The Community Reinforcement Approach: History and New Directions

Abstract

This article provides an overview of 2 closely linked treatment approaches for the substance abusing client: The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). In 1973, Hunt and Azrin created CRA in an attempt to restructure an individual's "community" so that a sober lifestyle was more rewarding than one dominated by alcohol. One salient CRA premise was that an individual's substance abuse recovery was heavily influenced by his or her social and occupational environment. Sisson and Azrin (1986) later built upon this premise in their work with a new type of client; the loved one of an alcoholic individual who refused to enter treatment. This program was an early version of CRAFT, which is an intervention that works through a nonusing individual to affect the behavior of a substance abuser. This article provides an empirical review of the evolution of these 2 interventions, including their application to illicit drug using clients. It also outlines the clinical procedures that comprise CRA and CRAFT, and considers future research directions. Keywords: [AU: Provide 4 to 6 keywords for indexing]T he Community Reinforcement Approach (CRA) is a cognitive-behavioral intervention that was founded on the belief that environmental contingencies play a critical role in encouraging or discouraging substance abuse (Hunt & Azrin, 1973). Accordingly, CRA utilizes community (i.e., familial, social, recreational, and occupational) reinforcers to support change in an individual's drinking or drug using behaviors. In essence, the goal is to rearrange environmental contingencies such that sober behavior becomes more rewarding than substance abusing behavior. This comprehensive intervention blends operant conditioning with a social systems approach to address multiple problem areas.In this chapter we outline the history of CRA, beginning with its original use with alcohol patients, and then tracing its eventual application to drug using populations. Additionally, we discuss the development of an outgrowth of CRA designed to work with the loved ones of treatment-refusing substance abusers; namely, Community Reinforcement and Family Training (CRAFT). Briefly, three early, well-designed studies demonstrated CRA to be more effective than existing standard treatment for alcohol dependence (Azrin, 1976;Azrin, Sisson, Meyers, & Godley, 1982;Hunt & Azrin, 1973). Some of the more recent alcohol studies replicated this success with larger, ethnically diverse samples (Smith, Meyers, & Delaney, 1998). In the four meta-analytic reviews of treatments for alcoholism conducted over the past 12 years, CRA has consistently placed among the top programs. Depending on the review, it has been ranked from the first to the fifth position out of a group of 30-50 interventions (Finney & Monahan;Holder, Longabaugh, Miller, & Rubonis, 1991;Miller et al., 1995;Miller, Wilbourne, & Hettema, 2003). In addition to its contributions to the alcohol field, CRA has a more recent history of being used in conjunction wi...

Contemporary Modes of Probation Officer Supervision: The Triumph of the “Synthetic” Officer?

“…Trends include: an increasing level of partnership with local organizations such as schools, businesses, law enforcement, and community groups (Burrell, 2005;Clear, 2005;Solomon et al, 2008); the assignment of community corrections officers to specific geographical "beats" where offenders live and spend time (e.g. Clear, 2005;Reentry Policy Council, 2005;Reinventing Probation Council, 2000;Solomon et al, 2008;Taxman, 2008); and an increasing emphasis on direct engagement with familial supports to provide resources and support (diZerega & Verdone, 2011;Shapiro & diZereaga, 2010) and to help reinforce positive behaviors (Crime and Justice Institute at Community Resources for Justice, 2009;Meyers, Villanueva, & Smith, 2005).…”

How Probation Officers Leverage “Third Parties” in Offender Supervision

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‘Hero to Healing’ drink driving program for Indigenous communities in Far North Queensland

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