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CRA

The Community Reinforcement Approach (CRA) is a comprehensive behavioral intervention for treating adults patients with substance- use problems. In order to reduce an individual’s alcohol and drug problem and departing from Skinner’s operant learning paradigm, Nathan Azrin and George Hunt composed this treatment form in the early seventies. As CRA is rooted in operant principles, CRA uses positive reinforcement for each treatment step, no matter how small (successive approximation). Consequently, a CRA therapist looks continually for opportunities to reinforce the substance using individual.

Several meta analyses appraised the effectiveness of CRA and consistently found CRA among the top five most-effective interventions. Thus, CRA is an evidence based integrated therapy that focuses on the reinforcement of an alternative lifestyle that is more rewarding than substance use. The treatment stratifies environmental contingents to pursue non-substance-using behavior, by enhancing and supporting the individual’s ability to cope with several major life areas. Primarily, CRA does not address directly internal psychological changes, but focuses on environmental contingencies. It is based on the operant belief that environmental contingencies are pivotal in encouraging or discouraging substance abuse. Consequently, it utilizes social, recreational, familial, and vocational reinforcers to assist consumers in the recovery process. As a behavioral program, CRA makes extensive use of modeling, role-playing, and shaping. Its goal is to make a sober lifestyle more rewarding than the use of substances.

CRA has been applied to a variety of substance use disorders other than alcohol abuse and dependence, such as cocaine dependence, opioid addiction, and nicotine dependence. Although almost all studies have aimed at abstinence as the treatment goal, other options, like stabilizing and controlling use, i.e. harm prevention, are also targeted as a treatment goal. A CRA therapist is supportive, directive, energetic and engaging. In addition he/she shows empathy, and is genuinely caring with respect to the therapist-patient relationship.