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Community Reinforcement Approach (CRA)

Topic: Alcohol/Drugs/Tobacco, Employment, Relationships

Target Population: Adults

Sector: Community-Based

Target Audience

This program is for adults who have substance abuse concerns.

Summary

Community Reinforcement Approach (CRA), a community-based program, is designed to help participants develop and sustain a fulfilling drug- and alcohol-free lifestyle.

Evidence

One study conducted in a homeless alcohol-dependent inpatient population demonstrated significantly better short-term outcomes for the group assigned to CRA compared to a standard treatment group. A second study in opiate-dependent inpatients on methadone maintenance demonstrated that the CRA treatment group was significantly more likely than the standard treatment group to have 3 consecutive weeks free from opiates. Because studies were conducted in specific populations and results were not maintained on all outcomes, generalizability of program effects is difficult to establish. One study was implemented among a group of homeless people with alcohol disorders and with or without mental illness who received assertive community treatment and integrated dual disorders (ACT/IDDT) services or CRA, respectively. Results indicated improvements across both groups in substance abuse, mental health, housing, employment, and health at 6 months that were maintained at program discharge.

Components

CRA intends to help participants restructure their lives to improve their chances of attaining and sustaining sobriety. Participants receive positive reinforcement for their sober behaviors from their family, friends, and colleagues. Therefore, living without drugs/alcohol becomes more rewarding than using drugs/alcohol, and participants are encouraged to engage in alternative non-substance-related social activities. The basic procedures of the CRA program are as follows:

Functional Analysis of Substance Use - Examine precursors and the positive and negative consequences of substance use;
Sobriety Sampling - Establish a time-limited period of abstinence;
CRA Treatment Plan - Identify areas for improvement, and encourage adults to set goals;
Behavioral Skills Training - Learn problem-solving, communication, and drink/drug refusal training skills;
Job Skills Training - Develop skills for obtaining and keeping a meaningful job;
Social and Recreational Counseling - Explore new social and recreational activities;
Relapse Prevention - Recognize high-risk situations, and anticipate and cope with possible relapse; and
Relationship Counseling - Strengthen patient's relationship with his or her partner.

In addition, disulfiram therapy, with clinical or family supervision, is a standard component of CRA therapy for patients with alcoholism.

Previous Use

CRA was developed in 1973 for individuals with alcohol use disorders; however, the program has been used to treat other substance use disorders. Translations have been created in German, Dutch, and Finnish, and the treatment has been considered for use in other diagnoses including eating disorders.

Training

This program is delivered by a trained counselor or therapist. A 3-day, on-site training is required. Please use details in the Contact section for more information on training and costs.

Considerations

Considerations for implementing this program include hiring a skilled therapist and ensuring he or she receives training; acquiring participant buy-in and commitment to continue treatment; and finding locations to hold sessions.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Implementation

If you are interested in implementing CRA, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Time

Weekly, 50- to 60-minute sessions are recommended for 12 to 16 weeks; however, implementation time can vary.

Cost

Information on implementation costs was not located. Please use details in the Contact section to learn more.

Evaluation Plan

To move CRA to the Promising category on the Clearinghouse Continuum of Evidence, at least one evaluation should be performed demonstrating positive effects lasting at least one year from the beginning of the program or at least six months from program completion.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact Dr. Robert J. Meyers by mail 3216 La Mancha Dr. NW, Albuquerque, NM 87104, phone 1-505-270-6503, email bmeyers@unm.edu, or visit https://www.robertjmeyersphd.com/cra.html

Source

https://www.cebc4cw.org/program/community-reinforcement-approach/detailed; https://www.robertjmeyersphd.com/cra.html; https://archives.drugabuse.gov/sites/default/files/cra.pdf; and Meyers, Roozen, and Smith (2011).

References

Used in Placement

Abbott, P. J., Weller, S. B., Delaney, H. D., & Moore, B. A. (1998). Community reinforcement approach in the treatment of opiate addicts. The American Journal of Drug and Alcohol Abuse, 24(1), 17-30. https://doi.org/10.3109/00952999809001696

Kalman, D., Longabaugh, R., Clifford, P. R., Beattie, M., & Maisto, S. A. (2000). Matching alcoholics to treatment: Failure to replicate finding of an earlier study. Journal of Substance Abuse Treatment, 19(2), 183-187. https://doi.org/10.1016/S0740-5472(00)00096-9

Morse, G. A., York, M. M., Dell, N., Blanco, J., & Birchmier, C. (2020). Improving outcomes for homeless people with alcohol disorders: A multi-program community-based approach. Journal of Mental Health, 29(6), 684-691. https://doi.org/10.1080/09638237.2017.1340617

Smith, J. E., Meyers, R. J., & Delaney, H. D. (1998). The community reinforcement approach with homeless alcohol-dependent individuals. Journal of Consulting and Clinical Psychology, 66(3), 541-548. https://doi.org/10.1037/0022-006X.66.3.541

Not Used in Placement

Not Empirical

Meyers, R. J., Roozen, H. G., & Smith, J. E. l. (2011). The community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380-388.

Miller, W. R., Meyers, R. J., & Hiller-Sturmhöfel, S. (1999). The community-reinforcement approach. Alcohol Health and Research World, 23(2), 116-120.

Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97(3), 265-277. https://doi.org/10.1046/j.1360-0443.2002.00019.x

Roozen, H. G., Boulogne, J. J., van Tulder, M. W., van den Brink, W., De Jong, Cor A. J., & Kerkhof, A. J. F. M. (2004). A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug and Alcohol Dependence, 74(1), 1-13. https://doi.org/10.1016/j.drugalcdep.2003.12.006

Other

De Jong, C. A. J., Roozen, H. G., van Rossum, L. G. M., Krabbe, P. F. M., & Kerkhof, J. F. M. (2007). High abstinence rates in heroin addicts by a new comprehensive treatment approach. The American Journal on Addictions, 16(2), 124-130. https://doi.org/10.1080/10550490601184472

Roozen, H. G., Van Beers, S. E. C., Weevers, H. J. A., Breteler, M. H. M., Willemsen, M. C., Postmus, P. E., & Kerkhof, A. J. F. M. (2006). Effects on smoking cessation: Naltrexone combined with a cognitive behavioral treatment based on the community reinforcement approach. Substance Use & Misuse, 41(1), 45-60. https://doi.org/10.1080/10826080500318665

Last Reviewed Date: 8/22/2022

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