Erasmus University Medical Centre, Department of Forensic Psychiatry, Rotterdam, the Netherlands.
Addiction. 2010 Oct;105(10):1729-38. doi: 10.1111/j.1360-0443.2010.03016.x.
Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs.
The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model.
CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11-5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28-3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically after [corrected] four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window.
CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.
许多物质使用障碍患者反对寻求正式治疗，这常常导致与关心他们的重要他人（CSO）之间关系破裂。这种情况令人不安，因为未经治疗的患者通常与各种其他成瘾相关问题有关。社区强化和家庭培训（CRAFT）为更传统的治疗和干预方法提供了一种选择。本系统评价的目的是比较 CRAFT 与酒精匿名/麻醉品匿名（Al-Anon/Nar-Anon）模式和约翰逊研究所干预在促使患者接受治疗和改善 CSO 功能方面的效果。
检索了电子数据库 PubMed、PsycINFO、EMBASE、CINAHL 和 Cochrane 图书馆。确定了四项高质量的随机对照试验，共有 264 名 CSO 参与。使用随机效应模型合成数据以量化 95%置信区间的效应。
CRAFT 使患者参与治疗的比例比 Al-Anon/Nar-Anon 高三倍[相对风险（RR）3.25，95%置信区间（CI）2.11-5.02，P < 0.0001；需要治疗的人数（NNT）= 2]，比约翰逊研究所干预高两倍[RR 2.15，95%CI 1.28-3.62，P = 0.004；NNT = 3]。总体而言，CRAFT 促使大约三分之二的治疗抵抗患者接受治疗，通常在进行[校正]四到六次 CRAFT 治疗后。在 6 个月的治疗窗内，CSO 无论被分配到 CRAFT、Al-Anon/Nar-Anon 还是约翰逊研究所干预组，都表现出明显的心理社会和身体改善。
与传统方案相比，CRAFT 在促使治疗抵抗的物质滥用个体接受治疗方面表现出优越性。
