WEEK 6 COMMUNITY REINFORCEMENT APPROACH

background reinforcement

based on positive reinforcement

person to give up significant reinforce like drugs or alcohol

if punishment cured addiction - far less addiction

functional analysis (connection with CRA)

• identify the triggers and consequences of SUD behavior replace with rewarding alternative 

pros and cons of monitored medications?

pros - can prevent misuse 

cons- patient distrust 

what other practical considerations factor into CRA 

• avaliabilty of resources 

• patient preference and motiation 

• support system involvement 

cra based on positive reinforcement

• gets rid of eliminationg positive reinforcement with drugs and replacing it with sobriety

why are drugs so strong?

drugs are strong because they are reinforcing

lab animals will self administre drugs for stuff like food and sex

psychosocial reinforces for drugs

• relaxation, suppression of memories, sexual facilitation, well-being of power 

what are the awards of CRA (community reinforcement approach) 

• seeks increase positive reinforcemnt for positive and rewards 

• focus on connecting people with natural alternative sources - inconsistent with substance abuse 

• goal = make sobriety reinforcing 

what are the cra procedures ?

• community reinforcement approach

• flexibility usef for individual clients

• some clients only need a few sessions (6-18) 

assessment 

• current happiness scale 

• based on the happiness of certain domains 

what are the ABCs?

• antecedent, behavior, and consequences

antecedent

triggers

external (what are you thinking about)

• the drink

• see who is gonna show up

  • the next day

behavior

• what do u usually drink 

  • how much do u drink  

consequences

when asking questions can be positive or negative

• positive 

  • what do you like about drinking ?

• negative 

  • what are the negative results of ur drinking in each other of these drinks 

    • interpersonal, physicals, emotional 

what are the two factors that is involved in sobriety sampling

reasoning and advantages

reasoning — sobriety sampling

• counselor and client negotiate a period of abstinence the client is willing to try

• long term intention is moderation

• close contact with client during sobriety period espeically in first few days

• carefully monitor for signs of withdrawal

advantages — sobriety sampling

• build rapport with client while recognizing severity

• set goals tg that client feels are reasonable appropriate and obtainable 

• having a ‘time out’ from drinking allows for sober 

• old patterns 

monitored medication

• disulfiram (antabuse)

  • induces discomfort and illness if client drinks 

  • the drug blocks effects and reduces the effect of alcohol 

  • people quit

what is the advantages of medication with sobriety?

• reduction in family worry, increase family trust, can help different drinking triggers at one, therapy time, coping, self confidence 

what if a client refuses treatment, altogether?

• dont get in a power struggle with them, not gonna work

• sobriety for a month have trouble with that

behavioral skill straining

communication skills (give an understanding statement.. offer to help)

problem solving steps (defining the problem, generating alternatives, decling on a solution evaluating the outcome 

how can someone be successful with drink refusal

• enlisting support of friends and family

• avoiding high risk situations 

• prepare and practice responses 

• suggest alternatives, change the subject 

job counseling

• stable employment is strong predictor of sobriety 

• developing a resume 

• avoiding jobs with high relapse potential 

• completing job applications

practicalities

no one size fits all

counselor chooses different procedures most likely to address client needs

strong emphasis on encouragement and positive reinforcement 

what is the efficency of CRA?

• adds signifcant to effectives of SA of approaches with which it has been compared 

• large effects for homeless adults and youth