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

J Consult Clin Psychol. 1999 Oct;67(5):688-97. doi: 10.1037//0022-006x.67.5.688.


In a randomized clinical trial, 130 concerned significant others (CSOs) were offered 1 of 3 different counseling approaches: (a) an Al-Anon facilitation therapy designed to encourage involvement in the 12-step program, (b) a Johnson Institute intervention to prepare for a confrontational family meeting, or (c) a community reinforcement and family training (CRAFT) approach teaching behavior change skills to use at home. All were manual-guided, with 12 hr of contact. Follow-up interviews continued for 12 months, with 94% completed. The CRAFT approach was more effective in engaging initially unmotivated problem drinkers in treatment (64%) as compared with the more commonly practiced Al-Anon (13%) and Johnson interventions (30%). Two previously reported aspects of the Johnson intervention were replicated: that most CSOs decide not to go through with the family confrontation (70% in this study) and that among those who do, most (75%) succeed in getting the drinker into treatment. All 3 approaches were associated with similar improvement in CSO functioning and relationship quality. Overall treatment engagement rates were higher for CSOs who were parents than for spouses. On average, treatment engagement occurred after 4 to 6 sessions.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol-Related Disorders / psychology
  • Alcohol-Related Disorders / therapy*
  • Alcoholics Anonymous
  • Analysis of Variance
  • Chi-Square Distribution
  • Family Therapy / methods
  • Family Therapy / standards*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Treatment Outcome