Community Reinforcement Approach (CRA)

Primer

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.

Indications

Formats

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

Length

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

Principles

Basics

  • 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.

Functional Analysis

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)

Functional Analysis of Healthy Behaviours

External Triggers • Who are you usually with when you do [substance]?
• Where do you usually you do [substance]?
• When do you usually you do [substance]?
Internal Triggers • What are you usually thinking about right before you do [substance]?
• What are you usually feeling physically right before you you do [substance]?
• What are you usually feeling emotionally right before you do [substance]?
Behaviour • What do you usually do [substance]?
• Who are you with when do you do [substance]?
• Over how long a period of time do you do [substance]?
Short-Term Negative Consequences • What do you not like about doing [substance] with [who]?
• What do you not like about doing [substance] at/in [location]?
• What do you not like about doing [substance] [when]?
• What are some of the unpleasant thoughts you have while you are about doing [substance]?
• What are some of the unpleasant physical feelings you have while you doing [substance]?
• What are some of the unpleasant emotional feelings you have while you doing [substance]?
Long-Term Positive Consequences What are the positive results of your drinking/using in each of these areas:
A. Interpersonal
B. Physical
C. Emotional
D. Legal
E. Job
F. Financial
G. Other

Resources