The results were divided into three overall domains that corresponded to our three areas of interest: Reasons for entering the CRAFT program, Strengths of the CRAFT program and Limitations of the CRAFT program. The thematic analysis of the interviews with parents who have experience of the CRAFT program is presented under each domain, see Table 4.

Table 4 Overview of the resultsReasons for entering the CRAFT program

The analysis of the parents' narratives resulted in the following themes regarding reasons for entering the CRAFT program: Feeling of powerlessness, Easily accessible support and Gain increased knowledge and strategies to help young adults.

Feeling of powerlessness

The time from parents becoming aware of their young adults’ substance use up to entering CRAFT differed substantially within the sample. One parent was more or less still in shock when starting CRAFT since she only a few weeks earlier had discovered that her daughter had used cocaine, while other parents reported cannabis and extensive use of alcohol since about five years back. Some parents reported early discoveries, often regarding cannabis, among their young adults, while other parents had started to suspect problems by noticing changes in the young adults’ behavior, such as skipping school and staying out late at night. When confronted, the young adults often admitted to having used substances and said they would stop, but over time, more incidents occurred, which made parents feel that they lacked power to change the situation:

“He has repeatedly promised to stop [using cannabis] and so on, but he doesn’t, and then there has been a number of, well, incidents when he has used and come home under the influence and so on. And we felt a little powerless in that, I guess.

(Informant no. 2)

For some parents, the young adult’s substance use had intensified over several years, leading to progressively worse incidents:

For a while there it was pitch black. The situation derailed, he became very aggressive and violent and broke things at home, such as windowpanes. He backfired and became a completely different person when he drank.”

(Informant no. 8)

Several parents felt that they had no control over the situation or ability to help their young adults, which created a mix of emotions, including frustration, powerlessness, and a feeling of shock and not knowing what to do. This led parents to seek information and help.

Easily accessible support

The parents described that they needed all the help they could get. They searched for information on the internet, made phone calls to different agencies, and found it hard to access support for parents when their young adults weren't involved and didn’t want to participate. The parents reported that most support services assume that the young adults take the initiative to seek help, before the parents can get involved. Several parents explained that they encountered the CRAFT program by coincidence, such as through advertisement or when it was mentioned in a nationwide radio broadcast:

“We were worried about him, and we didn't really know what to do (…). And then by chance I was sitting in the car on the way home from work and heard in a radio program about this study. And then I looked it up and we were lucky enough to participate.”

(Informant no. 7)

The parents were grateful that some support was available for them at all. They found the CRAFT program to be accessible and a quick path to help. Parents expressed appreciation that the support program was held digitally, which facilitated their participation as they did not have to take time off from work and, in some cases, both parents could be involved.

Gain increased knowledge and strategies to help young adults

Several parents applied to the CRAFT program since they perceived the young adults’ substance use as a serious and challenging phenomenon, which they lacked information or knowledge about. Parents also reported that they wanted to be able to communicate better in order to “reach” their young adults and wanted advice on how to approach or relate to their young adults’ problems.

Some parents described that they wanted to influence their young adults, e.g., to “get free from their problem behavior to be able to live a normal life” and wanted information about available help for their young adults to seek. At the same time, parents also acknowledged the complexity in a situation where they were trying to seek help for someone that didn’t want help. One parent described conflicting motifs; from one perspective seeking tools to change her young adult, but from another point of view not changing him too much. The interviewed couple made the following comment:

“- Actually, it’s a reflection of the whole system. It’s not that obvious what to do when you want to help someone close to you, how to do that in this system.

- When, well, when the person doesn’t want any help. Or can’t receive any help, perhaps one should say.”

(Informants no. 9 & 10)

Strengths of the CRAFT program

All parents reported that they would recommend the CRAFT program to others facing similar challenges. Although it requires effort from the parents to complete homework, they found it to be helpful and beneficial, and one parent even described participation in the study as life-changing. Several strengths of the treatment were identified in the thematic analysis, resulting in the following themes: Acquired communication skills, Shifted focus from substance use to encouragement, Improved relationship and Helped young adults to reduce substance use and seek treatment. The parents’ collected answers on most helpful sessions are showed in Fig. 1.

Fig. 1

The most helpful CRAFT sessions (multiple answers possible), as reported by interviewees (N = 10)

Acquired communication skills

The interviews showed that the CRAFT program trained the parents in altering their communication towards their young adults. Many parents reported having no previous strategy on how to approach their young adults, leading to long arguments and emotional conflicts, mostly about substance use. Understanding the benefits of being less confrontational, more clear, direct, and concise in their communication, was described by parents as extra valuable. The parents found it helpful to choose the right moment for conversation by assessing, as one parent stated, “whether the traffic light is green or red”. Instead of arguing and fighting in situations that previously had caused such negative interactions, they tried to let the situation be and awaited a better time for dialogue. This felt counterintuitive, but it was beneficial to direct more energy towards what the parents wanted to see more of. The learned communication skills felt supportive even long after the program ended.

“Training in changing the way I communicate with my son is probably the biggest change. I got to learn strategies for how I should think about it.”

(Informant no. 1)

Shifted focus from substance use to encouragement

Parents described an increased understanding on why people use substances, which was helpful as a means of empathy towards their young adults and to see the importance of support to overcome substance use. Parents reported that this increased knowledge about substance use, together with the newly learned communications skills, helped them to shift the subject of conversation. Instead of feeling stuck and only focusing on the substance use, they tried to highlight and support what was positive in life and to find such activities to perform together. Hence, the CRAFT-component Encouraging sobriety and positive reinforcement was reported as helpful by many parents as an integral part in shifting focus towards constructive aspects of young adults’ behaviors.

“In some way, I realized that addressing it when he's down won't get you anywhere. Instead, the key to success is trying to make him think that life is fun.” (Informant no. 9)

Parents described that the shift from negative aspects to positive also led to changed attitudes between the parents and the young adults. Fewer conflicts resulted in less guilt for the parents and it felt like a beginning to create a more sustainable family life. The parents still expressed their thoughts about substance use clearly, but in a less confrontative manner than before, and they tried to be clear that they disliked the behaviors but loved their young adults.

Improved relationship

Despite the challenges posed by the young adults’ substance use, the parents felt that their relationship with their young adults had improved after implementing the communication skills they had learned. Some parents described how the relationship had changed over time, and that the relationship was very good before the substance use, and then rapidly deteriorated due to conflicts. But recently, after the program, it had started to improve again. One parent reflected about how the improved relationship affected the substance use:

“I believe that he values our opinion and well-being, not only for our sake but also for his own. He doesn't want to cause us distress and this has likely played a role in his decision not to use drugs. He also acknowledged that drug use is not working for him.” (Informant no. 6)

Other factors, such as the young adults growing older and maturing, and external circumstances like changing social circles, were also described as having a positive impact on the relationship. Parents described their relationship as more open and honest after the program. They tried to make it clear that they prefer to hear the truth, whether they like it or not. For some parents, the improved relationship made it more evident that their son or daughter needed professional help to stop substance use.

Helped young adults to reduce substance use and seek treatment

Several parents reported that their participation in the CRAFT program, and the improved relationship that it led to, was a contributing factor for their young adults to become open to receive treatment, or to reevaluate their views on substance use. Parents believed that their own altered behavior, in terms of new communication skills and shifted focus to encouragement, had a positive impact. It was easier to approach their young adults in the challenges they were facing and to be supportive. Before CRAFT, the young adults completely refused to go to treatment, but now there was an opening, which one parent describe in following words:

“So that he has taken a first step in actually saying that he now wants to go and talk to someone.”

(Informant no. 2)

Limitations of the CRAFT program

During the interviews the parents described issues in relation to their involvement in the CRAFT program, which were themed into four potential areas of limitations: Difficulties to practice CRAFT components, Lacked follow-up for parents,

Challenges when trying to affect substance use, and Insufficient support and treatment options for young adults.

Difficulties to practice CRAFT components

Some parents reported difficulties practicing CRAFT strategies due to specific life-circumstances at the time of engaging in the support program. First, several parents reported that it was hard for them to find time to increase their own life-quality, as they felt they needed to prioritize their young adults’ situation, and/or felt a constant worry for them. For instance, one parent described that:

“I felt I didn’t have time to… well, take care of myself. I wanted to focus on him first, at the time (...). For instance, if my husband and I would go out to dinner, we shouldn’t talk about our problems, but sort of like, talk about other things (...). I guess it was good that we did that, but it felt hard for me to prioritize.”

(Informant no. 6)

Second, parents reported that it was hard for them to let their young adults face the natural consequences of their substance use. Parents described that this part of the CRAFT program was important, but that they struggled with it, e.g., because they did not want the consequences to be too severe, that their young adults would “sink so deep”. One parent reported that:

“The problem was that when we had that dialogue [about facing natural consequences], it was during the hardest period, and I feared that he would kill himself (...). So, for me it wasn't relevant to, so to speak, freeze him out if he had behaved badly (...). Um… Because I somehow just wanted to make him see the meaning of life.”.

(Informant no. 8)

Third, several parents reported that their young adults moved out of the home during the time of the study, naturally leading to less time spent together. The distance created by this change in young adults’ residence deprived the parents of many opportunities to practice certain components such as positive reinforcement and face natural consequences of substance use. To some parents however, mainly those describing a less severe substance use in their young adults, the distance was perceived as somewhat beneficial, as it helped them to realize that their children had turned into adults that could handle their own issues.

Lacked follow-up for parents

Most parents expressed the need for additional support after the CRAFT program had ended. The most common request was for more follow-up visits with the CRAFT therapist (and possibly including the young adults), e.g., at three or six months, or by scheduling appointments on demand. Parents described that such meetings could be important to sustain the CRAFT strategies they had acquired in the program, to receive continuous support, or just to be able to talk to somebody about how to handle situations they were struggling with.

Challenges when trying to affect substance use

Some parents reported that their young adults’ substance use did not change because of their participation in the CRAFT program. A few parents had tried to talk to their young adults about seeking help, but it had failed as the young adults did not have the same perspective on their substance use. Other parents said that they had not come as far in the process yet to be able to speak to their young adults about their substance use.

Parents described that it was hard for them to be sure about the frequency of substance use as it occurred outside of their home or “under the radar”, which caused worry to some parents. However, to other parents, letting go of controlling behaviors was a conscious strategy. When asked about her young adult’s current substance use, one parent responded:

“I can’t really give an answer to that (...). I know there is substance use. But to investigate it further, you do the things you shouldn’t do, by using control strategies. And those I have let go.”

(Informant no. 1)

Another reason that several parents mentioned regarding unchanged substance use was the importance of the young adults’ social contexts as reinforcers of substance using behavior. One parent described how her son lost contact with most of his positive milieus when the Covid-19 pandemic started and instead engaged with “bad company” that introduced him to substance use. Another parent explained how her daughter was not susceptible to arguments that her substance use was hazardous:

“She says that it’s like that, that everybody drinks. That’s her standard answer, everyone uses drugs (…) she’s no different from the others in that respect. She even uses less drugs and drinks less alcohol than many others, she says”

(Informant no. 3)

In some cases where a decrease in substance use had occurred, parents described that it was triggered by social consequences in relation to friends and relationships outside of the family. For example, one parent recounted that her son had an “eyeopener” when he was thrown out of the apartment he was sharing with a friend due to his substance use, causing him to move back home, and his cannabis use reportedly decreased significantly as a result. Another parent said that her son’s drinking behavior had changed markedly, albeit not yet entirely “cured”, after the destructive romantic relationship he was in had ended. A third parent had just found out that her son was not allowed to rent an apartment from a friend’s relative since the relative was aware of his recurring substance use. The parent saw that this had affected her son and was now planning to use this information as motivation to change.

Insufficient support and treatment options for young adults

Several parents raised an issue of insufficient support and treatment options for the young adults after the CRAFT program had ended and expressed concerns that the program had lacked “a bridge” to easily accessible support. Several parents suggested that the young adults could be included in CRAFT-sessions, or that there would be a previously determined treatment provider ready to make a scheduled appointment for their young adults. Parents described that the lack of treatment options led to stress and frustration as they were “left alone to find help”. They portrayed the path towards a more open dialogue about substance use and discussing treatment seeking as fragile, and that it is crucial that support is available when the young adults are motivated. One parent described that she had to make quite an effort to find a “way in” to treatment. When her son finally called the addiction center, he was told that he could not schedule an appointment until three months later. This parent emphasized that:

“What I want to convey to the study is the importance of having an entrance into healthcare that is easily accessible. When you have come so far it is important that there are no remaining barriers. That it’s possible to schedule an appointment with a clinician available who can meet the youth, and not being told ‘we don’t have time for you right now’”.

(Informant no. 4)