Community Reinforcement Approach

What Is A Community Reinforcement Approach?

Community Reinforcement Approach (CRA) refers to evidence-based behavioral therapies developed for treating addiction. In a community reinforcement approach, a person’s community provides positive reinforcement while they engage in treatment. These reinforcements might have a financial or tangible reward or focus more on interpersonal interactions.

Community reinforcement approaches are flexible and focused on long-term gains instead of immediate responses. They recognize the importance of relationships and systems instead of viewing addiction recovery as an individual responsibility.

Instead of being confrontational and demanding immediate change, community reinforcement approaches provide support and encouragement for recovery with a focus on progress, not perfection. Although CRAs often require more time, effort, resources, and patience, the research and clinical evidence show they can lead to long-term recovery and improved relationships.

It’s important to note that CRAs are different than policies that punish people for substance use. Community reinforcement approaches do not include punishment for substance use or unhealthy behaviors. Instead, they focus on providing or withholding positive reinforcement while not preventing natural negative consequences.

How Do Community Reinforcement Approaches Work?

The philosophy guiding most CRAs is that substance use and addiction-related behaviors have specific benefits and consequences, which can be altered to shape and encourage healthier choices. Community reinforcement approaches are based on the processes of conditioning and reinforcement.

Conditioning is the process of shaping behavior with positive reinforcement (adding something positive), negative reinforcement (taking away something negative), and punishment (inflicting something negative or withholding something positive). Reinforcement, whether positive or negative, is intended to increase a certain behavior, whereas punishment is intended to decrease a certain behavior.

Natural consequences of substance use could include an altered state of mind, euphoria, relief of pain or withdrawal, hangovers, guilt, shame, and risky behaviors while under the influence.

Manufactured consequences of substance use are typically attempts from others to discourage the person’s substance use with punishments like penalties, avoidance, arguments, and loss of freedoms or privileges.

CRAs focus on changing substance-related consequences to shift the balance to motivate the person to reduce/stop their substance use and/or engage in treatment and recovery-supportive behaviors. Over time, the shifts in reward patterns can help people struggling with addiction change their choices and behaviors.

Some types of CRA include:

• Compensated Work Therapy (CWT)
• Contingency Management (CM)
• Community Reinforcement and Family Training (CRAFT)

Compensated Work Therapy

Compensated Work Therapy (CWT) is a particular type of evidence-based CRA that is hard to find in the U.S. outside of the Veterans’ Healthcare System. CWT provides paid work experience for people actively engaged in other forms of therapy. It incentivizes people to continue their therapy, which is set around their work schedule. It also gives clients valuable work experience and financial compensation that helps them establish healthy lifestyles and independence. This form of therapy has strong evidence of helping people sustain sobriety and addiction recovery.

Contingency Management

Contingency Management (CM) is a CRA that helps people establish healthy recovery patterns by providing external motivators. Particularly in early recovery, external incentives can help people stay focused on their recovery goals.

For example, some CM protocols reward attendance at counseling sessions, and others reward drug screening tests that show sobriety. Most CM protocols involve earning rewards over time, with bonuses that build for consistency. The incentives could be prizes, money, vouchers, free time, or any other token to motivate a particular person.

Although CM has been controversial since some claim that clients shouldn’t be rewarded for “doing the right thing” by staying sober or attending therapy, research and clinical evidence support the effectiveness of CM, particularly in early recovery, when external incentives can be particularly powerful.

Community Reinforcement And Family Training

Community Reinforcement and Family Training (CRAFT) focuses on how loved ones respond to a person struggling with addiction. CRAFT was developed to provide an alternative to “tough love” strategies, and it can be particularly helpful for families who don’t want to detach from someone struggling with addiction.

CRAFT helps people learn to change their response patterns to someone’s substance use, with a focus on increasing positive reinforcement, decreasing punishment, and emphasizing personal well-being. The overall goals of CRAFT are to help loved ones encourage sobriety and treatment engagement with healthy support strategies, self-care, and non-confrontational interactions.

Are CRAs A Good Fit for Your Family?

Loving someone who has an addiction can be frustrating, exhausting, and heartbreaking. However, most people in that situation have made many attempts to help the person acknowledge their addiction and seek help.

If you haven’t been happy with the results of Al-Anon, interventions, ultimatums, punishments, or detachment, then community reinforcement approaches are worth trying.

These evidence-based support strategies are compatible with abstinence and harm minimization goals. They can help you support addiction recovery in healthy ways that help you maintain your relationship with someone struggling with addiction without sacrificing your own wellbeing.

How Do I Find A Community Reinforcement Approach Program?

Finding a qualified CRA and CRAFT practitioner can be a challenge, as these forms of therapy require specialized training and a particular philosophy about how addiction, recovery, and relationships interact.

Veterans with access to VA Care are more likely to find CRA and CRAFT practitioners since many VA Medical Centers offer Compensated Work Therapy, Contingency Management, and CRAFT-based family therapy for people struggling with addiction.

You may consider utilizing online therapy providers that offer CRA-type programs. Online therapy has become incredibly popular in recent years, which has not only helped increase access to mental health care but also improved the quality-of-care people receive. To learn more about online therapy, visit our online therapy guide here.

Find Help Today

CRAs have strong scientific evidence to support their effectiveness in treating substance use disorders. If you believe a community reinforcement approach is a good fit for your family, you can search for a treatment center that offers it, or find a practitioner online or in your area who specializes in CRA. To start your search for a treatment center, contact a treatment provider today.