Community Reinforcement Therapy

Community reinforcement therapy is a method of substance abuse treatment that is especially used to treat alcohol, cocaine, and opioid use disorders. According to The American Academy for Addiction Psychiatry, the community reinforcement approach (CRA) is a broad-spectrum cognitive-behavioral approach which has the belief that a patient’s environment can have a strong impact on their substance use at its core.

It works to help people gain the motivation to change and to teach them how they can do it. The approach seeks to do this in part with the help of rearranging rewards to eliminate positive reinforcement for substance abuse, and by developing positive reinforcement for sobriety and productive behavior. In so doing, a person’s life is rearranged in such a way that their new, sober and drug-free lifestyle is more rewarding than one that was filled with substance abuse.

How Does Community Reinforcement Therapy Work?

Community Reinforcement Therapy

The community reinforcement approach helps people foster interest in activities that are not related to substance abuse.

The process of this type of therapy may sound invasive and troubling, but in reality everything is done in a non-confrontational manner. First the counselor discusses the patient’s life with them, and they discover the triggers that lead to substance abuse through a look at all aspects of their life. A job, social activities, family, and all other aspects of life can and likely do contribute in some way to substance use. When possible and necessary, significant others may also be included in treatment.

According to the National Institute on Drug Abuse, patients are likely to attend one or two individual counseling sessions to start off. Here, in addition to discussing their life and their triggers, patients learn skills to minimize drug use, receive vocational counseling, and develop new recreational activities and social networks.

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At this time, as well, the counselor helps explore the client’s motivation for change and works to find things that could act as incentives for a particular individual. They will likely discuss the negative consequences of past and potential future substance use in order to help foster motivation for change.

Sobriety and abstinence may not be immediate. Instead, patient and therapist will work together to set goals for eventually achieving sobriety, such as planning one month without drugs or alcohol to begin with and moving on from there.

The main components of community reinforcement therapy are:

  • Building motivation
  • Putting a trial period of sobriety into place
  • Analyzing the person’s drinking and/or drug using behavior
  • Increasing positive reinforcement for non-substance using
  • Rehearsing coping behaviors
  • Involving significant others of the client

How the CRA Changes People’s Perspectives

At the core of community reinforcement therapy is the idea that the way to get over substance abuse is to make abstinence more rewarding than substance abuse. According to a publication in the National Institute on Alcohol Abuse and Alcoholism, this may be accomplished in a few different ways.

While some therapeutic approaches confront the person in treatment with the unpleasant and costly consequences of drinking and drug use, CRA goes another route. Individuals are provided with incentives for reduced substance use, rather than punishments for the opposite.

In the community reinforcement approach, the therapist will work with the patient to analyze their substance use, identifying anything that positively reinforced it, and anything that negatively reinforced it. This helps to individualize the approach, and allows treatment to focus on areas that are particularly effective for the particular person in treatment. Rewards and incentives will work to promote the positive behaviors and prevent others based on what was discovered in the analysis of the client’s drinking patterns.

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Considerations about CRA and Activity Sampling

People who abuse or are addicted to drugs and/or alcohol tend to have lost interest in or the possibility for many positively reinforcing activities outside of substance use. Hobbies they previously enjoyed, friends they spent time with, and other interests and activities were likely thrown to the wayside, or at least given much less attention than prior to substance abuse.

In order for the goals of the CRA to be met, this kind of ‘isolation’ has to be reversed. Special therapeutic and counseling techniques such as social and recreational counseling help people in treatment become involved in a range of activities that do not involve substance abuse.

Activity sampling is another technique that helps here. In activity sampling, the client is provided with several different things to try, such as attending a church, getting involved in art classes, and joining a sports team. This helps to foster ideas for new, healthy activities.

Community Reinforcement and Family Training (CRAFT)

Community Reinforcement Therapy

Family involvement in therapy can help restore relationships.

The Community Reinforcement and Family Therapy (CRAFT) approach to substance abuse treatment has shown to be effective in many cases, as well. This method adds onto the community reinforcement approach and combines it with family therapy, as the name suggests. Here, family members of addicts, often referred to as Concerned Significant Others (CSOs), become directly involved in treatment.

This method has been used in instances when a person is reluctant to enter treatment as well as when they are ready and willing and has shown to be effective in both, according to Dr. Robert J. Meyers. It is most often used as a method of intervention, where a CSO is taught behavioral techniques for getting their loved one into treatment.

CRAFT helps both the substance abuser and their family understand addiction and what they can do to fight it. It is intended to help CSOs and addicts alike. Addiction affects the whole family, and CRAFT helps to remedy the effects it has.

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Community Reinforcement Therapy for Cocaine Addiction

The community reinforcement approach has shown to be effective for the treatment of cocaine addiction, as well. For this treatment, however, the CRA is combined with contingency management program. According to The American Journal on Addictions, this type of program includes vouchers or rewards for clean drug samples. The value of vouchers often increases with consecutive clean samples. They are redeemable for movie tickets and other retail goods that are safe, productive, and drug and alcohol free.

Using the CRA to Treat Alcohol Abuse

Studies have shown community reinforcement therapy to be helpful in the treatment of alcohol abuse and addiction, as well. In fact, alcohol was the first addiction that the method was used for. CRA for alcohol addiction does not always use a contingency management system, but instead works mainly through therapy and counseling.

Benefits of the Community Reinforcement Approach

Approaching substance abuse treatment with community reinforcement therapy is a great way to help people with substance use problems. Some of the benefits of this method include:

  • It is nonconfrontational
  • It helps to encourage engagement in treatment
  • It offers vocational and skills training
  • It can easily include the family and loved ones of the person in treatment
  • It is easily integrated with other treatments
  • It can take place in either an inpatient or an outpatient treatment setting
  • It addresses many aspects of a person’s life and lifestyle
  • It offers alternatives to substance use
  • It prepares people for life after rehab, thus helping to prevent relapse

For these reasons, the CRA is flexible, well-rounded, and applicable to many different situations.

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