User:Luvoneanother/sandbox

Community reinforcement approach (CRA) "is a comprehensive behavioral 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 reinforcers to assist … in the recovery process. Its goal is to make a sober lifestyle more rewarding than the use of substances."


 * For CRAFT, see Community reinforcement and family training

Introduction
The community reinforcement approach (CRA) was "originally developed for individuals with alcohol use disorders, [and] has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning [a type of learning], CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use."

"CRA is a time-limited treatment." "In time-limited therapy, a set number of sessions (for example, 16 sessions) or time limit (for example, one year) is decided upon either at the very beginning of therapy or within the early stages of therapy."

CRA has two offshoots based on the same operant mechanism:


 * 1) A-CRA - Adolescent Community Reinforcement Approach - "targets adolescents with substance use problems and their caregivers."
 * 2) CRAFT - Community Reinforcement and Family Training - "works through family members to engage treatment-refusing individuals into treatment."

Research
The community reinforcement approach has considerable research supporting it as effective. Community reinforcement has both efficacy and effectiveness data. Started in the 1970s, community reinforcement approach is a comprehensive operant program built on a functional assessment of a client's drinking behavior and the use of positive reinforcement and contingency management for non-drinking. When combined with disulfiram (an aversive procedure) community reinforcement showed remarkable effects. One component of the program that appears to be particularly strong is the non-drinking club. Applications of community reinforcement to public policy has become the recent focus of this approach.

History
CRA was designed by Nate Azrin in the early 1970s:

"The most influential behaviorist of all times, B. F. Skinner, largely considered punishment to be an ineffective method for modifying human behavior (Skinner 1974). Thus it was no surprise that, many years later, research discovered that substance use disorder treatments based on confrontation were largely ineffective in decreasing the use of alcohol and other substances (Miller and Wilbourne 2002, Miller et al. 1998). Nate Azrin already was convinced of this back in the early 1970s, when he designed an innovative treatment for alcohol problems: the Community Reinforcement Approach (CRA). Azrin believed that it was necessary to alter the environment in which people with alcohol problems live so that they received strong reinforcement for sober behavior from their community, including family, work, and friends. As part of this strategy, the program emphasizes helping clients discover new, enjoyable activities that do not revolve around alcohol, and teaching them the skills necessary for participating in those activities. p. 380"

Up to 2009, CRAFT and CRA programs were not widespread amongst addiction counselors. Instead, many addiction counselors were tied to a twelve-step model that had much less research support. Recent trends by the National Institute on Drug Abuse (NIDA) have been to help deploy these intervention techniques.

Procedures
The following CRA procedures and descriptions are from Meyers, Roozen, and Smith:


 * 1) Functional Analysis of Substance
 * 2) * explore the antecedents of a client’s substance use
 * 3) * explore the positive and negative consequences of a client’s substance use
 * 4) Sobriety Sampling
 * 5) * a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence
 * 6) CRA Treatment Plan
 * 7) * establish meaningful, objective goals in client-selected areas
 * 8) * establish highly specified methods for obtaining those goals
 * 9) * tools: Happiness Scale, and Goals of Counseling form
 * 10) Behavior Skills Training
 * 11) * teach three basic skills through instruction and role-playing:
 * 12) Problem-solving
 * 13) * break overwhelming problems into smaller ones
 * 14) * address smaller problems
 * 15) Communication skills
 * 16) * a positive interaction style
 * 17) Drink/drug refusal training
 * 18) * identify high-risk situations
 * 19) * teach assertiveness
 * 20) Job Skills Training
 * 21) * provide basic steps for obtaining and keeping a valued job
 * 22) Social and Recreational Counseling
 * 23) * provide opportunities to sample new social and recreational activities
 * 24) Relapse Prevention
 * 25) * teach clients how to identify high-risk situations
 * 26) * teach clients how to anticipate and cope with a relapse
 * 27) Relationship Counseling
 * 28) * improve the interaction between the client and his or her partner

(For details, please see the article: "The Community Reinforcement Approach: An Update of the Evidence" published in the Alcohol Research and Health journal by NIAAA)

Association for Behavior Analysis International
The Association for Behavior Analysis International (ABAI) has a special interest group in clinical behavior analysis and behavioral counseling ABA:I. The association is developing a special interest group for behavioral pharmacology and addictions. The association serves as the core intellectual home for behavior analysts. The ABAI sponsors two conferences per year—one in the U.S., and one internationally.

Association for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, ABCT has a special interest group on addictions.

The World Association for Behavior Analysis
The World Association for Behavior Analysis, a subsidiary of the Behavior Analyst Online Organization, offers a certification in behavior therapy that includes Community Reinforcement Approach as well as Community Reinforcement Approach and Family Training as content areas for the test.