Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members

In a randomized clinical trial, 130 concerned significant others (CSOs) wer e offered 1 of 3 different counseling approaches: (a) an Al-Anon facilitati on therapy designed to encourage involvement in the 12-step program, (b) a Johnson Institute intervention to prepare for a confrontational family meet ing, or (c) a community reinforcement and family training (CRAFT) approach teaching behavior change skills to use at home. All were manual-guided, wit h 12 hr of contact. Follow-up interviews continued for 12 months, with 94% completed. The CRAFT approach was mere effective in engaging initially unmo tivated problem drinkers in treatment (64%) as compared with the more commo nly practiced AL-Anon (13%) and Johnson interventions (30%). Two previously reported aspects of the Johnson intervention were replicated: that most CS Os decide not to go through with the family confrontation (70% in this stud y) and that among those who do, most (75%) succeed in Setting the drinker i nto treatment. All 3 approaches were associated with similar improvement in CSO functioning and relationship quality. Overall treatment engagement rat es were higher for CSOs who were parents than for spouses. On average, trea tment engagement occurred after 4 to 6 sessions.