Trump Presidency: What this Means for Your Mental Health Care

 

I’m going to touch upon a few things with some educated guessing since at this point we have no information on any strategy for changing the healthcare system, including the Affordable Healthcare Act (aka. Obamacare).

Medications

Big Pharma may be big winners in this election. There is a good chance regulation will decrease which means drugs will be pushed through the regulatory process. There is also a very good chance your medications will get more expensive Obamacare will be directly targeted for dismantling. At this point, the federal government has some impact on what drug makers charge (at least for Medicare, Tricare and Medicaid clients). There is a very real fear that whenever there is a conflict between industry and clients/customers, the Trump administration may very well choose big business.

Affordable Health Care Act – Obamacare

This was one of Trump’s big targets and will likely be a focal point as the Trump administration sharpens its agenda in 2017. One big problem with Trump’s over simplistic promise to ‘get rid of Obamacare’ is that it took years and years to recalibrate and organize healthcare at the federal, state and corporate levels. Billions of dollars went into this law. Changing the law will take years and years and more billions. Insurance rates have gone up for many people and that hurts. But, the dismantling of Obamacare will likely have a dramatic and catastrophic effect on providers, clients and hospitals. The prediction at this point is that while the current system is experiencing growing pains, the replacement will likely compromise the little leverage we have over insurance companies meaning they will go back to charging whatever they want and having pre existing conditions the hallmark of how they keep people from needed care.

Mental Health Parity and Addiction Equity Act (MHPAEA)

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical benefits. With the Trump administration taking the reigns in a few months, there is the possibility the act could be dismantled in favor of insurance companies, most of which have fought, lied and deceived policyholders from the very beginning of the law in 2009. What this means for you: Insurers may no longer be required to pay for comparable level of mental health and substance abuse treatment as you have within your medical policy.

I will continue to monitor Trump policy changes and post again soon. Till then, take a deep breath, stock up on canned goods and sweep out your bomb shelter. We’re likely in for a wild ride.

Opioid Epidemic: John Oliver Sums it Up Best on HBO

Don’t Think Pain Meds and Heroin is Really a Big Deal? Check Out What the Surgeon General Just Did…

Surgeon General Writes to Every Doctor in U.S. About Opioid Epidemic

Opioid abuse is not like other problems. With very little use, pain meds and heroin can quickly become an addiction. This addiction has unusual drug dealers. Some are intentional (Big Pharma like Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Actavis) that exploit our pain and desperation. Other’s are likely well-meaning like primary care doctors most of whom are manipulated by the pharmaceutical companies to write prescriptions.

If you or a loved one is prescribed pain meds, take this seriously. Use as little as possible and work closely with your doctor. If you can’t stop, get help immediately. The longer someone abuses opioids, the harder it is to get back on track.

Missouri: Only State Not on Prescription Drug Monitoring Program

It was a mystery for the last few years – why were so many people going to Missouri to get their prescriptions (…mostly opioids like Vicodin/Lortab or Oxycodone)? Mystery solved. As of 2012, Missouri was the only state in the United States that did not participate in a national registry for prescription drugs.

Just in case you forgot where Missouri is

Just in case you forgot where Missouri is

Let’s dive a bit deeper…

What’s The prescription drug monitoring program?

Better known as PDMP, it’s an online database that collects data on controlled substance prescriptions dispensed within each participating state. It can act as an early warning system for prescribers to avoid dangerous drug interactions and to ensure quality patient care. 

PDMP is also a tool that also can be used to intervene in the early stages of prescription drug abuse, as well as to assist providers in preventing prescription drug abuse and enable providers of pain medications to know if they are treating someone who has been “doctor shopping”  (going from doctor to doctor for multiple prescriptions).

PDMP does not impact the legal prescribing of drugs by a provider – it simply makes it possible to spot a potential problems or trends.

Why Missouri Doesn’t want PDMP?

Well, Missouri kind-of does want PDMP. In 2012 the state came oh so close to enacting PDMP. But while proponents say most Missouri citizens and legislators support participation in PDMP, it has been blocked by lawmakers like State Senator Rob Schaaf, a family doctor who argues (…inaccurately in my humble opinion) that allowing the government to keep prescription records violates a patient’s personal privacy. He’s probably referring to HIPAA and/or HITECH which are privacy laws that protect a patient’s health records. After successfully combating the 2012 version of the Missouri legislative bill, Dr. Schaaf said of drug abusers, “If they overdose and kill themselves, it just removes them from the gene pool.” Dr. Schaaf is seemingly more focused on individuals liberty (…for prescription drugs) than on life. Fortunately, he appears to be in the minority within Missouri.

How to access the PDMP information

It’s not so easy. You’ve got to be a doctor, part of the legal system or law enforcement to get access. The PDMP data is stored by specified statewide regulatory, administrative or law enforcement agency as designated by state law. The agency distributes data from the database to individuals who are authorized under state law to receive the information. Information is shared across state lines when needed. 

5 Signs of Suicide Risk in College Students

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

FACT: 15% of graduate and 18% of undergrads have seriously considered attempting suicide

There is nothing more exciting than dropping of your college freshman in late August as the cool nights of Autumn return. But not all students carry with them the same energy and positive outlook for the Fall. Some are carrying some heavy baggage from High School or even younger while others don’t start to develop any major issues until they first get to college (and their first taste of freedom from parents). What parents don’t know is that you likely know your college friends (or at least a side of them) better than their own parents do, and you may be able to tell that something is wrong way before anyone else. This quick list is as much for parents as it is for you students out there. 

The following signs might indicate a student is considering suicide:

  1. A good student who’s behavior suddenly changes – they start ignoring assignments and missing classes which are likely signs of depression or drug and alcohol abuse, which can affect their health and happiness and put them at risk of suicide. And yes, good students and good kids use drugs. Seriously. 
  2. Anyone who doesn’t have friends or who suddenly rejects their friends may be at risk. A friend who suddenly rejects you, claiming, “You just don’t get it,” may be having emotional problems.
  3. College students may be physically or emotionally abused by a member of their family or their girlfriend or boyfriend – or suffering from abuse that occurred long ago but triggered by the new college environment. Abusive relationships can make a college student feel like crap about themselves. Signs that a person may be in an abusive relationship include unexplained bruises or other injuries that he or she refuses to discuss. 
  4. This is a common one – Significant changes in a someone’s weight, eating or sleeping patterns, and/or social interaction style may indicate that something is wrong. Eating disorders are super common at college. Lot’s of perceived competition, anxiety and stress that translates into really unhealthy views of one’s self. 
  5. Coming Out? College students may suffer from depression or have thoughts of suicide if they have a difficult time adjusting to their sexual orientation or gender identity. Gay, lesbian, bisexual, and transgendered students have higher suicide attempt rates than their heterosexual peers.

We understand regret and their could certainly be a real consequence of getting help for someone who seems to be really hurting. They might get pissed at you for not minding your own business. But think of it this way – is the regret of possibly losing a friend better or worse than the potential of knowing you could have saved your friend’s life but did nothing? Tough choice but that’s part of the burden of mental illness. 

FREE Parent Support Group: Residential Treatment and Higher Levels of Care

If you are a parent who wants to learn more about residential treatment for your teen or young adult child, our Parent Support Group is for you. This group is specially designed for Parents of Teens and Young Adult Children either in residential treatment or in need of residential treatment. Whether you have an acting out teen obsessed with gaming or a daughter exhibiting what seems like an eating disorder, residential treatment may be an option. But how do you choose? How do you know the good ones from the bad? We will walk you through the basics of the therapeutic program world through a discussion format. 

Topics will range from residential and treatment options, how to creatively pay for programs and use insurance, myths vs reality of treatment, parenting advice and skill building, and finally, sharing and venting. This is also an open forum to address any other problems related to acting out teens/adults – you’re not alone. 

WHEN

Mondays 7:00pm Starting September 8

WHERE

Fonthill Counseling Conference Room – 141 Providence Rd Suite 160 Chapel Hill NC 27514

COST

Free

FACILITATOR

Licensed therapist with expertise in residential treatment, counseling and parenting education will lead didactic, interactive and experiential sessions.  

RSVP

Due to limited seating, preregistration is required. Please email us at help@fonthillcounseling for sign-up instructions. 

Program Review: Kolmac Clinic

In May 2014 Dr. Marino visited The Kolmac Clinic with six locations spread around the Washington DC, Maryland and Virginia region. This is your classic substance abuse program geared towards adults. Kolmac has been around since 1976 and slowly increased the depth and breadth of services with a consistent focus on drug abuse treatment. 
 
What They Do
 
Kolmac offers IOP levels of care in group format. Initially patients will attend three hours of group IOP sessions five times a week. Next, individuals step down to less frequent group meeting, ending with just once weekly group. Kolmac noted they are a CBT program and encourage patients to use AA for outside support. Providers who refer to Kolmac often are able to continue outpatient therapy or decide to transfer to Kolmac until the initial treatment course has reduced in frequency. 
 
Kolmac also provides outpatient detoxification. Each location is staffed with medical providers and mental health providers. Patients are able to go through detox during the day and return home in the evenings. 
 
Who They Serve
 
The Kolmac Clinic provides outpatient rehabilitation and treatment programs for adults with alcohol, drug, and other substance abuse problems. Because Kolmac is an outpatient treatment center, patients can receive rehab help without taking leave from work or family responsibility.
 
Locations

Kolmac Clinic has six locations in Washington DC area. Unfortunately the program does not offer services in Virginia, but has locations in downtown DC and Maryland. Each site boosts group treatment tailored to the population in need. For example, the Towson, MD site has a larger population of young adults and targets programming to this population. The K St location specializes in corporate executive’s substance concerns. 

During the visit to he K St location, the office appeared dated and office presentation seemed less important (e.g., stain on rug, old furniture). Staff appeared friendly, but often passed through the waiting room (in the middle of the office) without acknowledging guests waiting for appointments.

Fees + Insurance + Financing

The daily charges are $400 for detoxification, $193 for rehabilitation, $120 for the initial clinical evaluation and $100 for continuing care. Most insurance plans cover part or all of the costs at Kolmac. The exact out-of-pocket expense for the patient varies accordingly. Patients interested in treatment with us should call with insurance information and our staff will explain costs.  Once the patient has scheduled an appointment our staff will verify the insurance coverage.  Payment plans are available if needed.

The clinic accepts all insurances except Tricare and state funded plans (e.g., medicare and medicaid). 

Reviews

There is quite the mixed bag of reviews found online. With an agency the size of Kolmac, this is to be expected. There generally are either really terrible reviews or really great reviews without much in between. This is one of those clinics we HIGHLY recommend visiting first before you make a decision about starting treatment with them. 

Contact Information 

Best way to reach them is through their online contact form found here or their general number at 301.589.0255. 

Final Thoughts
 
Overall, the staff at Kolmac seemed friendly and knowledgeable. Staff also seemed genuinely interested in learning about resources and referral options in the community. 

How to Lose a Fortune: The Stroh Family Tale

I posted the article below to highlight a typical evolution within family wealth. It’s part cautionary tale and part voyeuristic experience for those of us that will never be billionaires. It’s a tale of rise and greed and fall. The important lesson here is that the tale of this once prominent family doesn’t end just because the money did. Lives are changed and rebuilt. 

The once proud and lucrative Stroh brewery in Detriot.

The once proud and lucrative Stroh brewery in Detriot.

The original version of this article is from 7/8/2014 on www.forbes.com and was written by Kerry A. Dolan who specializes in writing about the world’s wealthiest people and philanthropy. 

AS WITH MANY OF AMERICA’S GREAT FORTUNES, the Stroh family’s story starts with an immigrant: Bernhard Stroh, who arrived in Detroit from Germany in 1850 with $150 and a coveted family recipe for beer. He sold his brews door-to-door in a wheelbarrow. By 1890 his sons, Julius and Bernhard Jr., were shipping beer around the Great Lakes. Julius got the family through Prohibition by switching the brewery to ice cream and malt syrup production. And in the 1980s Stroh’s surged, emerging as one of America’s fastest-growing companies and the country’s third-largest brewing empire, behind only public behemoths Anheuser-Busch and Miller. The Stroh family owned it all, a fortune that FORBES then calculated was worth at least $700 million. Just by matching the S&P 500, the family would currently be worth about $9 billion.

Yet today the Strohs, as a family business or even a collective financial entity, have ceased to exist. The company has been sold for parts. The trust funds have doled out their last pennies to shareholders. While there was enough cash flowing for enough years that the fifth generation Strohs still seem pretty comfortable, the family looks destined to go shirtsleeves-to-shirtsleeves in six.

“We made the decision to go national without having the budget,” sighs Greg Stroh, a fifth generation family member and former Stroh Brewery employee. “It was like going to a gunfight with a knife. We didn’t have a chance.” His analysis comes tinged with inevitability. It wasn’t. A handful of family-owned regional brewers such as Yuengling and Schell’s continue to thrive, while others, like Olympia and Hamm’s, sold out. And the Strohs’ largest rivals during the 1980s and 1990s, the Coors, who also aspired to turn their no-frills, regional suds into a national powerhouse, remain in the top 100 on the FORBES America’s Richest Families list.

The Strohs chose a different path, a saga that serves as a powerful reminder: Hard as it is to build a family business designed to last in perpetuity, it’s shockingly easy for any successor to tank it.

FOR ITS FIRST CENTURY the Stroh beer business, based in Detroit, grew by following the basics: respect your customers; respect your employees. The former meant catering to Midwest working-class tastes at working-class prices (the family watered down Bernhard Stroh’s precious recipe, after hops and wheat shortages in World War II left Americans accustomed to weaker brews). The latter by treating every employee like an honorary member of the clan. John Stroh, who oversaw a dramatic sales surge in the Eisenhower years, “was known for walking the brewery and knew everyone’s first name,” his grandnephew Greg remembers. “Employees would run through walls for the family.” As if to connect the customers and the business, the Stroh signature was emblazoned on every bottle, topped by a family crest with a lion. Sales surged in lockstep with postwar Detroit, from 500,000 barrels in 1950 to 2.7 million barrels in 1956.

The Stroh Family Management - Not as clever or frugal as they needed to be.

The Stroh Family Management – Not as clever or frugal as they needed to be.

The mammoth changes came in the early 1980s. John Stroh had moved into the chairman’s role in 1967 and handed control of the brewery to his nephew, Peter, who became CEO in 1980. Like John, he had a plan to grow, but not incrementally: He would do it by acquisition. In 1981 Stroh bought New York-based brewer F&M Schaefer, which, like Stroh, was founded by a German immigrant in the mid-1800s and also offered low-priced suds to its regional fans (famous marketing line: “The one beer to have when you’re having more than one”). The next year, in what family members describe as “the minnow swallowing the whale,” Peter Stroh bet the family business, borrowing $500 million (the book value of the Stroh business was $100 million at the time) to buy Joseph Schlitz Brewing of Milwaukee.

Suddenly Stroh was the third-largest brewer in the U.S., with seven plants and a national footprint. On paper there was synergy. FORBES valued the company at $700 million in 1988, listing the Strohs with one of the largest family fortunes in the U.S. at the time, shared by 30 relatives.

But Peter Stroh’s grand vision of a thriving U.S.-wide brewer failed to materialize. It largely missed the boat on the biggest industry trend in a generation: light beer. And Stroh’s core product–cheap, watery, full-calorie beer–was a commodity. But saddled with debt, Stroh couldn’t afford to match the ad spending of its bigger rivals, Anheuser-Busch and Miller. Unable to spur demand through marketing, Stroh turned to price, introducing a 15-pack for the price of 12 cans and a 30-pack for the price of a case of 24. While the latter had legs, it wasn’t enough to outrun the shrinking margins.

Meanwhile, an ambitious family from Colorado began moving into the Stroh markets. “It became a competition between Stroh and Coors,” says Scott Rozek, a former director-level employee who spent 12 years at Stroh. “At that time there were four big breweries in a three-brewery industry–there was really only room for three.” By the end of the 1980s Coors overtook Stroh as the country’s third-largest brewer.

In August 1989 the Stroh Brewery Co. was in retreat. The company that had treated employees like family laid off 300 people, one-fifth of its white-collar workforce. “I had to let go four of the five people in the marketing research department. It was heartbreaking,” remembers Ed Benfield, former director of market research at Stroh.

The next month Peter Stroh, who died in 2002, agreed to sell the family business to Coors for $425 million. But Coors got cold feet and pulled out of the deal a few months later. “It had something to do with due diligence, and Bill Coors,” says Benjamin Steinman, longtime editor of newsletter Beer Marketer’s Insights. “There were lots of stories.”

Desperate, Peter Stroh brought in renowned adman Hal Riney to give the Stroh’s brand a more upscale look and position. The cherished Stroh signature gave way to block print, prices were raised, and the 15- and 30-packs were nixed. It could not have been a worse decision. But since the product hadn’t changed, customers could do the math: Sales of Stroh’s-brand beer fell more than 40% in one year, “the biggest drop in sales in the history of beer,” says Benfield.

Market share for Stroh’s, as well as for its acquired brands like Schaefer, Schlitz and Old Milwaukee, fell from 13% in 1983 to 7.6% in 1991. Even CEO Peter Stroh admitted the troubles. “We’ve been through a very difficult period,” he told FORBES in 1992. “We tried to do too much.”

And yet it tried to do more. In 1996 Stroh repeated his mistake, borrowing yet more money for the $300 million acquisition of struggling brewer G. Heileman. The purchase fell flat. Heileman had breweries in cities like Seattle and Portland, where Stroh didn’t, but it lacked a big stable of strong brands. One industry analyst remembers the deal described as “two sick chickens–they were both declining.”

It got worse. Peter Stroh had tried to diversify the business, with investments in biotech and Detroit real estate. Both were far from the family’s core competencies and lost them millions more. By 1998 cousin John Stroh III had taken charge at Stroh Cos., the brewery parent. And while the company had turned to contract brewing for others, including Sam Adams, as a way to make up for plummeting sales, Stroh took a mortal hit in 1998 when it lost a contract with Pabst.

By 1999 there was internal concern about whether they could even make their interest payments on the debt incurred, says one former executive. And so Bernhard Stroh’s legacy was sold for scraps: Miller Brewing, owned at the time by Philip Morris, bought Stroh’s Henry Weinhard’s and Mickeys brands, while Pabst bought the rest of the brands owned by Stroh’s as well as its brewery near Allentown, Pa., for a price several sources peg at around $350 million–about $250 million of which was used to pay down debt incurred with the Heileman purchase. Some of the remaining $100 million or so was transferred to a fund to pay employee pension liabilities, which Stroh had retained in the sale. The rest went into a fund for the family that dribbled out checks until 2008, when it was completely tapped.

FOR GENERATIONS, GROWING UP STROH meant a life of comfort. “My life with my father felt like being inside a gilded bubble,” says Frances Stroh, whose father, Eric, quit the company after a fight with his brother Peter in 1985. An artist at heart, Eric spent millions buying hundreds of antiques–guns, cameras, guitars–to fill the big house that Frances grew up in. Saving, Frances says, was not a priority.

And why would it have been when the checks rolled in? In the 1980s the seven members of the fourth generation got $800,000 a year. (There were another 20 or so shareholders from the third and fifth generations as well, who received differing amounts.) That enabled several Stroh families to live in stately homes on gated Provencal Road in the tony Detroit suburb of Grosse Point Farms, with maids, cooks, country club memberships, boarding school tuition and no need for 9-to-5 jobs. “A lot of people were living off the family business,” says Greg Stroh, who’s now 47.

As with too many families with more money than direction, drugs and alcohol followed. Frances Stroh was kicked out of boarding school at Taft after she was caught drinking. Her three brothers also got kicked out of different prep schools. In an excerpt from a memoir about the family that Frances is writing, she describes one incident during her college years when she was snorting cocaine with her brothers while the rest of the family was downstairs having Christmas dinner at their Grosse Point Farms home.

One of her brothers, Charlie, narrowly avoided going to prison for dealing cocaine in college in the early 1980s. His parents forced him to join the Marines, and good behavior in the service was the key to evading a prison sentence. Yet the demon of addiction reappeared two decades later, in 2003, when he fell to his death from a tenth-floor hotel balcony in Texas, as the sheets he tied together to form a rope failed to hold. He was 43. One report quoted police saying he called the front desk at the hotel “to report a bank robbery and other nonsensical things.”

There have been other tragedies throughout the years. Nick Stroh, a fourth-generation member of the family and a freelance journalist in Africa, was bludgeoned to death by Ugandan troops in 1971 after he investigated reports of an army massacre. Peter’s brother Gari Stroh Jr., who ran the Stroh Ice Cream division, became a quadriplegic after a fall from a horse on his farm in 1982. And so on.

All of which served to make 1989–the year of the failed sale to Coors–something of a shock to the family. For the first time the company couldn’t come up with dividend payments. “My generation probably grew up with the illusion that things were going to be pretty good,” says Greg Stroh. “We had to make adjustments.”

Eric Stroh was hit particularly hard. His first wife had to briefly loan him money to help him make ends meet. In 2009, a few months after the checks stopped for good, the overweight and diabetic Eric collapsed, alone, after letting a leg wound go untreated–most of his estate went into trusts to pay liabilities to his two former wives (the second one had gone to high school with Frances).

Frances and her two surviving brothers each inherited $400,000 from a trust. She also inherited her dad’s collections of antique cameras, guns and guitars–some of which turned out to be fakes, and others, fittingly, worth pennies on the dollar of what her father had paid for them.

To learn more about how to insulate your family from the unintended consequences of wealth, contact Fonthill Counseling for a fee consultation. 

Is CRAFT the Best Unused Substance Abuse Treatment?

Community Reinforcement Approach and Family Training

Today I’d like to introduce you to one of the most effective treatments/interventions for substance abuse that is rarely used and even-more rarely discussed. It’s called CRAFT and is a behavior therapy approach designed primarily for those with substance abuse issues. Developed by Nate Azrin in the 1970s, his technique focused on operant conditioning to help people learn to reduce the power of their addictions and enjoy healthy lifestyle. CRA was later combined with the FT (…family training), which equips family and friends with supportive techniques to encourage their loved ones to begin and continue treatment, and provides defenses against addiction’s damaging effects on loved ones.

The first part of this acronym – Community Reinforcement Approach (CRA) was originally created for individuals with alcohol issues. Clinicians later went on to apply it to a variety of substance use disorders for more than 35 years. The clinical premise is based on operant conditioning (…type of learning in which an individual’s behavior is modified by its antecedents and consequences), basically, CRA helps rearrange the client’s life so that healthy, drug-free living becomes more interesting/stimulating and thereby competes with substance use.

CRA is designed to be a time-limited intervention. The time limit is decided upon between the clinician and client. For example, a set number of sessions (for example, 16 sessions) or time limit (for example, one year) may be decided upon either at the very beginning of therapy or within the early stages of therapy.

One major goal of CRAFT is to increase the odds of the substance user who is refusing treatment to enter treatment through close support of family members, as well as improve the lives of the concerned family members. CRAFT clinician and participants teach and reinforce the use of healthy rewards to encourage positive behaviors. Additionally,  it focuses on helping both the substance user and the family strengthen their relationships which is often torn apart.

In the model, the following terms are used:

  • Identified Patient (IP) – the individual with the substance abuse issues that is refusing treatment
  • Concerned Significant Others (CSOs) – the relevant family and friends of the IP.

Three goals

When a loved one is abusing substances and refusing to get help, CRAFT is designed to help families learn practical and effective ways to accomplish these three goals:

  1. Move their loved one toward treatment
  2. Reduce their loved one’s substance use
  3. Improve their own lives

This comprehensive behavioral program accomplishes these objectives while avoiding both the detachment espoused by Al-Anon and the confrontational style taught to families by the Johnson Institute Intervention.

CRAFT and these traditional approaches all have been found to improve CSO functioning and increase CSO-IP relationship satisfaction. However, CRAFT has proven to be significantly more effective in engaging treatment-resistant substance users in comparison to the Johnson Institute Intervention and Al-Anon (or Nar-Anon) facilitation therapy. 

CRA Breakdown of Treatment

The following CRA procedures and descriptions are typical recommended clinical content areas for the substance user:

  1. Functional Analysis of Substance
    • explore the antecedents of a client’s substance use
    • explore the positive and negative consequences of a client’s substance use
  2. Sobriety Sampling
    • a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence
  3. CRA Treatment Plan
    • establish meaningful, objective goals in client-selected areas
    • establish highly specified methods for obtaining those goals
    • tools: Happiness Scale, and Goals of Counseling form
  4. Behavior Skills Training
    • teach three basic skills through instruction and role-playing:
    1. Problem-solving
      • break overwhelming problems into smaller ones
      • address smaller problems
    2. Communication skills
      • a positive interaction style
    3. Drink/drug refusal training
      • identify high-risk situations
      • teach assertiveness
  5. Job Skills Training
    • provide basic steps for obtaining and keeping a valued job
  6. Social and Recreational Counseling
    • provide opportunities to sample new social and recreational activities
  7. Relapse Prevention
    • teach clients how to identify high-risk situations
    • teach clients how to anticipate and cope with a relapse
  8. Relationship Counseling
    • improve the interaction between the client and his or her partner

Communication 

With CRAFT, CSOs are trained in various strategies, including positive reinforcement, various communication skills and natural consequences. One of the big pieces that has a lot of influence over all the other strategies is positive communication. 

Here are the seven steps in the CRAFT model for implementing positive communication strategies.

  1. Be Brief
  2. Be Positive
  3. Refer to Specific Behaviors
  4. Label your Feelings
  5. Offer an Understanding Statement – For example, “I appreciate that you have these concerns, … [or] I understand that you really want to talk right now, and that this feels urgent, … [or] I would love to be there for you.”
  6. Accept Partial Responsibility – This step “is really designed to decrease defensiveness on the part of your loved one. … It’s not about accepting responsibility for things you are not responsible for. … [Rather, it’s to] direct you towards the piece that you can own for yourself. … [For example, ] what you can take responsibility for are the ways that you communicate,” etc.
  7. Offer to help

Take home message – Help decrease defensiveness on the part of the loved one that you are speaking to, and increase the chances that your message is really going to be heard—so, increasing the ability that you have to really get across the message that you want. 

Consequences with specific limits/expectations being in place is essential in terms of communicating your message, but it’s also really important, maybe even more so, to be consistent in following through with those consequences and rewards.

Al-Anon 

As an organization, Al-Anon does not currently adopt, hold, or promote the view that CSOs can make a positive, direct, and active contribution to arrest compulsive drinking, which is the opposite premise of CRAFT. Al-Anon is a fellowship with a focus on helping families and friends, themselves, without promoting a direct intervention process for alcoholics. Because “no one ever graduates” from Al-Anon, it can be viewed as an open-ended program, not time-limited.

Al-Anon view

Regarding the CSO’s relationship to alcoholism and sobriety, the view from the Al-Anon organization can be summarized:

  1. PowerlessnessAl-Anon‘s First Step promotes a powerless view for families and friends, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
  2. Disease viewAl-Anon writes, “As the American Medical Association will attest, alcoholism is a disease.” Al-Anon also states, “Although it can be arrested, alcoholism has no known cure.”
  3. Three C’sAl-Anon has a dictum called “the Three C’s—I didn’t cause alcoholism; I can’t control it; and I can’t cure it.”
  4. Loving detachment. Al-Anon “advocates ‘loving detachment’ from the substance abuser.”
  5. Family illnessAl-Anon writes, “Alcoholism is a family disease,” and “we believe alcoholism is a family illness and that changed attitudes can aid recovery.”

Summary

CRAFT is not perfect and is not easy to implement partially due to lack of clinician training and also because of having multiple people involved (ie. IP, concerned others, and clinician). Programs, agencies and clinicians may not even be aware of CRAFT if you ask so if you or a loved one are in need of a non-residential approach that’s well researched and effective, find a substance abuse therapist able and willing to use it.