The community-reinforcement approach (CRA) is an alcoholism treatment approach that aims to achieve abstinence by means of eliminating positive reinforcement for drinking and enhancing positive reinforcement for sobriety.

The community-reinforcement approach (CRA) is an alcoholism treatment approach that aims to achieve abstinence by means of eliminating positive reinforcement for drinking and enhancing positive reinforcement for sobriety. CRA integrates several treatment component parts including building the client's motivation to quit drinking, helping the client initiate sobriety, analyzing the client's drinking pattern, increasing positive reinforcement, learning fresh coping behaviors, and involving significant others in the regaining process. These components can be adjusted to the individual client's emergencys to achieve optimal treatment result In addition, treatment outcome can be influenced according to factors such as therapist mode of address and initial treatment intensity. Several studies have provided evidence for CRA's effectiveness in achieving abstinence. Furthermore, CRA has been favorably integrated with a variety of other treatment approaches, as it is as family therapy and motivational interviewing, and has been exampleed in the treatment of oth er mix with drugs abuse. KEY WORDS: AODU (alcohol and other medicine use) treatment method; reinforcement; AOD (alcohol and other drug) abstinence; motivation; AOD use pattern; AODD (alcohol and other unsalable article dependence) recovery; treatment outcome; cessation of AODU; professional client relations; family therapy; motivational interviewing; spouse or significant other; literature review

In nearly each review of alcohol treatment consequence research, the community-reinforcement approach (CRA) is listed among approaches with the strongest scientific evidence of efficacy. in addition many clinicians who treat alcohol riddles have never heard of it, despite the fact that the first clinical trial of CPA was published through the whole extent of a quarter of a hundred years ago--an example of the continuing gap between research and practice.

The underlying philosophy of CPA is disarmingly simple: In order to beat alcohol problems, it is important to rearrange the person's life in such a manner that abstinence is more rewarding than drinking. The use of alcohol as well as other unsalable articles can be highly reinforcing: The user experiences meanings that motivate him or her to continue drinking, which can lead to alcohol dependence

What then would make a conditioned drinker want to give up drinking? undivided common approach is to "turn up the pain"--that is, to bring into the presence of the person with unpleasant and sumptuous consequences of drinking. This approach attempts to restore drinking less attractive, and can include aversion therapies, pharmacotherapy with the medication disulfiram, confrontational counseling, and infliction of negative events (i.e., punishment). Such negative approaches, however, not seldom have been found to be ineffective in decreasing drinking and alcohol point in disputes (Miller et al. 1998).

smooth seasoned clinicians are often amazed at for what cause much adversity an alcoholic will experience in order to continue drinking. In fact, it has been said that if punishment worked, there would be no alcoholics.

CRA takes a different approach to overcoming alcohol riddles one that is based in succession providing incentives to stop drinking rather than punishment for continued drinking. To that cessation client, therapist, and significant others work together to change the drinker's lifestyle (eg his or her social support body and activities) so that abstinence becomes more rewarding than drinking. Since its introduction from Hunt and Azrin in 1973 CRA treatment has evolv considerably, and the clientele has expanded to include spouses of alcoholics and users of medicines other than alcohol. This article summarizes the constitutings of CRA as well as factors influencing its effectiveness. In addition, the article briefly reviews clinical studies demonstrating CRA's efficacy in treating clients with alcohol and other unsalable article (AOD) problems.

WHAT Is CRA?

To provide an alcoholic with the incentive to quit drinking, CRA has the following sum of two units major goals:

* Elimination of positive reinforcement for drinking

* Enhancement of positive reinforcement for sobriety.

To achieve those goals, CRA therapists combine a variety of treatment strategies, as it was as increasing the client's motivation to stop drinking, initiating a trial period of sobriety, performing a functional analysis of the client's drinking behavior, increasing positive reinforcement in consequence of various measures, rehearsing new coping behaviors, and involving the client's significant others. Other factors, so as therapist style and initial treatment intensity, also may influence the client's result These treatment components and treatment-related factors are described in the following sections.

Building Motivation

The initial pace in CRA generally is an exploration of the client's motivations for change. Particularly in early versions of CRA, this proces involved the identification of positive reinforcers (eg praise and shared pleasant events) that could oblige as effective incentives for the client to change his or her behavior. The CRA therapist also reviews with the client the now passing and future negative consequences of the client's drinking patterns. For example, the therapist may propose an "inconvenience review checklist"--a list of of frequent occurrence negative consequences of drinking, so as medical problems, marital point in disputes or difficulties at work. The client then checks all those negative inferences that apply to his or her in every one's mouth situation or are likely to come into one's head in the future. This assessment can be directioned in an empathic motivational interviewing cast rather than a confrontational title (Miller and Rollnick 1991), thereby encouraging the client, rather than the therapist, to voice the advantages of change an d the disadvantages of his or her passing from hand to hand drinking.