CRA and Treatment of Cocaine and Opioid Dependence

Abstract

This chapter reviews positive results from a series of well-controlled clinical trials supporting the efficacy of Community Reinforcement Approach (CRA) treatments for cocaine and opioid dependence. It presents a brief description of the rationale for adding the voucher-based incentives to CRA. In developing this treatment for cocaine dependence in the late 1980s, the goal was to develop an intervention to treat cocaine dependence in outpatient settings. More substantially, the trial by Abbott and colleagues with opioid-dependent individuals did not involve vouchers and yet the CRA treatment resulted in greater reductions in opioid use than standard drug-abuse counseling. Delivered with or without vouchers, CRA represents an efficacious treatment that can enhance treatment outcomes with cocaine and opioid-dependent patients. Recognizing the importance of reinforcement to substance dependence and integrating systematic use of that principle into clinical efforts to reduce cocaine and opioid dependence has the potential to substantially improve treatment outcomes.