Getting Unstuck Part 3: A Map You Can Use When Creating Road Maps

My last blog post continued the discussion of creating road maps as part of Community Reinforcement and Family Training (CRAFT).  Briefly, CRAFT trains family members of people with addiction how to non-confrontationally change their loved ones’ use and to rebuild their lives not centered on their loved one’s addiction. Briefly, a road map (a.k.a., a functional analysis) is an assessment of the triggers and consequences of the addicted person’s substance use.  Creating a road map can be a difficult task. Furthermore, being flexible in your approach to creating a road map can be tough, particularly in the beginning when you are just learning how to create and work with road maps. Luckily, there’s a document that you can use to help you when you are helping family members create road maps. It’s like a key for the road map:  it tells you which direction you’re headed and how much ground (distance) you need to cover to get to your destination.

The Key:  The CRAFT Functional Analysis Form

The CRAFT Functional Analysis Form is your guide in creating the road map. It lays out all the information that you need to collect and even offers you prompts to help you gather the information. The Functional Analysis Form has 5 columns that represent the major areas of information that you need to collect to make the road map. The form offers some small differences from the form provided in Smith and Meyer’s CRAFT manual, but contains all the same major elements (the differences I’ve made to the form include additional questions and comments to gain information that I believe is useful in creating the road map and to help clarify parts of the form).

The first column is called “External Triggers” and contains questions that you can ask the family member to help elicit information about the environmental triggers associated with his/her loved one’s use (who, when, and where). The second column is labeled “Internal Triggers” and lists questions you can use to inquire about the loved one’s emotional, cognitive, and physiological triggers associated with his/her use. The third column, “Behavior,” has questions about the details of their loved one’s using behavior. What does the person use/drink? How much does the person use/drink? Over what period of time does the person use/drink? “Short-Term Positive Consequences” is the fourth column and provides questions about the possible emotional, cognitive, physiological, and environmental benefits their loved one obtains when using. The final column, “Long-Term Negative Consequences,” lists the life domains (e.g., interpersonal, financial) where possible negative consequences have occurred. In this post I am going to focus on the first 2 columns of the Functional Analysis Form (I will discuss the last 3 columns in my following posts).

Where to Begin? Try the “External Triggers” Column.

There is no right way to start using the Functional Analysis form; however, Smith and Meyers (2004) suggest that beginning with the first column, “External Triggers,” may be easiest for family members to complete because it is focused on the external factors (i.e., the factors that can be seen by outside observers) associated with his/her loved one’s use. To obtain the needed information for the column, you need to help the family member focus on a typical episode of drinking or using.

Most individuals have a pattern of drinking/using and we are more interested in the pattern of use than the precise details of each instance of use. From the information that we gain from the person’s pattern of use, we can develop a general understanding of the types of triggers that elicit use and later, help the family member develop strategies for minimizing their loved one’s contact with these types of triggers and help them develop strategies for coping with these triggers that they cannot change. Three questions are listed in the column:  1.) Who is your loved one usually with when drinking/ using? 2.) Where does he/she usually drinking/ using? 3.) When does he/she usually drink/ use?

Let’s use an example to illustrate how you might go about getting this information from a family member. Here’s the Road Map I’ve been using in previous posts about CRAFT:

Sue gets home from work and goes to the kitchen to pour herself a drink à Joe is in the kitchen preparing dinner and asks Sue how her day at work went à Sue begins to talk about her day at work and appears more and more irritated as she talks about work. à Joe listens, but is starting to become irritated because Sue has not asked about his day à Sue continues talking about her work and pours herself another drink à Joe, irritated, says “do you really need another? You just finished that one.” à Sue, angry, snaps, “I’m the one who works all day while you get to sit around and collect unemployment. If I want a drink, I’m gonna drink.” à Joe, angry, argues “I don’t sit around all day. You know I’ve been looking for work and that I hate being unemployed.” à Sue tells Joe “when you get a job again, then you can tell me how to spend my time.” She finishes her drink, pours herself another, and walks out of the kitchen. à Joe, still angry but realizing that dinner still needs to be cooked, goes back to preparing dinner. à Dinner is eaten in silence.

So, how might you go about getting the information about the external triggers in this situation? First, it’s important that you ensure that the situation that the family member discusses with you is a typical or common drinking situation (i.e., it is a situation that happens often or regularly). At times family members have difficulty picking one situation that is common or typical. It can be helpful to remind the family member that you are looking for his/her loved one’s patterns of use.

Additionally, you can let them know that you can create additional Road Maps for other typical using situations if that applies to their loved one’s use. Once you’ve determined that the situation represents a regular, frequent, or typical pattern of use, you can ask the family the questions in the “External Triggers” column of the form. Using the Road Map from above, we might obtain the following answers to these questions:

1.  Who is your loved one usually with when drinking/ using? Alone. Although the Joe is present when Sue is drinking, Joe is not drinking with her. If Joe were also drinking and it is typical that Sue and Joe drink together, then the answer to the question would be “with Joe.
2.  Where does he/she usually drinking/ using? At home. You could even get more specific and inquire if Sue tends to drink in the kitchen, the living room, or another room in the house.
3.  When does he/she usually drink/ use? In the evening after work. Again, you could get more specific about the times Sue drinks (e.g., from 6 p.m. to 10 p.m.). You may also want to inquire about whether Sue’s drinking occurs every day after work, most days during the week, or 1-2 days during the week.

You’ve Got the External Triggers, Now It’s Time for Something a Little Tougher:  The Internal Triggers

Once you’ve obtained the information about the external triggers related to his/her loved one’s drinking or using, you can move onto the internal triggers. Internal triggers are the emotional, cognitive, and physiological states that precede using. In my last blog post I discussed how it can be difficult for family members to see the costs and benefits of using from the perspective of their loved one. Similarly, it can be difficult for family members to imagine what is happening emotionally, cognitively, and physiologically for their loved one prior to their use. You can use similar strategies as I reviewed previously to help family members identify the internal triggers for their loved ones’ use as you did to help them identify the positives and negatives of use from their loved ones’ perspectives. Additionally, it can be helpful to remind family members that identifying the internal triggers associated with drinking/using can:

1. Help you and the family member better understand the factors that contribute to the person’s drinking.
2. Help you and the family member identify non-using ways to counteract or cope with internal triggers.

Finally, it can be helpful to remind family members to take their best guesses about what is happening internally for their loved one prior to drinking. Remind them that their access to their loved one allows them to observe and learn about their family members’ motivations, feelings, and thoughts. They probably have some good information about what their loved one thinks and feels prior to using/drinking.

Returning to our Road Map example, we can answer the following questions from the “Internal Triggers” column of the form:

1.  What do you think your loved one is thinking about right before drinking/ using? Sue is probably thinking about her work, particularly the stress she has at work right now, and probably about how much she doesn’t enjoy her work. After I make a comment about her not asking about my day, she is probably thinking about how much I don’t appreciate how much she works and all that she is doing for the family.
2.  What do you think he/she is usually feeling (emotionally) right before drinking/ using? Stressed and irritable at first, then angry when I make my comment about not asking about my day.
3.  What do you think he/she is usually feeling (physically) right before drinking/ using? Sue tends to get tense in her shoulders and neck (she often rubs them and talks about how she needs a massage). I’m guessing she is feeling tense, as well as a little bit relaxed when she starts drinking.

Before I conclude this post, I’d like to say a few words about style. As best you can, complete the form using a conversational tone. Remember that the aim of the form is to be helpful to you and to the family member, thus a warm and empathic style will probably make the process of completing the form more therapeutic and enjoyable. Also, it’s important to be compassionate and non-confrontational when completing a functional analysis. Imagine that you were being asked to share a painful (and possibly shameful) family secret that was going to be analyzed. You’d probably prefer someone who is acting compassionately and not arguing or badgering you about the information you present. Finally, a collaborative stance is useful. The family member is the expert on his/her loved one’s use and the effects of this person’s use; you are the expert on how to change behavior in a non-confrontational and values-consistent manner. Combined, you make a great team that can really make an impact on their loved one’s life.

Stay tuned to the blog. I’ll be talking about the remaining columns of the Functional Analysis form in my next posts.

• CRAFT