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Rationale for Working with CSOs

Community Reinforcement and Family Training (CRAFT) with Concerned Significant Others of Problem Gamblers Nicole Peden & David C. Hodgins University of Calgary. Rationale for Working with CSOs. Engaging CSOs is an excellent way to access problem gamblers who are resistant to treatment

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Rationale for Working with CSOs

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  1. Community Reinforcement and Family Training (CRAFT) with Concerned Significant Others of Problem GamblersNicole Peden & David C. HodginsUniversity of Calgary

  2. Rationale for Working with CSOs • Engaging CSOs is an excellent way to access problem gamblers who are resistant to treatment • Problem gamblers report that family influence was an important reason why they quit gambling • CSOs are in need of help themselves

  3. Traditional Approaches • 12 Step Programs • Johnson Institute Intervention • Mental Health Counseling • Nothing

  4. 12 Step Programs • Loving detachment • Acceptance of CSOs inability to control IPs behaviour • Group support for CSO

  5. Johnson InstituteIntervention • IP is confronted at a “surprise party” • 29% of CSOs complete training and carry out the intervention • Overall success rate: 24% enter treatment

  6. CRAFT Goals 1) Engage addict into treatment 2) Reduce addictive behaviour 3) Decrease CSO distress

  7. CRAFT Theory • Rooted in Behaviour Theory • Operant Conditioning • Aspects • Problem focused (e.g., problem solving, functional analysis) • Skills based (e.g., communication training, use of positive reinforcement and time out from pr, natural consequences for using) • Active during sessions (e.g., role plays, exercises) • Active between sessions (e.g., assignments, suggesting treatment)

  8. Empirical Support • Makarchuk, Hodgins, & Peden (2002) Method • 31 CSOs randomly assigned to CRAFT workbook vs. standard treatment package • 3 month follow up Results • Gambling behaviour decreased in CRAFT workbook group • Treatment entry rates similar for both groups • CSO distress improved in both groups

  9. Empirical Support • Hodgins, Toneatto, Makarchuk, Skinner, & Vincent (2004) Method • 186 CSOs randomly assigned to 1) CRAFT workbook, 2) CRAFT workbook + telephone support, 3) a control package • 3, 6 month follow ups Results • Fewer days gambled in CRAFT workbook groups • Treatment entry rates similar for all groups • CSO distress improved in all groups

  10. Empirical Support

  11. CRAFT Study Conclusions CRAFT is the only therapy that is aimed at helping both the gambler and the CSO AND Has some empirical evidence to support its utility

  12. Study Objectives Phase I • Modify and deliver the CRAFT intervention in an individual face-to-face format to CSOs of problem gamblers Phase II • Compare CRAFT individual intervention to the CRAFT self-help intervention

  13. Collaboration and Funding • Collaboration with AADAC Counseling Services in Calgary • Funding support from Alberta Gaming Research Institute

  14. Ethics • Department of Psychology Research Ethics Board (DPREB) November 2005 • Conjoint Faculties Research Ethics Board (CFREB) January 2006

  15. Development of CRAFT therapist manual, client handouts, and treatment integrity checklist.Initial telephone contact, screening, and recruitment.Administration of pre-treatment assessment measures(face-to-face interview).Assignment to treatment condition.CRAFT Self-help CRAFT Individual Workbook Intervention Post-treatment assessment (telephone interview).Six-month assessment (telephone interview) + gift certificate mail out.

  16. Sample Advertisement

  17. Inclusion Criteria • CSO be over the age of 18 • CSO have a minimum of 3+days/week of contact with the gambler • Gambler be resistant to suggestion for treatment • Gambler and the CSO must have not attended treatment for gambling related problems in the last 2 months • Gambler must meet criteria for problem gambling (as reported by the CSO) and the CSO should be free of problems with gambling • Record sessions • Provide follow-up data • Provide the name of a collateral to help locate them for the post-assessment and 6-month interviews

  18. Measures

  19. Measures CSO PSYCHOLOGICAL FUNCTIONING • Brief Symptom Inventory • Depression Anxiety Stress Scales • State-trait Anger Expression Inventory-II REACTIONS TO TREATMENT • Attendance/Workbook adherence • Working Alliance Inventory • Satisfaction questions about the program

  20. CRAFT in 7 Modules(8-12 Sessions) • Building and sustaining motivation • Functional analysis of the gambling behaviour • Improving communication skills • Positive reinforcements for non-gambling behaviour • Use of negative consequences • Helping the CSO enrich their own lives • Suggesting treatment/Termination and additional resources

  21. Hypotheses 1) CRAFT individual intervention = less gambling and more gamblers entering treatment 2) CRAFT individual intervention = lower levels of personal distress and better relationship functioning with the gambler

  22. Data Analysis Hypotheses = group (CI, CW) x time interaction (Pre, Post, 6m) ANOVA will examine differences between groups for each outcome category • Days gambled • Treatment engagement • CSO functioning

  23. STRENGTHS Unique contribution Random assignment Use of treatment manual Treatment adherence check (non-invested rater) Blind follow-ups LIMITATIONS CSO report Less experienced clinicians Sample size Limited measurements

  24. Questions

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