Frequently Asked Questions
Is my donation tax-deductible?
Yes, CMC:Foundation for change is a 501(c)3 charitable organization All donations are tax exempt. Please contact your tax advisor before making a gift to confirm the details of your exemption. Click here to donate.
Do you provide treatment?
How do I donate?
Is your training like CRAFT?
Many people ask us if The Invitation to Change Approach is the same as CRAFT (Community Reinforcement and Family Training). Essentially, we think of it as CRAFT on steroids. CRAFT is a combination of behavioral and motivational strategies that has been shown to be tremendously effective for loved ones trying to encourage someone they care about to enter treatment and was developed by Dr. Robert Meyers and Dr. Jane Ellen Smith. We are huge fans of CRAFT and the co-founders of CMC:Foundation for Change wrote an award winning book, “Beyond Addiction: How Science and Kindness Help People Change that explains CRAFT concepts in a user friendly way. CRAFT is the foundation of our approach.
Through our clinical practice and our years of work developing the Invitation to Change, we have incorporated other evidence-based techniques and concepts to supplement CRAFT. We have amplified the use of Motivational Interviewing (MI) techniques to help families understand how to positively impact their loved one’s motivation to change and improve communication tools. We have added strategies from Acceptance and Commitment Therapy (ACT) to help families maintain kindness and compassion for their loved one and themselves through the whole process of change. With the addition of these strategies, we have built what we consider to be a broadly applicable change model – something useful and accessible to people in diverse situations and from a wide range of backgrounds.
If you are looking specifically to be certified in being a CRAFT practitioner, which is a more lengthy process, please contact Dr. Robert Meyers (https://www.robertjmeyersphd.com) If, however, you are interested in learning a combination of approaches that draws heavily on CRAFT and that we find to be effective and exciting, our trainings would be a good fit!
What does the science say about Medication-Assisted Treatment (MAT)? Some people have told me that my loved one should be on an opiate replacement medication. Others say it’s ‘just a crutch’ and that they won’t really be sober until they’re drug-free.
The science is clear – though moral judgements often cloud the data. Research shows that people who are an appropriate candidate for an opiate replacement medication, such as Suboxone, have dramatically lower rates of overdose. The majority of people using Suboxone as prescribed are safer than those who detox completely from opioids and do not follow up with maintenance or blocking medications.
There is no one medication that will work for everyone, and medication isn’t the right choice for everyone. We advise making decisions based on the particulars of your situation and the applicable research. There are more and more medications available to help ease cravings, decrease substance use, and decrease the risk of overdose while people work to rebuild their lives. And you should be asking – what’s wrong with a crutch? If someone uses crutches while healing from a broken ankle, is that not ‘real’ recovery? You and your loved one deserve everything you need to make and sustain real, lasting change.
What are narcan and naloxone? Should I have a naloxone kit?
If you or someone you care about is at risk for opioid overdose, it is wise to be prepared. Narcan (naloxone) is a medication, chemically similar to naltrexone, which can save the life of someone beginning to overdose from opioid use. It works by ejecting opioids from their receptor sites in the brain (i.e. reversing the effect of the opioids) and thus prevents them from shutting down the central nervous system. It is important to note this reversal effect is just temporary, and depending on the type and amount of opioids consumed, a person may need repeated doses of naloxone. For this reason, it is essential to call 911 at the same time as administering naloxone for an overdose, so that you can also get professional medical care as urgently as possible. You should seek out emergency medical help right away after a dose of naloxone, even if a person wakes up and seems better.
Narcan (naloxone) is available upon request without a prescription in many states from participating pharmacies. If you or someone you live with is at risk of opioid overdose, it can be lifesaving to have Narcan on hand and to be trained in how to administer it. We encourage you to learn more about how to obtain and administer naloxone via the following resources:
Chain pharmacies which have naloxone available on standing order without the need for a prescription:
- CVS, Price Chopper, Rite-Aid, Stop and Shop, Walgreens/Duane Reade, Wegmans
- New York Directory: http://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/directories.htm
- Massachusetts Directory: http://www.mass.gov/eohhs/docs/dph/quality/boards/pharmacy/pharmacies-so-nalaxone.pdf
Should I go to Al-Anon?
A common response when a family member is looking for help is to recommend Al-Anon (or other “Anon” programs). Al-Anon is a 12-step support group where family members can come together to get support from other family members. It’s free and many people find the message that you are not responsible for and can’t control your loved one’s disease very comforting. Unfortunately, many meetings support the idea that your loved one will need to hit rock bottom until anything in your family can change, which is simply not true and for many a life-threatening message. Family influence is the most commonly cited reason for treatment entry among help-seeking substance users and you can learn skills to help your loved one change and to take better care of yourself in the process. Additionally, Al-Anon does not have the goal of helping your loved one get into treatment, which is something you probably really want to happen. In controlled trials, engagement rates of substance users whose loved ones participate in Al-Anon only range from 0%-15%, compared to family members who learned CRAFT skills who were able to support their loved one entering treatment.
But Al-Anon saved my life!
That is amazing! Support groups can help you realize you are neither alone nor crazy and they create a stigma-free zone for venting and solidarity. The value in having the company of other people sharing common struggles cannot be overstated. We are glad you found the support you need. As you consider learning some of the evidence-based skills in the Invitation to Change Approach you may however hear conflicting feedback in your Al-Anon meeting. You may hear that your loved one can’t be helped until he “hits bottom,” which is not true. You may be told you have disease of co-dependence, something that does not exist. They may give you the message that your loved one is an addict and that addicts are the same in certain ways, and that abstinence is the only solution, again not true. They may be against medication—which can be life-threatening for many. One of the Twelve-Step slogans says “take what you need and leave the rest.” This is good advice if you hear opinions you may not appreciate but want to see if you can feel supported by an Al-Anon group.
It feels like everyone has advice on the ‘right way’ to get my loved one to change. I mostly just feel like I’m doing something wrong all the time. How do I know what the right way to help is?
It sounds like you’re trying to do your best in a very difficult situation. You’ve probably been given a lot of advice and told that there is only one right thing to do. You may have been told to use ‘tough love’ or to stage an intervention. Many people recommend these approaches because they don’t know about other options, because they seem like a quick fix, or because one of these strategies seemed to have worked for them (in one way or another) in the past.
The reality is that every person with a problem and their family is unique, and you should trust what you know about yours. You may sense that your loved one would not react well to ‘tough love’ approaches or to an intervention. The research supports this: compared to CRAFT, which gets a substance-using loved one to treatment about 70 percent of the time, interventions work about 30 percent of the time.
Take some time to consider your situation and your loved one. Read through the 20-Minute Guide and learn more about how motivation works. There is no one right way to help and you will be best served by thinking through your unique situation.
What if my spouse and I aren’t on the same page about using this approach? Can I still help my child change?
Nothing is more important for parents, and perhaps nothing is harder to do well, than cooperation. Whatever the constellation of parental figures involved—two-parent couples, divorced parents, step-parents, single parents, extended family—your influence depends on consistency among you. Imagine trying to work for two bosses who don’t agree on what you’re supposed to be doing or how to run the company! That’s what it’s like for a child when parents aren’t aligned. If there has been a history of conflict between you or you have noticed differences in your perspectives, we encourage you to take a step back and remember the goal—helping your child move in a positive direction. Try to put aside your differences and find a way to collaborate as you and your partner are in unique positions to have a positive impact on your child.
My child no longer lives in my house, can this approach still help?
Yes. Understanding the problem and your child’s experience helps to increase your empathy while forming the basis of constructive action. And being far away or separated from your loved one doesn’t mean you have nothing to work with.
The skills that you learn through the Invitation to Change Approach can help you support healthy behavior and encourage change, especially through more open, honest, frequent, and constructive communication. The skills you learn will help you stay connected even as you learn how to have difficult conversations. The better your communication with your loved one, the more opportunities you will have to reinforce healthy behaviors and encourage change.
Are the communication skills in the Invitation to Change Approach good for any type of addiction?
Yes! The communication skills we teach have been found in studies to reduce defensiveness and increase positive communication in families facing all kinds of substance problems. And they help in other areas as well! We have had clients talk about using them at work and in the grocery check-out line and say they help them across the board.
We are parents of teenagers and are pretty sure our kids are not using, but want to know how to bring up the topic as a precaution. Can the Invitation to Change Approach still help?
Yes! The strategies and understandings in the Invitation to Change Approach are all about helping people make positive decisions. We wish every parent of a teen would learn these skills as they can potentially prevent a substance use problem from ever taking hold of their child. You don’t already need to be coping with a serious problem to make use of them. With behavioral approaches, you can proactively reinforce the behavior you want, whether that is coming home sober or putting the dishes away. And you can use communication skills to have tough conversations about the ‘dangers out there.’ You can use the skills we teach at any point – and it doesn’t hurt to start early.
Kindness is all well and good, but don’t some people just need a swift kick in the pants? Some people need tough love to change.
If there was evidence that ‘kicking’ worked, we might recommend it. But studies show that confrontation and aggressive measures don’t engage substance users in treatment or help them change. In fact, confrontation and coercion can predict relapse rates – that is, they make things worse.
People use substances because, in one way or another, they work for them (e.g. ‘If I use cocaine I feel more confident’ or ‘if I have a few drinks I feel less pain’). Punishment and aversive approaches like yelling don’t compete very well with the powerfully reinforcing effects of substances. They may even become reasons to use if substances help your loved one to tune out or forget about your reactions.
What makes things better? The evidence supports understanding, positive reinforcement, problem solving, and allowing the natural negative consequences of substance use to occur. Communication also helps, and the communication skills in the 20-Minute Guide and the Invitation to Change Approach can help you express your feelings more constructively (even when you’re angry!). These strategies aren’t always as ‘swift’ as kicking – but they are more effective.
Won’t my loved one interpret kindness as weakness? How do I avoid being taken advantage of?
Being kind does not mean being a doormat, sacrificing yourself, or reinforcing your loved one’s use. A good, change-supportive relationship will respect your boundaries and your need for self-care. The communication skills included in the Invitation to Change Approach are designed to help you express your limits clearly and kindly. The maintenance of these of these limits is integral to the change process for you and your loved one.
Bear in mind that setting limits around negative behavior is most effective as a technique when it is complemented by reinforcing positive behaviors! Kindness lowers resistance and defensiveness and enhances motivation. Think of your efforts to help your loved one like planting a garden. It’s not enough to only pull out weeds – the plants that you want in the garden need water, light, and fertilizer to grow.
It makes sense to me to reinforce healthy behaviors, but what do I do when everything is going wrong and it feels like there is no good behavior to reinforce?
The families we work with often understandably feel dismayed and hopeless. We sometimes say “get out your microscope.” If they look closely enough, they can almost always find something small to reinforce or a small window of opportunity in which to insert something positive. It can be hard at first to identify these opportunities – but that’s why ‘practice, practice, practice’ is one of our main mantras! Finding small things to reinforce and noticing the positive before it slips back underwater take time to get good at.
And don’t underestimate the power of these small things! Even a small act can be a step in the right direction, and reinforcing it increases the likelihood that your loved one will do it again. Good, life-changing habits – healthy eating, for example – are often made up of a number of small individual actions, such as going to the grocery store, preparing food, and eating a meal.
I’m too mad to be kind!
Many people feel this way. Your anger makes sense given the stress and fear you are living with (and likely have been living with for a long time). The anger you feel is a real, understandable obstacle – both to kindness and to helping your loved one.
You may want to start by working on being kind to yourself. You don’t have to suffer so much. It’s not good for anybody. We cannot overemphasize the importance of self-care: developing your resilience, strengthening your distress tolerance, increasing your capacity to keep some perspective, and developing your awareness of your own emotional triggers.
You put so much emphasis on self care. Why should I take care of myself when my loved one needs help?
This is one of the most common reactions we see in family members. Guilt, anxiety, and fear prevent people from stepping away long enough to do something for themselves. Compared to your loved ones substance use, your own need for time to talk with a friend or to get a good night’s sleep may seem pretty small and insignificant. And in some situations it may make sense to put your own needs aside until a crisis is over or contained. But substance use problems are in many ways like active volcanoes. What will you do in the days, months, or years between eruptions? Change takes time. It’s best to take the long view.
Your resilience in the face of adversity, brainpower for problem solving, energy for healthy communication, patience for the gradual process of change, and ability to set a positive example for your loved all rest upon your physical and mental wellbeing. When framed this way, self-care is not a luxury, but a necessity. Taking care of yourself is a vital part of helping your loved one. And if doing so also makes you healthier and happier, isn’t that a small price to pay?
About evidence-based approaches:
What is CRAFT?
The Community Reinforcement and Family Training approach (CRAFT) is a behavioral and motivational treatment for families (Smith and Meyers 2004) based on the empirically supported Community Reinforcement Approach (CRA). It has been studied extensively in randomized controlled trials with a variety of populations (socio-economic groups/ethnic groups, types of substance used, etc.) and has been found to be more effective than more traditional approaches like Al-Anon and interventions.
CRAFT has two goals: engaging the substance user in treatment through behavioral training for the family members, and enhancing family member self-care. It helps family members create a relationship environment where abstinence/change behaviors are positively and incrementally reinforced and recognizes the family as powerful collaborators in effecting change instead of encouraging them to detach or use confrontation to impact their loved one.
In clinical trials, CRAFT engaged the substance user into treatment with rates of 74%-64%, and families reported significant improvements in their own happiness and sense of family cohesion as well as reduced anxiety, depression, and anger. The substance users studied also significantly reduced substance use, regardless of whether they entered treatment.
Is CRAFT as effective with adolescents as it is with adults?
The evidence we have from clinical studies says yes. Adolescence is a unique developmental period, and both parents and children are subject to challenges – for adolescents, these include a combination of influence from peers and a natural desire for experimentation. At the same time, the parent-child relationship is incredibly important in this period – more important than many parents believe. Parents have certain kinds of leverage, such as allowances and other gifts, that they often don’t think about as leverage or don’t feel comfortable using. Understanding the skills in CRAFT can help you harness the power of positive reinforcement.