Community Reinforcement Approach

What is the Community Reinforcement Approach (CRA)?

  • CRA is a time-limited, behavioral psychotherapy for individuals with substance abuse disorders. Initially, CRA was developed as a treatment for individuals with alcohol abuse (Hunt & Azrin, 1973), but in the last 40 years, multiple research reviews also have shown its effectiveness as a treatment for a variety of substances of abuse (e.g., stimulants, opioids, cannabis; see Meyers, Roozen, & Smith, 2011).
  • CRA is based on operant conditioning and assumes that environmental variables (e.g. relationships, employment opportunities, enjoyable activities) have an impact on an individual’s sober behavior and/or substance use. CRA works by altering clients’ environments so that clients receive reinforcement for sober behavior from their community, family, work, and friends. Clients are supported in engaging in prosocial activities that do not revolve around the use of substances and are taught skills necessary for participating in those activities.  Essentially, the goal of CRA is to make a sober living lifestyle more rewarding than the use of substances. 

What are the main treatment components of CRA?

  • Family/Concerned Significant Other Involvement
    Because CRA involves altering the sober living/substance use environment, family members concerned and significant others are involved during all stages of treatment.
  • Functional Analysis of Substance Use
    Triggers and positive and negative consequences of substance use are examined.
  • Sobriety Sampling
    Client agrees to a time-limited period of abstinence.
  • CRA Treatment Plan
    Clients select meaningful treatment goals, and sessions are structured using activities designed to support clients in obtaining their goals.
  • Behavior Skills Training
    Clients are taught problem-solving, communication, and drink/drug refusal skills.
  • Job Skills Training
    Clients are taught skills for obtaining and keeping a job.
  • Social and Recreational Counseling
    Clients are provided with opportunities to sample new social and recreational activities.
  • Relapse Prevention
    Clients are taught how to identify high-risk situations and how to cope with relapse.
  • Relationship Counseling
    Sessions focus on improving interactions between the client and a concerned significant other.

Is there an adolescent version of CRA

  • Yes, the Adolescent Community Reinforcement Approach (A-CRA) is a slightly modified version of CRA that accounts for adolescent developmental needs (Godley et al., 2001). A-CRA is an evidence-based intervention for treating adolescents with substance use disorders.
  • In addition to including the basic of components of CRA, A-CRA also utilizes the adolescent’s caregiver(s) involvement in treatment. Caregivers attend four sessions of A-CRA. Two of these sessions emphasize parenting rules.  Other sessions focus on teaching caregivers CRA skills that the adolescent has learned in individual sessions, such as communication skills and problem-solving skills.

Is there family version of CRA?

  • Yes, Community Reinforcement and Family Training (CRAFT) is a variant of CRA that is designed to encourage treatment-refusing, substance-abusing individuals into treatment by working through family members.
  • Through participation in CRAFT, family members and concerned significant others are taught how to change the home environment of the treatment-resistant individual to reward behaviors that promote sobriety and to withhold rewards when the individual is using substances (Smith & Meyers, 2004).

Where can I find more information on CRA, A-CRA, and CRAFT?