to want to seek help. And then patience and timing. So you’re going to be looking for those windows of opportunity, like I was standing in front of and did not see with my son.
it’s really important to wait for the right moment and to avoid pushing too hard, which can often trigger resistance. So those are the principles involved. Now I will give you an overview of the process or the procedure, which is that step by step structured way to approach talking to and inviting your child to accept
Step One – Positive Communication/SURF
Just like with everything CRAFTy, you will start from a positive, supportive stance. This means you’re approaching your child from a nonjudgmental place. This is not a, if you don’t go, if you don’t accept this today, We’re kicking you out. It’s not that type of a confrontational intervention. And I’m going to talk a little bit about how the CRAFT protocol.
It differs from traditional interventions here in a little bit. You may have listened to episode 73, where I talk about the surf communication tool. If you don’t know how to use surf, that’s an acronym, by the way, you’re going to want to rewind your podcast machine and take a listen, episode 73, practice it, get comfortable with it because you’re going to be using it.
Step Two – Plan Ahead for Treatment/Help Options
You’re also going to provide treatment options. So in advance of this conversation, you are going to have done research into different options. That could be a therapist, an IOP, a PHP. A residential program, detox, it could be a mentor. It could look like a lot of different things. Just like I was sitting in a therapist office with my son.
I had the opportunity and he had the opportunity to take advantage of a 60 day outpatient program. Was that ideally what I wanted for him? No, I would have loved to have, you know, shipped him off to Iceland and barricaded him and been safe for the rest of his life. But that’s not what I had. I had an opportunity right in front of me.
Ideally, the person or the program that you are going to be talking with will have a CBT oriented lens, or better yet, they would be CRAFT certified so that you know that they are going to get a consistent approach in the treatment program or from the therapist. Also think of inviting your child to accept.
Use the word help because treatment can be a scary word. And sometimes the only thing people think about when they hear the word treatment is detox and inpatient. You’ll already have checked out availability, insurance, finances, all of the details that can trip you up and delay getting started. If you have to figure that stuff out after they accept your offer for help,
Step Three – Windows of Opportunity
Then you’re going to work on noticing those windows of opportunity, which are times when your child is more likely to be willing to accept your invitation. The creators of CRAFT and the experts in this approach have outlined four general windows of opportunity to are especially pertinent with young people, which are when your child is remorseful about something that has happened or something maybe that they didn’t get to have happen as a result of their substance use.
Like they got caught with drugs or drug paraphernalia at school and they’re facing being expelled or the other common window of opportunity. It could be when they’re upset about a substance related remark or treatment from somebody that they respect.
For example, they learn that someone has talked to their boss about smelling alcohol or marijuana on them and they don’t want to lose that job or they lose a boyfriend or a girlfriend who doesn’t support their substance use. So paying attention to those windows of opportunity is a very important part of the process.
Step Four – Motivational Hooks
The next element of the invitation is finding a motivational hook, a reason why your child would engage with help. There are six tried and true motivational hooks that the CRAFT experts have identified, and they range in applicability depending on the age of your child. If your child is a young adult.
They have to buy into accepting help versus if you have a teen, you usually have a little more authority to enforce help. The important part about motivational hooks is that they have to be appealing to your child, not to you. The thing you think is the most important reason for them to get help may be very different from theirs.
This is where we refer back to the behavior roadmap that is part of the invitation to change and CRAFT where you observe your child for a period of time. to understand what kinds of rewards they enjoy and what naturally motivates them. If you’ve done that work, it’ll be easier to find the motivational hook that you’ll use in your invitation to help.
A couple of examples of motivational hooks are one, the ability for your child to choose between two programs or therapists that you have already vetted and feel good about.
That way they don’t feel trapped and it also relieves some of the burden from you to make a decision. Another common motivational hook is to let them know that the help you’re offering is going to allow them to focus on things other than their substance use, and that they’ll be focusing on their anxiety or depression or dealing with trauma they’ve experienced, which means that you need to make sure you’re asking the right questions about dual diagnosis programs when you’re doing your research, where they will, in fact, address the mental health issues as well as the substance use. This hook can be appealing to someone because they don’t necessarily have to admit they have a substance use problem that needs to be addressed right away.
For adolescents in particular, finding a program that utilizes the seven challenges can be a good place to start, and you can learn more about the seven challenges in episode 211, where I spoke with Robert Schwebel, who’s the founder of that approach, which was specifically created for adolescents.
Practice
Then, of course, there’s practice because none of this stuff comes naturally. So we recommend writing out what you think are the one or two most promising windows of opportunity, construct your positive communication or your surf statement. Write out the motivational hook that you are planning to use and double and triple check the resources that you researched and lined up.
Also, know, it doesn’t necessarily have to be you who has this conversation. If your child has a good relationship with an uncle or an aunt or a brother in law or sister in law or a cousin, somebody else who isn’t mom or dad, you can also teach them this process. So here’s an example of what this could sound like.
This is a conversation that someone is having with a 24 year old treatment resistant male. The parent says, “Hey, I was hoping you had a few minutes to talk. I’m worried about you. You seem a little lost. You don’t really seem happy anymore. I should probably have suggested this a while ago. What do you think about getting some professional help?
I imagine the idea of talking to a stranger might seem odd at first, but I promise it gets easier each time. my own therapist said that he could help find somebody who’d let you work on whatever you want to work on. It wouldn’t be all left up to your therapist to decide and you wouldn’t have to make a big commitment upfront. You could just try a few sessions To see if you like it, if you don’t, you can stop going and maybe try to find something else. What do you think? Is there something else that I could do to make this happen?”
So there’s all kinds of different, tools in there. There was the positive communication statement. There was taking a little bit of responsibility where the person’s, the parents said, I probably should have suggested this a while ago. and then they used a motivational hook, which was that you could try it first, try a couple of sessions. So that works well, obviously, if you have a young adult, if they’re working with a therapist or a coach or a mentor, probably not the best, if you have a teenager who needs to get into a residential program, but that’s where this approach is so flexible and it allows you to really Adjust it to work for your situation.
Plan for a refusal
I’ll also say that it is a good idea to plan for your own response to a refusal of help. It can be devastating to hear no and planning in advance how you’ll take care of yourself and your heart is critical. It’s also good to know that typically your first invitation isn’t likely to be accepted. So consider that practice and know that you’ll probably have another chance.
If your child refuses treatment, you’ll go back to observing for windows of opportunity, figure out if you had the right motivational hook. Maybe you didn’t. You can think about whether or not you use positive communication during the conversation and you can keep checking back in on your resources for availability and adjustments that need to happen there.
You’re going to be strategic at this point about scanning and observing what is going on to know when the next right opportunity might be. One of the clues that I could have taken in my example that I gave was that my son was fairly receptive to seeing a therapist in an outpatient setting.
Again, not necessarily the ideal that I would have liked, but But it was a step in the right direction and he was not actively refusing it until the girlfriend got involved. So that was a clue for me that maybe I need to use that as the motivational hook that we could go back to an outpatient therapist setting.
Now I mentioned earlier that I would talk about how CRAFT is different from a traditional intervention. There are a few reasons, and these are from Lara Okoloko, who is a therapist and CRAFT professional trainer, who talked with me on episode 225 about adolescent treatment resistance. It is so good. If you have not listened, be sure to go back episode two 25, because Lara is truly a master at the practical application of CRAFT.
How is CRAFT different from interventions?
Here are four ways that this conversation, this invitation to help is different from a traditional intervention. First is a process, not an event. Like I said a minute ago, this is likely a conversation that you are going to have several times. You’re going to be tweaking and adjusting based on the motivational hook based on the window of opportunity.
This is not a one time one hit wonder in and out event. Second, you are the one having the conversation with your person, whether that’s a child or a partner or somebody else that you love. You don’t bring a third party into the conversation necessarily all the time. You could, but traditionally this is you having the conversation.
The third way that this is different than a traditional intervention is that as part of the process, you over time are changing your behavior as you seek to influence your child’s behavior. Again, it’s not a one and done. It’s not, we’re going to bring somebody in, have a conversation and they’re out.
This is a process over time. And then fourth, in a CRAFT invitation or treatment, many paths. of getting help are recognized. It is not rigid about what treatment the person must do to begin recovery. Again, it could range from anything from, we want you to start seeing a mentor once a month all the way to we’re recommending detox and residential.
Summary & key takeaway
I know it’s a lot. I tried to keep it a little high level because this is a procedure that we teach over two complete hours, go into a ton of detail, but I wanted to introduce it and to get you thinking about how and when you might have this conversation with your young person.
The key takeaway is that you as the parent. has the most intimate knowledge of what is rewarding and motivating for your child. Even if those things seem to have faded in the recent past, you are still massively influential in helping use that knowledge that often only a parent has to start to create.
Positive change. And if you use the CRAFT and invitation to change skills and procedures as they are intended, you can have a conversation with your child that is proven by research to be effective about 74 percent of the time over the course of 12 ish weeks in having them accept help in one form or another.
Again, help can look like a lot of different things. And it is most likely going to take more than one of these conversations. If this is the kind of material that you think would help you to start to build confidence and to get some sanity and control in your home or in your relationship, I would highly encourage you to take advantage of the free two week trial in our private parent community.
We do this kind of work regularly. This is what we’re about. And you’re able to get live coaching around the issues that you’re struggling with. Go to HopeStreamCommunity. org forward slash communities to learn more about the membership options there.
Download the Worried Sick e-book
And while you’re there, you can download a free ebook. I wrote called worried to sick, a compassionate guide for parents of teens and young adults struggling with substance misuse. It’ll give you additional information about CRAFT about this approach and guide you through some of the difficulties that you might be facing right now.
My friend, it’s a lot. I know, take a deep breath, know that you’re working on it. You’re here. You are here. I just want to say. You are truly an elite level parent. I can’t say that enough. You are an elite level parent. You are dealing with things that most parents will never, ever be able to comprehend. So take it easy, be ridiculously good to yourself , and I will meet you right back here next week.
