Community Reinforcement Approach

The Community Reinforcement Approach (CRA) "is a broad-spectrum behavioral treatment approach for substance abuse problems...that utilizes social, recreational, familial, and vocational reinforcers to aid clients in the recovery process" (Meyers and Smith 1995, p. 1).

This approach uses a variety of reinforcers, often available in the community, to help substance users move into a drug-free lifestyle. Typical components of CRA treatment include (1) functional analysis of substance use, (2) social and recreational counseling, (3) employment counseling, (4) drug refusal training, (5) relaxation training, (6) behavioral skills training, and (7) reciprocal relationship counseling. In the very successful approach developed by Higgins and colleagues for cocaine-dependent individuals (Higgins et al. 1991, 1994), a contingency management component is added that provides vouchers for staying in treatment. The vouchers are redeemable for items consistent with a drug-free lifestyle and are contingent upon the patient's provision of drug-free urine toxicology specimens.

Thus, CRA and CBT share a number of common features, most importantly, the functional analysis of substance abuse and behavioral skills training. CBT differs from CRA in not typically including the direct provision of either contingency management (vouchers) for abstinence or intervening with patients outside of treatment sessions or the treatment clinic, as do community-based interventions (job or social clubs).

Motivational Enhancement Therapy

CBT has some similarities to Motivational Enhancement Therapy (MET) (Miller and Rollnick 1992). MET "is based on principles of motivational psychology and is designed to produce rapid, internally motivated change. This treatment strategy does not attempt to guide and train the client, step by step, through recovery, but instead employs motivational strategies to mobilize the client's own change reResources" (Miller et al. 1992, p. 1).

CBT and MET share an exploration, early in the treatment process, of what patients stand to gain or lose through continued substance use as a strategy to build patients' motivation to change their substance abuse.

CBT and MET differ primarily in emphasis on skill training. In MET, responsibility for how patients are to go about changing their behavior is left to the patients; it is assumed that patients can use available reResources to change behavior and training is not required. CBT theory maintains that learning and practice of specific substance-related coping skills foster abstinence. Thus, because they focus on different aspects of the change process (MET on why patients may go about changing their substance use, CBT on how patients might do so), these two approaches may be seen as complementary. For example, for a patient with low motivation and few reResources, an initial focus on motivational strategies before turning to specific coping skills (MET before CBT) may be the most productive approach.

Dissimilar Approaches

While it is important to recognize that all psychosocial treatments for drug abuse share a number of features and may overlap or closely resemble one another in several ways, some approaches differ significantly from CBT.