Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions

Rikke Hellum,Kjeld Andersen,Morten Hesse,Gallus Bischof,Anette Søgaard Nielsen,Claus Thorn Ekstrøm,Randi Bilberg

doi:10.1186/s12889-019-6632-5

Abstract

BackgroundAround 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.MethodsThe study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.DiscussionWe expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.Trial registrationClinical trials.gov ID: NCT03281057. Registration date: September 13th, 2017.

Highlights

Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence
Ethics In view of the fact that the Community Reinforcement and Family Training (CRAFT) intervention has proven highly effective in the US, and since living close to a problem drinker is such a burden to the individual and, because the Danish National Guidelines strongly recommend the implementation of CRAFT, we find it un-ethical and problematical not to offer CRAFT in some form to all the participants, even to the control condition
The aim of this study is to investigate whether concerned significant others (CSO) assigned to individual CRAFT or group CRAFT would be more able to motivate their drinking relative to enter treatment, compared to CSOs randomly assigned to the control condition and, to investigate whether six-weeks group CRAFT improves the quality of life and psychological functioning of CSOs significantly more than individual CRAFT and self-directed CRAFT

Summary

Introduction

Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. It is estimated that 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from alcohol dependence [1]. Only 15,000 [2] seek specialist treatment for their alcohol problem, often after they have been suffering from an alcohol use disorder (AUD) for more than 10 years [3]. The concerned significant others (CSOs), such as spouses, parents, or adult children, are affected by the drinking, often suffering almost as much as the PWAUD him - or herself [6]. Compared to the general Danish population, the frequencies of such symptoms are two to three times more common both among persons with an AUD and among their partners [10, 11]

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