The Community Reinforcement Approach: An Update of the Evidence

The Community Reinforcement Approach (CRA), originally developed for individuals with alcohol use disorders, has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning, CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use. Consequently, practitioners encourage clients to become progressively involved in alternative non-substance-related pleasant social activities, and to work on enhancing the enjoyment they receive within the “community” of their family and job. Additionally, in the past 10–15 years, researchers have obtained scientific evidence for two off-shoots of CRA that are based on the same operant mechanism. The first variant is Adolescent Community Reinforcement Approach (A-CRA), which targets adolescents with substance use problems and their caregivers. The second approach, Community Reinforcement and Family Training (CRAFT), works through family members to engage treatment-refusing individuals into treatment. An overview of these treatments and their scientific backing is presented.