Community Reinforcement Approach For Addiction Recovery

It has been said before that if punishment could cure addiction, no one would have it. After all, for all the temporary pleasure that drugs and alcohol might offer, the long-term reality of addiction is harmful, painful, and difficult both for those who experience it and for their loved ones.

This discomfort may not stop those who experience addiction, and it may even make the problem worse, as those experiencing addiction rely more and more on substance use to cope with the harm that it is causing. The same can be said of negative motivators like punishment, incarceration, and estrangement, which may push a person further and further into a self-destructive cycle instead of helping to boost them out of it. 

Positive treatment options, on the other hand, do have the potential to help people build long-lasting recoveries. A form of positive treatment known as the community reinforcement approach is one lesser-known but highly effective option for both treatment professionals and people in recovery to consider. 

What Is The Community Reinforcement Approach (CRA) For Addiction Recovery?

CRA is a psychosocial treatment method that is based on:

1. the theory of operant conditioning, or the idea that a person’s behavior is shaped by both positive and negative consequences in predictable ways
2. the idea that it is possible to make recovery a more enjoyable experience than addiction (rather than making addiction a worse experience than recovery)

Put simply, if a treatment team can make it so that a person experiences good things when he or she stops drinking or using drugs, they will learn to want to avoid substance use in the future (“reinforcement”). 

This effect is especially powerful when it comes to social activities (“community”), as spending time with others is one of the best ways to generate positive, healthy feelings to reinforce and reward sobriety. So, CRA focuses on providing people in recovery with a wide range of positive experiences, while contrasting them with the negative effects of drug and alcohol use that they are not currently experiencing. 

CRA was originally developed as a treatment for alcohol use disorder, but it has been found to be effective in treating many different forms of drug addiction. Specialized forms of CRA have also been developed specifically for adolescents (A-CRA) and for those who may refuse or be reluctant to engage with treatment (CRAFT).

How Does Community Reinforcement For Addiction Recovery Work?

First of all, CRA is not another form of contingency management, a treatment option that is often recommended to treat stimulant use disorders. While contingency management has the same overall goal (long-term sobriety and recovery) and uses the same mechanism (operant conditioning), contingency management relies on clients earning tangible rewards like prize drawings and gift cards. 

In contrast, CRA focuses on intangible rewards like spending meaningful time with loved ones, learning a new skill, being part of a group, and having fun events and positive experiences to look forward to. 

Some of the elements involved in community reinforcement for addiction recovery include the following.

Initial Assessment  

Treatment providers will begin by collecting basic background info as well as more targeted information regarding a client’s history of substance use, their functional condition, what in their lives may motivate them to change, and even their current level of happiness.

Identifying Triggers

While many people might say that their substance use “just happens,” the truth is that substance use is usually a result of a long series of small decisions or a reaction to other circumstances. By identifying and understanding these triggers (be they people, places, feelings, or events) people can learn to avoid or manage them. 

Developing Goals

A person’s goals in CRA will be specific to them, challenging, but achievable. They will also be limited to a limited period of time, e.g., a “90-day abstinence trial period.” 

Behavioral Skills Training

Clients and providers will spend time in therapy developing specific skills to support these goals. These practical skills may include interpersonal communication training, problem-solving techniques, and rehearsing how to turn down drugs or drinks. 

Positive Reinforcement 

Clients will also participate in activities designed to have a positive impact on their lives. Some recommended options include a form of relationship or family therapy designed to improve communication, problem-solving, and intimacy; employment counseling and job skills training; and hobby activities or volunteering designed to help people in recovery make connections and have fun in a substance-free setting. 

Relapse Prevention

Clients (and their loved ones) will also learn about relapse and the early warning signs that come before it, identify their own specific triggers, and consider the potential consequences of relapse. Contingencies may be developed to help those who relapse get back on track as seamlessly as possible.  

Advantages Of The Community Reinforcement Approach

CRA has a wide variety of advantages including the following.

Strong Evidence For Effectiveness 

A 2011 review published in Alcohol Research & Health demonstrates that studies published between 1973 and 2005 have consistently shown CRA to be as or more effective than comparative treatment programming.

Highly Cost-Effective

CRA doesn’t specifically use medication, special equipment, or a large team of specialized staff. In fact, the same study found A-CRA to be the most cost-effective solution for one large-scale study group compared to a variety of other alternatives. 

Uplifting

Addiction is a difficult and painful condition. Because it is compassionate and warm, rather than punitive or harsh, CRA is often more inviting and humane than some other treatment systems. It also invites people to give their very best throughout the process, rather than just “get through it” while also building up their closest relationships. 

Flexible

CRA is also personalized and can be used alongside a variety of other treatment services including medical detoxification, other forms of psychotherapy, peer support groups, contingency management, medication-assisted treatment (MAT), dual diagnosis treatment, and more. It can also be used in a variety of settings including residential treatment centers and both intensive and non-intensive outpatient treatment.

Adolescent-Community Reinforcement Approach (A-CRA)

As its name suggests, A-CRA is a form of CRA that has been adjusted to better meet the needs of teens and preteens who have substance use disorders, as well as their loved ones. A-CRA uses a different form of the happiness-scale and age-appropriate goal-setting that relates to the client’s experience at school and their relationships with their peers. It also features anger-management counseling to help young people better manage volatile emotions. 

However, what is most unique about A-CRA is its inclusion of the client’s parents or guardians in the treatment program, with solo and group sessions specifically designed to teach caregivers healthy parenting skills as well as skills training in communication and problem-solving. This, ideally, will increase the trust, happiness, and positivity in the young person’s close relationships, making recovery more likely. 

Community Reinforcement And Family Training (CRAFT)

CRAFT is another variation developed to serve people who may refuse to participate in treatment at all, or who may be reluctant to fully buy-in to the process. This refusal to stop drinking or using drugs can deeply affect a person’s loved ones and their partner in particular, putting tremendous and sometimes dangerous stress on these relationships. 

So, instead of adding to this pressure to attend treatment, CRAFT invites a concerned significant other (CSO) to learn how to change their home environment to gently reward a treatment-resistant person when they do things that promote sobriety, and withhold those rewards when they use drugs or alcohol.

In other words, as part of CRAFT a spouse may inform their partner that they love them and they love doing a specific activity with them or spending time with them in a certain place or time (one that their partner values), but they will no longer participate if their partner is under the influence. Then, the spouse has to reinforce that ruling and respond to their partner’s behavior on an ongoing basis. 

This gentle process closely resembles that of setting healthy boundaries, and when done properly it can be highly effective in engaging those who are treatment resistant while also benefiting the safety and mental wellness of the CSO and their family. In fact, according to one study published in the Journal of Substance Abuse, up to 74% of partners receiving CRAFT care were able to bring their partners into a treatment program within six months, and 100% of participants reported experiencing mental and emotional benefits. 

Recovery That Fits Your Needs

The community reinforcement approach to addiction recovery may not be right for everyone who struggles with drug or alcohol addiction, and it works best when implemented as part of a comprehensive and personalized addiction treatment plan that meets you where you are and gives you the particular support and care you need. 

Ark Behavioral Health offers comprehensive, evidence-based, and personalized addiction recovery care for all forms of drug use disorder and alcohol use disorder, including dual diagnosis care. At one of our leading residential treatment centers, you will work with highly trained and compassionate addiction treatment professionals to identify the underlying factors that have fed into your SUD, while developing motivation and coping skills to meet your goals for sobriety. 

To learn more about all the different services and opportunities Ark Behavioral Health can offer you, please reach out to our team today.