Community Reinforcement Approach

Treatment Components

The CRA focuses heavily on the context within which substance abuse occurs and recognizes that this context is different for each individual in the program. As such, the CRA is designed in a way that allows therapists to tailor the program to individual clients by adopting those components likely to be most effective for the specific client. Although not all components are necessary for success, the assessment, treatment planning, and behavior skills components are generally used with most patients. Further, because the CRA recognizes that abuse takes place within the social environment and not within a vacuum, the components are chosen with care to maximize the effectiveness of the consumer's community. In this case, community refers to each individual's family, friends, work, social activities, and spiritual affiliations that have the potential to play a part in reinforcing using or non-using behavior. The various treatment components of the CRA are briefly described as follows:

•CRA Functional Analysis: Functional analysis is one of the early assessment components that involves taking a closer look at the individualized contexts in which substance abuse occurs. Consumers are encouraged to identify internal and external triggers that lead to abuse and to note both positive and negative consequences of abuse behavior. A focus on the positive consequences of use is especially important because these reinforcements must be effectively minimized if the behavior is to be reduced. This stage lays the groundwork for later treatment planning and behavioral reinforcement.

•Sobriety Sampling: The philosophy of sobriety sampling, which refers to negotiated, time-limited periods of abstinence, is not especially popular with many abstinence-based approaches; however, it may be an especially important component of CRA. The sobriety sampling approach is thought to serve two primary functions. The first function of the shorter, negotiated periods of abstinence is that it is a more realistic goal that is not as scary for many clients as is the prospect of never drinking or using again. The second function is that the shorter periods of abstinence can serve as a training ground for longer periods. That is, clients practice behavioral skills for meeting abstinence goals while identifying the newly experienced positive reinforcements for their drug-free behavior, both of which help to build self-efficacy for future drug-free behavior.

•CRA Treatment Plans: The treatment planning stage utilizes a Happiness Scale to help the consumer evaluate and identify issues in ten different life domains. The goals of counseling instrument is then used as a framework for developing goals, strategies, and time frames for addressing issues in the priority domains agreed upon by client and counselor.

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