Journal or Consuhing and Clinical Psychology 2(Xl2. Vol. 70. No.5. 1]82-] ]85 BRIEF REPORTS Copyright 1001 hy the Amclic.\Il Psychological Association, 1m.:. 0022- 006X/02/$5.00 DOl: 1O.1037//0022-006X.705.] 182 A Randomized Trial of Two Methods for Engaging Treatment-Refusing Drug Users Through Concerned Significant Others Robert J. Meyers, William R. Miller, Jane Ellen Smith, and J. Scott Tonigan University of New Mexico In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills: (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions: or (c) AI-Anon and Nar-Anon facilitation therapy (AI-Nar FT). All protocols received 12 hr of manual-guided individual treatment. Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than AI-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and AI-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed. Drug treatment facilities regularly receive desperate phone calls from concerned significant others (CSOs) regarding drug-abusing loved ones who refuse to seek treatment. This is not surprising, in that a majority of indivjduals with drug problems_are unmotivated to seek help (Institute of Medicine, Nationa] Academy of Sciences, ] 990). Historically, clinicians have had limited options for CSOs. This is regrettable because (a) CSOs have close contact with the drug user and, consequently, are in an excellent position to influence drug use (Stanton & Todd, 1982); (b) CSOs can play critical roles in prompting drinkers and drug users to seek treatment (Cunningham, Sobell, Sobell, & Kapur, ] 995); and (c) CSOs have to de a] with drug-related stressors, including violence, verbal aggression, financial problems, marital conflict, and social embarrassment (Velleman et aI., 1993). Options for CSOs have been] 2-step programs such as AI-Anon and Nar-Anon (A]-Anon Family Groups, 1990) or the Johnson Institute Intervention (HI; Johnson, ]986). The 12-step programs advocate detachment and acceptance of the CSO's inability to control the loved one's drug or alcohol use. For the HI, the intervention itse]f-a confrontational meeting with the alcoholicshows reasonable engagement rates for those whose families actually complete the intervention. However, a majority of the families find this confrontational approach unacceptable, with only 30% carrying through to the family meeting (Leipman, Nirenberg, & Begin, 1989; Loneck, Garrett, & Banks, ]996). Community reinforcement and family training (CRAFT) is an enhanced version of the community reinforcement training (CRT) program for CSOs, developed by RJM. These programs were Robert J. Meyers, William R. Miller, Jane Ellen Smith, and J. Scott Tonigan, Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico. Correspondence concerning this article should be addressed to Robert J. Meyers, Center on Alcoholism, Substance Abuse, and Addictions, Univer- sity of New Mexico, 2650 Yale South East, Albuquerque, New Mexico 87106. E-mail: bmeyers@unm.edu 1182 outgrowths of the well-supported, learning-theory-based community reinforcement approach for people with substance use disorders (Azrin, 1976; Azrin, Sisson, Meyers, & Godley, 1982; Hunt & Azrin, ]973; Smith, Meyers, & De]aney ]998). In a small..study with CSOs of drinkers (Sisson & Azrin, ] 986), 6 of the 7 drinkers whose CSOs received CRT entered treatment compared with none of the 5 drinkers whose CSOs received disease-concept treatment. As the study had only] 2 participants, further research was needed. In a much larger study, ]30 CSOs of treatment-refusing identified patients (IPs) with alcohol use disorders were randomly assigned to CRAFT, AI-Anon facilitation therapy (AFT), or the HI. CSOs in CRAFT were significantly more successful at engaging their IPs in treatment (64%) than were CSOs in JJI (30%) or AFT (13%; Miller, Meyers, & Tonigan, ]999). Recent]y CRAFT and CRT have been applied to drug-abusing populations. Significant differences in IP engagement were detected when CSOs who received CRT (64% engaged) were contrasted with CSOs who attended ]2-step meetings (17% engaged; Kirby, Mar]owe, Festinger, Garvey, & LaMonaca, ]999). An uncontrolled CRAFT study found that 74% of 62 CSOs of treatment-refusing drug users successfully engaged their IPs into treatment (Meyers, Miller, Hill, & Tonigan, 1999). The present study was an extension of the earlier CRAFT alcohol trial (Miller et a!., ] 999). The CRAFT and ] 2-step interventions from that study were compared for the CSOs of treatment-refusing illicit drug users. Because most CSOs in our earlier CRAFT studies (Meyers et a!., 1999; Miller et a!., ] 999) attended a majority of sessions and often desired continuing support, we decided also to test whether adding an aftercare group to CRAFT would improve outcomes, including engagement rates. The intent was to offer ongoing support, such as is available to 12-step participants through AI-Anon and Nar-Anon meetings, and to provide additional behavioral training as needed. It was predicted that CSOs assigned to either CRAFT condition would be more successful at engaging their IPs in treatment than would CSOs receiving AI-Nar FT and that CSOs in CRAFT + aftercare would show better engagement rates than those in CRAFT alone or