The information in this program outline is provided by the program representative and edited by the CEBC staff. The Community Reinforcement Approach (CRA) program has been rated by the CEBC in the area of: Substance Abuse Treatment (Adult).

• Types of Maltreatment: Does not target any specific kind of maltreatment
• Target Population: Individuals ages 18 and over who have a primary diagnosis of any Substance-Related Disorder (DSM-IV-R). Individuals with co-occurring disorders also respond well to this approach.

CRA is a comprehensive cognitive-behavioral intervention for the treatment of substance abuse problems. CRA seeks to treat substance abuse problems through focusing on environmental contingencies that impact and influence the client's behavior. Developed in accordance with the belief that these environmental contingencies play a crucial role in an individual's addictive behavior and recovery, CRA utilizes familial, social, recreational, and occupational events to support the individual in changing his or her drinking/using behaviors and in creating a successful sobriety. The goal is to rearrange multiple aspects of an individual's life so that a clean and sober lifestyle is more rewarding than one that is dominated by alcohol and/or drugs. Two other versions of CRA are highlighted on the CEBC: Adolescent Community Reinforcement Approach (A-CRA) and Community Reinforcement + Vouchers Approach (CRA+Vouchers).

CRA Assessment Procedures

Identification and enhancement of motivation for change:

• Identify internal/external reinforcers.
• Rapidly complete intake procedures.
• Set positive expectations.
• Include significant other.

CRA Functional Analysis of Drinking/Using Behavior:

• Identify Internal Antecedents (Internal Triggers) to drinking/using.
• Identify External Antecedents (External Triggers) to drinking/using.
• Complete comprehensive description of drinking/using behavior.
• Identify short-term positive consequences to drinking/using.
• Identify long-term negative consequences to drinking/using.

CRA Functional Analysis of Non-Drinking/Non-Using Behavior:

• Identify Positive Internal Triggers for Non-Drinking/Non-using Behavior.
• Identify Positive External Triggers for Non-Drinking/Non-using Behavior.
• Complete comprehensive description of non-drinking/non-using behaviors.
• Identify short-term negative consequences to non-drinking/non-using behaviors.
• Identify long-term positive consequences to non-drinking/non-using behaviors.

Specific CRA Treatment Procedures

Sobriety Sampling:

• Obtain client's agreement to sample time-limited sobriety or relative sobriety.
• Outline a strategy for accomplishing time-limited sobriety or relative sobriety.

Possible disulfiram use:

• Present disulfiram use as an option.
• Use the CRA-specific monitoring system.

CRA Treatment Plan:

• Use the Happiness Scales.
• Develop the Goals of Counseling.

Behavioral Skills Training:

• Teach communication skills.
• Teach problem-solving skills.
• Provide drink/drug refusal training.

Job Counseling:

• Provide skill-based job counseling.
• Provide solution-oriented job counseling.
• Give information about Job Club.

Social and Recreational Counseling:

• Provide Community Access.
• Provide Reinforcer Sampling.
• Provide Systematic Encouragement.
• Provide Response Priming.
• Provide Social Club.

Marital Counseling:

• Provide action-oriented counseling.
• Provide time-limited counseling.
• Provide goal oriented counseling.
• Teach positive communication skills.

Relapse Prevention:

• Perform Functional Analysis of Relapse Behaviors.
• Analyze Behavioral Chains.
• Activate Early Warning System.
• Teach Cognitive Restructuring.

Community Reinforcement Approach (CRA) was not designed with a child component.

Community Reinforcement Approach (CRA) was not designed with a parent/caregiver component.

Community Reinforcement Approach (CRA) was designed with an adult component that addresses the following presenting problems and symptoms:

• Substance abuse/dependency.

Community Reinforcement Approach (CRA) was not designed to be conducted in a group setting; but has been tested for use in a group setting.

Recommended group size:

8-10 with a single therapist, can be larger if 2 therapists are used.

Testing References:

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.

Dennis, M., et al. (2004). The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197-213.

Recommended Intensity:

1 session per week.

Recommended Duration:

The recommended duration is 50-60 minutes. The recommended length of treatment is 12-16 weeks. This is the amount of time that has been shown to be successful in clinical trials. Each program should examine the severity of addiction involved, and let that dictate the length of treatment and length of contact.

This program is typically conducted in a(n):

• Community Agency
• Hospital
• Outpatient Clinic
• Residential Care Facility

Community Reinforcement Approach (CRA) includes a homework component:

Homework is assigned in collaboration with the client after each session and is tailored to address therapeutic needs. Assignments are usually behavioral, such as trying a new activity, and are given within the framework of trying new behavior. Homework assignments are made so the client can be successful in completing them, so they are initially easy tasks to help build self-esteem and self-efficacy.

Community Reinforcement Approach (CRA) has materials available in languages other than English:

Dutch, German

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

All therapists using this approach should be certified as trained by Robert J. Meyers & Associates to ensure that the procedures are being delivered as they were intended. Since this is a psychotherapeutic approach, state laws also govern who should be allowed to serve as a therapist.

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:

• Robert J. Meyers, PhD
  www.robertjmeyersphd.com
  bmeyers@unm.edu
  phone: (505) 270-2650
  fax: (505) 925-2351

Training is obtained:

Onsite and regional.

Number of days/hours:

A basic training approach (which is not recommended) involves 3 days of onsite training. The recommended intensive training model involves quarterly onsite training over the course of 1 year with regular conference calls and review of audiotapes.

Additional Resources:

There currently are additional qualified resources for training:

Robert J. Meyers and Associates (including: Drs. Robert J. Meyers, Jane Ellen Smith and John Gardin II) provides comprehensive training in the adult program and the adolescent program.

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being