Community Reinforcement Approach (CRA)

Community Reinforcement Approach (CRA) is a psychosocial treatment commonly used in substance use disorders. CRA uses principles of cognitive and behavioural interventions. A core aspect of CRA is the idea that environmental factors play an important role in an individual's addictions and recovery. As a result, CRA uses familial, recreational, occupational, and social events to support the individual to change substance use behaviours.

• Alcohol use disorder
  • CRA is one of the most effective behavioural interventions for alcohol use disorder
• Opioid use disorder

• CRA comes in various formats including:
  • Adolescent Community Reinforcement Approach (A-CRA)
  • Community Reinforcement and Vouchers Approach (contingency management)

• The usual length of CRA is 12 to 16 weeks, but some may be longer or shorter.

• The main goal of CRA is to help rearrange an individual’s environment, such that non-substance using behaviours become more rewarding than substance-using behaviours.

A Functional Analysis is an individual's record of the patterns of their substance use. The analysis involves identifying:

• Situations where someone typically uses a substance (external triggers)
• The ways one thinks and feels before using (internal triggers)
• What actually occurs during the substance use
• What the benefits have been right after the substance use (short-term positive consequences or rewards), and
• The costs one has paid over time due to their substance use (long-term negative consequences)

• Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380.
• Canadian Centre on Substance Use and Addiction: What Is Community Reinforcement Approach?