Community Reinforcement Approach Plus Vouchers (Alcohol, Cocaine)
Community Reinforcement Approach (CRA) Plus Vouchers is an intensive 24-week outpatient therapy for treatment of cocaine and alcohol addiction. The treatment goals are twofold:
- To maintain abstinence long enough for patients to learn new life skills to help sustain it
- To reduce alcohol consumption for patients whose drinking is associated with cocaine use
Patients attend one or two individual counseling sessions each week, where they focus on improving family relations, learning a variety of skills to minimize drug use, receiving vocational counseling, and developing new recreational activities and social networks. Those who also abuse alcohol receive clinic-monitored disulfiram (Antabuse) therapy. Patients submit urine samples two or three times each week and receive vouchers for cocainenegative samples. The value of the vouchers increases with consecutive clean samples. Patients may exchange vouchers for retail goods that are consistent with a cocaine-free lifestyle.
This approach facilitates patients' engagement in treatment and systematically aids them in gaining substantial periods of cocaine abstinence. The approach has been tested in urban and rural areas and used successfully in outpatient treatment of opioid-addicted adults and with inner-city methadone maintenance patients with high rates of intravenous cocaine abuse.
Further Reading:
Higgins, S.T., et al. Community reinforcement therapy for cocaine-dependent outpatients. Archives of General Psychiatry 60(10):1043-1052, 2003.
Roozen, H.G.; Boulogne, J.J.; van Tulder, M.W.; van den Brink, W.; De Jong, C.A.J.; and Kerhof, J.F.M. A systemic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug and Alcohol Dependence 74(1):1-13, 2004.
Silverman, K., et al. Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry 53(5):409-415, 1996.
Smith, J.E.; Meyers, R.J.; and Delaney, H.D. The community reinforcement approach with homeless alcohol-dependent individuals. Journal of Consulting and Clinical Psychology 66(3):541-548, 1998.
Stahler, G.J., et al. Development and initial demonstration of a community-based intervention for homeless, cocaineusing, African-American women. Journal of Substance Abuse Treatment 28(2):171-179, 2005.