Clinicians’ experiences of delivering online Community Reinforcement and Family Training (CRAFT) for families affected by substance use in rural Australia

TL;DR

This study explores how clinicians in rural Australia delivered an online program to support families affected by substance use, finding it feasible but highlighting challenges like digital access and rural service gaps.

Contribution

First study examining the implementation of online CRAFT for rural families affected by substance use in Australia.

Findings

Online CRAFT was perceived as feasible and compatible with routine clinical practice.

Successful implementation relied on clinician enthusiasm, flexible delivery, and tailored content.

Challenges included digital literacy gaps, rural service inequities, and socio-cultural reluctance to discuss substance use.

Abstract

Interventions that support family members or concerned significant others (CSOs) of people with alcohol or drug dependence can enhance recovery, strengthen family functioning, and reduce recurrence rates. Yet factors influencing successful implementation of CSO-focused online programs, especially in rural Australia remain poorly understood. This study explored the implementation experiences of clinicians delivering online Community Reinforcement and Family Training (CRAFT).

This exploratory descriptive qualitative study involved semi-structured interviews with seven clinicians who delivered CRAFT. Data were analysed thematically using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.

CRAFT was perceived as well-structured, feasible, and compatible with routine clinical practice, enhancing clinicians’ confidence and enabling CSOs to develop skills in self-care, positive communication, problem-solving, and supporting healthy behaviours among loved ones. Successful implementation depended on clinician enthusiasm, flexible delivery modes (online as well as in-person), tailored content, and ongoing feedback, while challenges included CSO emotional overwhelm, competing responsibilities, limited digital literacy, and insufficient alcohol and drug services for loved ones. Socio-cultural factors, including reluctance to discuss alcohol or substance dependence, also limited engagement. Clinicians intended to retain key program components in practice but time constraints, telehealth limitations, and rural service gaps hindered sustained integration. Suggested improvements included cultural adaptation and structured opportunities for family–service collaboration.

Online CRAFT is a promising, practice-ready intervention for supporting and empowering rural families affected by alcohol and drug use. Its integration into health services will depend on addressing workforce capacity, digital access, and rural service inequities, alongside policy-level commitment to family-focused programs.

ACTRN12623000796684 (registered 26 July 2023)

•First study of online family-focused alcohol support in rural Australia.•Online Community Reinforcement and Family Training (CRAFT) was feasible and useful.•Implementation depended on clinician enthusiasm, flexibility, and tailored delivery.

First study of online family-focused alcohol support in rural Australia.

Online Community Reinforcement and Family Training (CRAFT) was feasible and useful.

Implementation depended on clinician enthusiasm, flexibility, and tailored delivery.