PS526 Unit 7 Family Involvement Case Study Example

The Mother Who Called Instead: A PS526 Unit 7 Case Study Applying Community Reinforcement and Family Training to a Son Who Refuses Treatment

[Student Name]

Purdue University Global

PS526: Advanced Addictions Counseling

Unit 7 Family Involvement Case Study

[Instructor Name]

[Date]

The family, the treatment center and every detail of the case are composite and illustrative; the sources cited are real.

The Call

Linda books appointments and answers phones for a large-animal vet in Belle Fourche. Her son, Brett, lives in her basement, works part time at a feed store and has been drinking heavily for three years, with cocaine on most weekends. He was arrested in a bar fight in March. When Linda suggested treatment, he left the house for two days. She has tried pleading, threatening to kick him out and pouring his liquor down the sink. She called our center, she said, "because I don't know what else to do, and he won't come."

Many programs would tell Linda that nothing can be done until Brett is ready, or refer her to a support group for families. This case study takes a different approach.

Why CRAFT

Community reinforcement and family training treats the concerned family member as the client. Smith and Meyers (2004) describe its aims as helping the family member encourage the loved one to enter treatment, reduce the loved one's substance use and improve the family member's own well-being, whether or not the loved one ever enters treatment. Its methods draw on the community reinforcement approach, a behavioral treatment whose research base Meyers et al. (2011) review, adapted here for the family: making sober behavior more rewarding, removing rewards for use, allowing natural consequences and improving communication.

Roozen et al. (2010) reviewed four high-quality randomized trials with 264 family members. Families trained in CRAFT got their reluctant relative into treatment roughly three times as often as families steered toward Al-Anon or Nar-Anon, and about twice as often as families who staged the kind of surprise confrontation that television calls an intervention, the Johnson Institute method. Family members' own functioning improved across all three approaches.

Linda had already tried the confrontation and the pleading; CRAFT offered her a third path in which her own behavior became the lever.

Assessment

In the first session I assessed safety. Smith and Meyers (2004) stress screening for domestic violence before teaching any strategy that might provoke anger. Linda said Brett had never hit her but had punched a wall and broken a door when drunk. We made a safety plan: if he turned threatening she would drive straight to her sister's place across town, and she would not raise treatment when he had been drinking.

I also asked about Linda herself. She sleeps poorly, has stopped seeing friends and has taken extra shifts to avoid being home. Her own well-being became a goal from the start.

Functional Analysis of Brett's Use

Linda and I mapped when Brett drinks and uses. The triggers are Friday payday from the feed store, nights when his friends from high school come by and arguments with Linda. The consequences that reward his use include relief from boredom, time with friends and, often, Linda cooking him breakfast and calling his boss to say he was sick. That last item was the one Linda had not noticed.

The Plan

Over eight weekly sessions, Linda will practice five skills.

First, positive communication. Linda will replace criticism with short, specific, positive statements and requests, such as "I enjoyed having dinner with you tonight" and "I'd like you to help me clean the gutters Saturday morning." We role-played these in session.

Second, rewarding sober time. When Brett is sober, Linda will spend time with him doing things he enjoys, such as watching hockey together or working on his truck, and will withdraw that attention when he has been drinking.

Third, allowing natural consequences. Linda will stop calling his boss and stop making the breakfast that eases his hangovers. She will not create punishments, only stop protecting him from the results of his use.

Fourth, self-care. Linda will rejoin her Wednesday bowling league and see her own doctor about sleep.

Fifth, inviting treatment. Smith and Meyers (2004) advise choosing a moment when the loved one is sober and showing regret, such as after a bad hangover or a consequence, and having a treatment option ready the same day. We arranged for our outpatient intake coordinator to see Brett within twenty-four hours of a call.

The Invitation

In week six, Brett lost his job after missing three shifts. The next morning, sober and quiet, he said he was "messing everything up." Linda used the words we had practiced: "I love you, and I've found a place where you can talk to someone who won't lecture you. They can see you today." He agreed to one appointment and was seen that afternoon.

Limits

CRAFT does not work for every family; even in the trials Roozen and colleagues reviewed, a substantial minority of loved ones never entered treatment. Brett's agreement to one appointment is a start, not a recovery. Linda will continue her sessions, since her own well-being is a goal in its own right.

Linda's Own Progress

CRAFT measures success in two ways, and Linda's own well-being is the second. By week six she had returned to her bowling league, slept better after seeing her doctor and stopped taking extra shifts to avoid being home. She said the biggest change was that she no longer spent every evening watching for signs that Brett had been drinking. Smith and Meyers (2004) note that family members often improve even when their loved one does not enter treatment, which means the work Linda did would have been worthwhile even if Brett had refused. Linda put it more simply in our last session: she had stopped waiting for her life to start until Brett got better.

Ethical Points

Because Linda is the client, her sessions are confidential, and nothing she says will be shared with Brett without her consent. If Brett enters treatment, his records will be separate and protected by federal confidentiality rules. Teaching a parent to change her behavior must never become teaching her to monitor or control an adult son, so every strategy was framed around her choices.

Conclusion

Linda's son refused treatment, but she did not have to wait. CRAFT, as Smith and Meyers describe it and as Roozen and colleagues' review supports, gave her skills to make sober time more rewarding, stop protecting Brett from consequences, care for herself and invite treatment at the right moment. In week six, that moment came.

References

Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380-388.

Roozen, H. G., de Waart, R., & van der Kroft, P. (2010). Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction, 105(10), 1729-1738. https://doi.org/10.1111/j.1360-0443.2010.03016.x

Smith, J. E., & Meyers, R. J. (2004). Motivating substance abusers to enter treatment: Working with family members. Guilford Press.