Community Reinforcement Approach (CRA)
CRA is a comprehensive behavioural program for treating substance-abuse problems. It is based on the belief that environmental contingencies can play a powerful role in encouraging or discouraging drinking or drug use. Consequently, it utilizes social, recreational, familial, and vocational reinforces to assist consumers in the recovery process. Its goal is to make a sober lifestyle more rewarding than the use of substances. Oddly enough, however, while virtually every review of alcohol and drug treatment outcome research lists CRA among approaches with the strongest scientific evidence of efficacy,
very few clinicians who treat consumers with addictions are familiar with it.
The adult CRA program repeatedly ranks as one of the top five alcohol treatments across various reviews that examine 30-50 different treatments. This cognitive-behavioral treatment has proven successful with populations that are ethnically-diverse, and across a wide range of ages. It has proven effective with both inpatients and outpatients, as well as with severely alcohol-dependent individuals and dually-diagnosed clients.
ACRA – Adolescent Community Reinforcement Approach
A scientifically-supported substance abuse treatment called the Adolescent Community Reinforcement Approach (ACRA). The adolescent version (ACRA) has recently proven effective with marijuana-abusing adolescents.
CRA is based on the belief that one’s environment plays a major role in determining whether an individual will use alcohol or illicit drugs. As such, it teaches individuals how to examine the triggers and the consequences (positive and negative) for drug use, and to then re-arrange their lives so that clean, sober behavior is more rewarding than is using alcohol/drugs. Strategies that increase the likelihood that sober behavior will be supported are taught, and skills deficits are addressed in the process (e.g., problem-solving, drug-refusal, communication). The important role of an adolescent’s caregiver is acknowledged, and special sessions are introduced to teach some of these same basic skills, as well as overall parenting strategies, to the caregivers.
The Community Reinforcement Approach and Family Training (CRAFT) intervention is a scientifically based intervention designed to help concerned significant others (CSOs) to engage treatment-refusing substance abusers into treatment. This new intervention method was developed with the belief that since family members can, and do make important contribution in other areas of addiction treatment (i.e. family and couples therapy), that the CSO can play a powerful role in helping to engage the substance user who is in denial to submit to treatment. In addition, it is often the substance user who reports that family pressure or influence is the reason sought treatment. Also, CSOs who attend the CRAFT program also benefit by becoming more independent and reducing their depression, anxiety and anger symptoms even if their loved one does not enter treatment.
CRAFT uses an overall positive approach and steers clear of any confrontation. CRAFT is a culturally sensitive program that works with the client’s values and beliefs to develop an appropriate treatment plan. The program emphasizes learning new skills to cope with old problems. Some of the components include how to stay safe, outlining the context in which substance abusing behaviour occurs, teaching CSOs how to use positive reinforcers (rewards) and how to let the substance user experience the natural consequences for their using behaviour.
No one has better information about the substance user’s behaviour patterns than a close family member. CRAFT teaches the CSO how to use this information in a motivational way to increase the chance of the substance user entering treatment. CRAFT research has shown that almost 7 out of 10 people who use the program get their substance user to attend treatment.
Information taken from www.robertjmeyersphd.com