Community Reinforcement Approach
The Community Reinforcement Approach (CRA) is a cognitive-behavioral intervention that aids individuals in recovery from mental health symptoms as well as substance abuse. The CRA program has been adapted for several populations including adolescents (Adolescent-Community Reinforcement Approach; A-CRA) and family members of individuals who are resistant or reluctant to enter a recovery program. (Community Reinforcement and Family Training; CRAFT).
CRA and CRAFT programs focus on helping individuals find healthier and more adaptive ways to meet social and emotional needs other than substances. A broad group of behavioral interventions are used to provide or withhold rewards and negative consequences swiftly in response to measured behaviors (ie: substance use measured by a toxicology screen).
HOW DOES THE COMMUNITY REINFORCEMENT APPROACH WORK?
The Community reinforcement approach brings clinicians and patients together to work collaboratively on identifying an individual's goals, conducting a functional analysis of the patient’s substance abuse (a look at the function served by the use of substances) and pro-social behaviors (behaviors intended to help others).
The functional analysis helps clinicians and patients to explore internal experiences and external situations that precede their substance abuse, as well as the short term rewards and long-term negative consequences of their substance abuse. Let's give clinicians and patients the ability to identify thoughts, feelings and situations that could be central to recovery. Real-life change targets are identified and a blueprint for the patient's needs and how they can be met through healthier alternative activities is developed.
Patients may be encouraged to include individuals whom they spend large amounts of time with in their recovery journey to help recognize triggers that are more difficult for individuals to notice.
During recovery with The Community Reinforcement Approach (CRA), patients learn practical skills to help them meet their goals. Counselors and patients use a combination of instruction with role play and feedback to help patients learn basic skills for recovery from their mental health symptoms and substance abuse. CRA Behavioral Skills Training teaches patients problem-solving skills, communication skills and assertive drink or drug refusal. As a part of The Community Reinforcement Approach (CRA) recovery program, Job Skills Training may be provided to help obtain and retain valued jobs. Social and Recreational Counseling may also be offered to help patients discover joy in life without drugs and alcohol and provide them with opportunities to sample new social and recreational activities.
CRA helps individuals to find highly reinforcing alternative ways to satisfy their needs as opposed to simply encouraging them to find a substitute activity.
WHERE DOES THE COMMUNITY REINFORCEMENT APPROACH ORIGINATE?
Nathan (Nate) Azrina, a psychologist, developed The Community Reinforcement Approach in the 1970’s. Azran believed that altering the environment in which people with mental health symptoms and substance abuse problems lived so that they received stronger reinforcement for sober behaviors from their community, family, friends and employers. The CRA program Azran created emphasizes helping patients find new and enjoyable activities that revolve around their sobriety and teaches them skills for participating in those activities. Over time, adjunctive plans and modified programs were added to include a medication plan, Adolescent Community Reinforcement Approach (A-CRA) and Community Reinforcement and Family Training (CRAFT). The first treatment manual based on CRA for clinicians working with patients in recovery was published by Robert Byers and James Smith in 1995.
COMMUNITY REINFORCEMENT APPROACH EVIDENCE
Research shows that CRA is highly effective. Participants' jobs and family relationships had better outcomes. Studies have found when people’s environments are enriched with non-substance related activities can encourage them to reduce substance abuse and seek assistance in recovery.