What is the Community-Reinforcement Approach (CRA)?

By Marcus Shumate, LCMHC, LCAS, Clinical Outreach Director, Green Hill

Community-Reinforcement Approach (CRA) is one of the more interesting clinical models for treating substance use disorders. It may lack the notoriety of other models, but it makes up for its lack of notoriety in its effectiveness. In the research arena, CRA has a strong evidence base to support its utilization (Resources: 1, 2).

What is the Community-Reinforcement Approach exactly? And, if it has such good outcomes, one could ask, why haven’t I heard of it? Hopefully this blog post can clear up some of those questions and introduce the approach to you. 

What is the Community-Reinforcement Approach (CRA)?


The Community Reinforcement Approach (CRA) is a psychosocial intervention for individuals with alcohol and other drug use disorders that focuses on helping individuals find healthier, more adaptive ways to meet their social and emotional needs than using substances.

Source: Recovery Answers – Community Reinforcement Approach

At the risk of removing some of the more interesting nuance about CRA, I’ll try to go beyond just a brief overview of what it is and how it works. That said, CRA is absolutely worth additional time and exploration so feel free to reach out to me or check out online resources to learn more about CRA (Such as 1, 2). Frankly, I believe more people in the substance use disorder treatment field should know about it and utilize it. 

Community-Reinforcement Approach relies heavily on assumptions found in behaviorism. Behaviorism is essentially the theory that human behavior is shaped by the environment through a process referred to as conditioning. CRA runs on the notion that a client can obtain sobriety through creating an incentive-rich environment that reinforces sobriety. It relies heavily on a tool called the Happiness Scale, which helps a client rate his/her level of satisfaction in various life areas (education, vocation, relationships, recreation, spirituality, etc.) during their initial sessions. From there a treatment plan is formed in which the client and therapist agree to focus on improving the level of satisfaction in agreed upon areas. 

How is Community-Reinforcement Approach (CRA) Different?

Unlike other modalities for addressing substance use disorder, CRA prioritizes improving quality of life independent of a person’s ongoing substance use. The great benefit in this difference is that, at some point, a natural tension is created where a client’s desire to keep using substances begins to interfere with his/her agreed upon life goals. In this way, an organic desire for change can begin to emerge while the client has been improving his/her life. 

Here is an example – imagine a scenario where a client rates their “overall satisfaction” with their education progress as “low”, and then working with them to identify the necessary skills that would allow them to elevate their satisfaction. However, their satisfaction here will likely meet an artificial ceiling if they can’t stop drinking excessively which leads to failing to complete assignments, or showing up to class hungover. Eventually, something has to change if they’d like to do better. On the other side of this process, they will have all the more reason to keep working on their sobriety because they are doing well in school and wouldn’t want to jeopardize that. 

The Community-Reinforcement Approach (CRA) Reward System

On a personal note, one of the reasons I love CRA is that I am skeptical about the amount of free will a person actually has. If you’ll indulge the notion that free will may be rather limited, I’ll build my case on why CRA does a good job of accounting for this. As humans we’re heavily driven by activities that we find rewarding and don’t have control over what we do find rewarding. 

In the case of addiction, that experience of “reward” can drive a person to ongoing and problematic use because of how intense the reward sensation can be. Over time, this can lead to a narrowing of priorities where a person’s brain is almost exclusively focused on obtaining that reward sensation through substances. 

CRA creates a system by which a client can focus on building other pathways for obtaining those reward sensations. Once an environment has been created that provides other rewarding experiences, substances start to lose some of their inherent appeal. 

Final Thoughts

Ultimately, CRA is focused on building a life that is more rewarding and meaningful than substance use. This meaningful and rewarding life then in turn helps pull someone towards a more sober life.

This emphasis on building a meaningful life is ultimately why this clinical model fits so perfectly with Green Hill’s approach to treatment and recovery. We remain focused on what we’re most passionate about: the work of helping our clients find purpose and flourish.

Register For Our Virtual CEU Session: Community Reinforcement Approach (CRA)

We’re happy to invite our community of professionals and friends to join our upcoming Virtual CEU Session: Community Reinforcement Approach!

This virtual Continuing Education event will cover CRA – Community Reinforcement Approach – and its application in substance use disorder treatment in young adults.

CRA is an evidenced based framework that relies on core tenets including functional analysis, sobriety sampling, relapse prevention and social/relational counseling to identify and implement treatment goals.

This event will provide 1 CEU to licensed clinicians. This event is pending approval by ACEP. We will provide certificate and documentation following approval.

To RSVP for this event, click here.

Recovery Isn’t Linear

By Jake Summers, Development Director and Partner, Green Hill

One of the most difficult struggles in early recovery is acceptance of the fact that healing and growth are not linear. It feels intuitive to believe that life will be easier at the one year milestone in sobriety than at the one week point. While these large trends hold over time, it certainly doesn’t mean that for each week in recovery, life gets better by a matching amount. Dealing with setbacks, including relapse, are an extremely important ingredient in long-term sobriety. The “one day at a time” mindset is a valuable tool in coping with the up and down periods in recovery. 

Often in 12-step meetings, I hear a person with 12, 18, or even 30 years sober sharing about how they were navigating their “toughest year in sobriety.” Life happens, to all of us. Painful events will happen to us in recovery. We may lose jobs or loved ones, become ill, or experience negative circumstances entirely out of our control. We cannot plan for life to go our way, but we can plan for how we will react when things don’t. Staying grounded in the reality that recovery isn’t linear and listening to those who have continued to stay sober under any circumstances are great places to start. 

Most recovery stories are divided into two parts. War with a substance, and a life without a substance. We enter an inpatient program or our first 12-step meeting because we have lost a battle with a substance. Our entire focus in early sobriety is to stop using. Fighting cravings, resisting urges, and controlling our surroundings is a full time job. While we want to get back into school, or rebuild our family system, those tend to take a back seat to the chief goal of just not using. 

As we move forward in recovery, eventually we reach an inflection point. The war turns into a scuffle which turns into an eventual passing thought. This is a promise of 12-step programs – at some point we still stop fighting drugs and alcohol. When this happens, we begin to focus on the rest of our lives. We begin to make amends, pursue dreams, become involved in the community.

The promise of recovery is not to make life easy; it is to give us a new set of tools to cope with life’s difficulties that doesn’t include drugs and alcohol. We have to learn how to have a meaningful life without substances. 

It is also important to think through the consequences of a return to use. We often view substances as our escape from the reality of a situation, but the truth is they only make life more complicated. For example, if we lose out on a job opportunity, and return to using as a way to cope, we will likely become less employable and less desirable for better positions with each day we use. Drinking or using magnifies our problems, and reduces our ability to solve them. 

Relapse is probably the biggest setback that can happen in recovery, although it is by no means necessary. While a relapse does mean that time  in recovery is starting over, we can zoom out and view it as an event in a life of sobriety. A return to use can serve as an extremely valuable and humbling wake-up call or a reminder of why we stopped using in the first place. Lessons learned, connections in the community, and an understanding of the condition will all carry over from before a relapse. All progress does not have to be lost during a relapse, and it is a setback many have used as a catalyst for another phase of personal growth. 

Extended care programs like Green Hill are designed to simultaneously build agency and self efficacy in clients, while providing them enough structure and clinical support to navigate challenging periods. As clients progress through the program, they become more confident and independent. Confidence and independence leads to expanding life experience, which adds complexity. The cycle continues! Feel better, pursue more opportunities, process the lessons learned when things do not go according to plan. Once we go through this cycle with support, we feel more confident that most of our ‘problems’ can be solved by the same solutions.

This cycle is accounted for in our phased system at Green Hill. Phase 4, the last in our clinical curriculum, is designed to empower residents to leave treatment feeling comfortable with their progress and confident in their ability to pursue a meaningful life . Our program allows residents to make mistakes and process them. The transition back to real life is designed to be a slow one. 

Green Hill utilizes the Community Reinforcement Approach (CRA) to substance use treatment. In this framework, clients redevelop their community to provide positive reinforcement for healthy behaviors in recovery. Surrounding oneself with a supportive community that rewards you for honestly evaluating your life and for vocalizing negative feelings is an important part of the foundational work done at Green Hill. Admitting when things are difficult and seeking support from others in recovery is a critical element of the communal approach to sobriety. 

The idea that clients can go to an inpatient facility living in a fully restricted environment and transition immediately back to normal life with little formal support is based on the assumption that recovery is linear. We know that recovery is more complex, and, for many, takes a winding path. At Green Hill, we have structured our curriculum accordingly. Recovery lasts a lifetime, and a foundation of recovery should be built slowly, deliberately, and for the long term. 

My life in recovery has certainly not been linear, but it has been fulfilling beyond imagination. I have had my share of highs and lows, but no matter what happens I know I have the tools to be okay with it. If you are on the fence about starting your journey in recovery you are not alone, but you can join any time!

Jake Summers