A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification
Open accessAbstract
Background Detoxification with psychosocial counseling remains a standard opioid-use disorder treatment practice but is associated with poor outcomes. This study tested the efficacy of a newly developed psychosocial intervention, Community Reinforcement Approach and Family Training for Treatment Retention (CRAFT-T), relative to psychosocial treatment as usual (TAU), for improving treatment outcomes.Methods A randomized, 14-week trial with follow-up visits at 6 and 9 months post-randomization conducted at two substance use disorder (SUD) treatment programs. Opioid-dependent adults (i.e., identified patient - IP) enrolled in a residential buprenorphine-detoxification program and their identified concerned significant other (CSO) was randomized to CRAFT-T (n=28 dyads) or TAU (n=24 dyads). CRAFT-T consisted of two sessions with the IP and CSO together and 10 with the CSO alone, over 14 weeks. TAU for the CSOs was primarily educational and referral to self-help. All IPs received treatment as usually provided by the SUD program in which they were enrolled. The primary outcome was time to first IP drop from treatment lasting 30 days or more. Opioid and other drug use were key secondary outcomes.Results CRAFT-T resulted in a moderate but non-significant effect on treatment retention (p=0.058, hazard ratio=0.57). When the CSO was parental family, CRAFT-T had a large and significant effect on treatment retention (p<0.01, hazard ratio=.040). CRAFT-T had a significant positive effect on IP opioid and other drug use (p<0.0001).Conclusion CRAFT-T is a promising treatment for opioid use disorder but replication is needed to confirm these results.
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Brigham et al. found a significant effect on retention only when the IP was the CSO's adult child.
“They found a significant effect on retention only when the IP was the CSO's adult child”
From Community reinforcement and family training and rates of treatment entry: a systematic review. (2020) · cites this paper as [37]
The Results (section 3.3) report a significant retention effect for IPs with parental-family CSOs, while the overall effect approached but did not reach significance. The Methods (section 2.4) define that subgroup to include parents, aunts, grandparents, and siblings—not only CSOs whose adult child was the IP. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCRAFT has been shown to reduce the patients' substance use.
“reduce the patients' substance use (61)”
From Initial insights from a quality improvement initiative to develop an evidence-informed young adult substance use program (2022) · cites this paper as [61]
The Discussion reports significant reductions in opioid and other drug-use days among patients assigned to CRAFT-T. The claim calls this CRAFT generally, although the Methods distinguish CRAFT-T from the original CRAFT model. The Discussion also cautions that follow-up rates were low and the findings were preliminary. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGreater engagement of patients' support persons in the care process could increase initiation and retention with OUD medication.
“Greater engagement of patients’ support persons (i.e., partner, parent, other family member, or close friend) in the care process could increase initiation and retention with OUD medication [52, 53].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [52]
Some studies acknowledged non-significant outcomes or suggested replication is needed, but still emphasized significant secondary outcomes or used phrases such as 'promising treatment' to overstate results.
“Some studies acknowledged that the outcomes were non-significant [21–23] or suggested that ‘replication is needed’ [24]; nevertheless, they still emphasized significant secondary outcomes or used phrases such as ‘… is promising treatment’ to overstate the results.”
From Overstatements in abstract conclusions claiming effectiveness of interventions in psychiatry: A meta-epidemiological investigation (2017) · cites this paper as [24]
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References 25 · Cited by 59
- Authors
- Brigham, G. S., Slesnick, N., Winhusen, T. M., Lewis, D. F., Guo, X., & Somoza, E.
- Affiliations
- University of Cincinnati (US)
- The Ohio State University (US)
- Cincinnati VA Medical Center (US)
- Corresponding author
- Brigham, Gregory S.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 138
- Pages
- 240-243
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC4022345
- OpenAlex
- W2008166428
- Cited by
- 59
- References
- 25
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 5 · 2023: 3 · 2022: 8 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 7 · 2015: 1 · 2014: 1
- FWCI
- 3.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (U10DA013732, K23DA021512)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- opioid use disorder, opioid detoxification, treatment retention, family involvement, psychosocial interventions, buprenorphine, parental family, addiction treatment
- MeSH terms
- Adult, Buprenorphine, Combined Modality Therapy, Female, Humans, Male, Narcotic Antagonists, Opioid-Related Disorders, Patient Compliance, Pilot Projects, Psychotherapy, Young Adult
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