Running Head: COMMUNITY REINFORCEMENT APPROACH
Community Reinforcement Approach
Submitted in partial fulfillment of the
Health Care Policy and Applied Economics
The Community Reinforcement Approach (CRA) is a comprehensive behavioral program developed by behaviorists Nathan Azrin and George Hunt. The Community Reinforcement Approach (CRA), originally developed for individuals with alcohol use disorders, focuses on the management of substance-related behaviors and other disrupted life areas for treating substance-abuse problems. It is based on the belief that environmental contingencies can play a ...view middle of the document...
In addition, practitioners encourage participants to progressively become involved in alternate, nonsubstance-related, sociable activities, and to work on enhancing the enjoyment received within their familial and employment “community”.
The basic concept is that therapy should structure around incentives to support the alcoholic's sobriety. However, if you isolate it out of behaviorism, it says that the therapy should improve and support the abuser’s capacity to effectively govern each major area of his or her life. The principal perception is that alcoholism is remedied to the extent the individual is capable of and comfortable with the challenges life presents him or her. Therapy is not about internal, psychological, or biological changes in as much as these changes support enhanced coping and comfort with life on the alcoholic's part.
The original CRA program procedures include:
(1) Functional Analysis of Substance Use. Here, the preceding events along with the negative and positive consequences of a client’s substance use are explored. This allows clinicians to identify reinforcing behaviors that will likewise discourage alcohol and drug use. For example, the client drinks daily after work because it alleviates stress and he enjoys being around people who can empathize and laugh with him about his unfavorable work conditions. It would therefore be critical to help this client find ways to relieve stress, receive empathy, and have fun without drinking. It also would be important to identify the constraining elements of his work environment, and afterwards contend with that straightway through communication skills training or problem solving directives. If he reported concern over a loved one’s feelings about his drinking, it would be important to see what type of role they may play in satisfying these objectives. Importantly, at some level, the client must understand that drinking excessively with these friends every night is not necessarily resolving his work problem. Consequently, he might be willing to “sample” some small changes in his daily pattern to see how they can improve his behavior.
(2) Sobriety Sampling. Once the client has identified factors that provide the motivation to change his or her abusive behavior, the therapist can move on to setting goals toward abstinence. Sobriety Sampling is based on the concept that it can be counterproductive for therapists to tell clients that they can never drink again. Because many participants are reluctant to commit to immediate, total, and permanent abstinence, this technique can be helpful. Sobriety Sampling is a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time limited period of abstinence. The client and therapist negotiate the period of time, and the therapist then helps the client develop a plan and the tools for achieving this goal. For example, the therapist may encourage the participant refrain from drinking for one (1)...