Community reinforcement and family training

Community reinforcement approach (CRA) and community reinforcement and family training approach (CRAFT) are behavior therapy approaches to treating substance abuse.

Research

The community reinforcement approach has considerable research supporting it as effective.^[1] Community reinforcement has both efficacy and effectiveness data.^[2] Started in the 1970s, community reinforcement approach is a comprehensive operant program built on a functional assessment of a client's drinking behavior and the use of positive reinforcement and contingency management for non-drinking.^[3] When combined with disulfiram (an aversive procedure) community reinforcement showed remarkable effects.^[4] One component of the program that appears to be particularly strong is the non-drinking club.^[5] Applications of community reinforcement to public policy has become the recent focus of this approach.^[6]

An off-shoot of the community reinforcement approach is the community reinforcement and family training approach.^[1] This program is designed to help family members of substance abusers feel empowered to engage in treatment. Community reinforcement and family training (CRAFT) have helped family members to get their loved ones into treatment.^[1][7] The rates of success have varied somewhat by study but seem to cluster around 70%.^{[7][8][9][10]} CRAFT is one of the only family aimed treatments with proven results for getting people with drug or alcohol problems into treatment.^[7] The program uses a variety of interventions based on functional assessment including a module to prevent domestic violence. Partners are trained to use positive reinforcement, various communication skills and natural consequences.

Drug policy

Unfortunately these programs are not widespread amongst addiction counselors. Indeed, many addiciton counselors are tied to a twelve-step model that has much less research support. Recent trends by NIDA has been to help deploy these intervention techniques. Several successful programs are underway.^[11]

Professional organizations

The Association for Behavior Analysis International has a special interest group in clinical behavior analysis and behavioral counseling ABA:I. The Association for Behavior Analysis International is developing a special interest group for behavioral pharmacology and addictions. The Association for Behavior Analysis International serves as the core intellectual home for behavior analysts.^[12][13] The Association for Behavior Analysis International sponsors two conferences/year—one in the U.S. and one international.

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. In addition, the Association for Behavioral and Cogntive Therapies has a special interest group on addictions.

The World Association for Behavior Analysis, a subsidiary of the Behavior Analyst Online Organization, offers a certification in behavior therapy that includes Community Reinforcement as well as Community Reinforcement and Family Training as content areas for the test [4].

See also

• Behaviorism
• Cognitive behavior therapy
• Behavior therapy

References

1. ^ ^{a b c} Smith, J.E., Milford, J.L. & Meyers, R.J. (2004) CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals. The Behavior Analyst Today, 5 (4), Page 391–403 [1]
2. ^ Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R.J., Delaney, Harold D., and Smith, J.E. (2009). Community Reinforcement and Family Training (CRAFT): An Effectiveness Study. Journal of Behavior Analysis of Sports, Health Fitness and Behavioral Medicine, 2 (1), [2]
3. ^ Hunt, G.M. & Azrin, N.H. (1973). A community-reinforcement approach to alcoholism. Behavior Research and Therapy, 11, 91–104.
4. ^ Azrin, N.H., Sisson, R.W., Meyers, R.J., & Godley, M.D. (1982). Alcoholism treatment by disulfiram and community reinforcement therapy. Journal of Behavior Therapy and Experimental Psychiatry, 3, 105–112.
5. ^ Mallams, J.H., Godley, M.D., Hall, G.M., & Meyers, R.J. (1982). A social-systems approach to resocializing alcoholics in the community. Journal of Studies on Alcohol, 43, 1115–1123.
6. ^ Jaime L. Milford, Julia L. Austin, and Jane Ellen Smith (2007): Community Reinforcement and the Dissemination of Evidence-based Practice: Implications for Public Policy. International Journal of Behavioral Cconsultation and Therapy, 3 (1), 77–87 [3].
7. ^ ^{a b c} Meyers, R.J., Smith, J.E. & Lash, D.N. (2005): A Program for Engaging Treatment-Refusing Substance Abusers into Treatment: CRAFT. IJBCT, 1 (2), Page 90–100 BAO
8. ^ Kirby, K.C., Marlowe, D.B., Festinger, D.S., Garvey, K.A., & LaMonaca, V. (1999). Community reinforcement training for family and significant others of drug abusers: Aunilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence, 56, 85–96.
9. ^ Meyers, R.J., Miller, W.R., Hill, D.E., & Tonigan, J.S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10, 1–18.
10. ^ Miller, W.R., Meyers, R.J., & Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688–697.
11. ^ Purvis, G., and MacInnis, D.M. (2009). Implementation of the Community Reinforcement Approach (CRA) in a Long-Standing Addictions Outpatient Clinic. Journal of Behavior Analysis of Sports, Health, Fitness and Behavioral Medicine, 2 (1), 33–44 BAO
12. ^ Twyman, J.S. (2007). A new era of science and practice in behavior analysis. Association for Behavior Analysis International: Newsletter, 30 (3), 1–4.
13. ^ Hassert, D.L., Kelly, A.N., Pritchard, J.K. & Cautilli, J.D. (2008). The Licensing of Behavior Analysts:Protecting the profession and the public. Journal of Early and Intensive Behavior Intervention, 5 (2), 8–19 BAO

External links

• Robert Meyer's webpage
• Community Reinforcement Approach, Alcohol Rehab Thailand
• Community Reinforcement Approach and Family Training additional information