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Here is a guide to the original research studies on the 9 tools people use to cut down on their drinking.

Psychologist Mark Edison has treated problem-drinking adults and teens for 17 years.

Located in Manhattan, he holds a Ph.D. in clinical psychology from the City University of New York and an honors bachelor's degree from Yale University.

Dr. Edison has served on the staffs of Mount Sinai Medical Center and St. Luke's-Roosevelt Hospital Center and consults to corporations when drinking affects top executives.

The father of teens, he is at work on a practical book titled "A New Way To Talk With Your Children About Alcohol And Drugs."

 

 

 The Community Reinforcement Approach (CRA) 

CRA is an alcohol treatment based on the idea that a drinker's "community" -- the family, friends and others close to the drinker -- plays an important role in the drinker's ability to cut down. 

CRA consists of a menu of seven behavioral procedures, and I derived the 9 tools from these procedures.    

For a full description of CRA treatment, the best source is the 1995 book "Clinical Guide to Alcohol Treatment:  The Community Reinforcement Approach," by Robert J. Meyers and Jane Ellen Smith. 

This book also cites the first three CRA research studies with problem drinkers that proved CRA worked.  These studies are:

 

  • "A community-reinforcement approach to alcoholism," published by George Hunt and Nathan Azrin in 1973 in the scientific journal Behaviour Research and Therapy;
  • "Improvements in the community reinforcement approach to alcoholism," published by Nathan Azrin in 1976 in Behaviour Research and Therapy; and
  • "Alcoholism treatment by disulfiram and community reinforcement therapy," published by Nathan Azrin and three colleagues in 1982 in the Journal of Behavior Therapy and Experimental Therapy.

Two more studies of CRA with larger groups of problem drinkers, completed after 1995, also found that CRA works.  These studies are:

  • "The community reinforcement approach with homeless alcohol-dependent individuals," published in 1998 by Jane Ellen Smith and two colleagues in the Journal of Consulting and Clinical Psychology; and

  • "Community reinforcement and traditional approaches:  Findings of a controlled trial," a chapter published by William R. Miller and three colleagues in 2001 in the book A community reinforcement approach to addiction treatment, edited by Robert J. Meyers and William R. Miller.

Four scientific reviews of dozens of different alcohol treatments were published in 1991, 1995, 1996 and 2003.  Every one of these reviews found that CRA worked better than the vast majority of all other alcohol treatments. 

In addition, studies published in 1997, 1998, 2004 and 2006 make clear that CRA works with problem drug users. 

The Adolescent Community Reinforcement Approach (A-CRA) 

In 1996, U.S. government survey data indicated that marijuana use among teens 12-18 had reached a 12-year high.  So the Center for Substance Abuse Treatment (a division of the federal Substance Abuse and Mental Health Services Administration, or SAMHSA) funded a 1997 trial of three marijuana treatments for teens. 

For this 1997 study, CRA was adapted to fit teens rather than adults.  The most important adaptation in A-CRA was helping teens better their relationships with parents and caregivers, as opposed to the focus on marital relationships in CRA. 

(You can get the details of how A-CRA was adapted from CRA in this SAMHSA monograph:  "The Cannabis Youth Treatment Series, Volume 4," published in 2001 by Susan H. Godley and 8 colleagues.) 

Between 1997 and 2007 two large studies were published showing that while all three marijuana treatments worked, A-CRA cost the least.  These two studies are: 

  • "The cannabis youth treatment study:  Main findings from two randomized trials," published by Michael Dennis and 10 colleagues in 2004 in the Journal of Substance Abuse Treatment; and

  • "Treatment outcome for street-living homeless youth," published by Natasha Slesnick and three colleagues in 2007 in Addictive Behaviors.

A-CRA and NREPP

NREPP stands for "National Registry of Evidence-Based Programs and Practices," a website maintained by the federal government. 

The purpose of the NREPP site is to help people find treatments

that are both proven to work by research and easy to use.

 

For a treatment to be listed on the site, the quality of

the research behind it must meet SAMHSA's rating standards.

 

Following the second A-CRA article published in 2007, Susan

Godley and her colleagues submitted the A-CRA for

publication on the NREPP site, and it was accepted.

 

So why doesn't the original CRA treatment also appear on the

NREPP site?  I asked Robert J. Meyers this in 2010 at an

Illinois CRA seminar.  Dr. Meyers has done more research on

CRA than anyone in the world.

 

He said that SAMHSA's requirements for inclusion on the NREPP

site were so time-consuming that his research group could submit

only one treatment.  Because they were studying A-CRA at the

time, that's what they chose instead of the older, original CRA.

 

Motivational Interviewing (MI)

 

MI is a brief treatment based on the idea that when people talk

about their motivations for change, they're more likely to make

the changes they've talked about.

 

Recent research shows that using MI with another treatment (such

as CRA) makes it more likely that patients will achieve their

change goals.

 

Because CRA was invented before MI, it does not explicitly

include MI in its original menu of behavioral procedures.  But I

have derived the part of the first tool directly from MI. 

For a full description of MI, the best source is the 2002 book "Motivational Interviewing:  Preparing People for Change (2nd Edition)," by William R. Miller and Stephen Rollnick.

Although more than 200 trials have been published showing that MI works, the most recent four trials were published after the 2002 book mentioned above.  These four trials are: 

 

  • "The efficacy of motivational interviewing:  A meta-analysis of controlled clinical trials," published in 2003 by Brian L. Burke and two colleagues in the Journal of Consulting and Clinical Psychology;
  • "Brief interventions and motivational interviewing with children, adolescents, and their parents in pediatric health settings," published in 2005 by Sarah J. Erickson and two colleagues in Archives of Pediatrics and Adolescent Medicine;
  • "Motivational interviewing," published in 2005 by Jennifer E. Hettema and two colleagues as a chapter in the book Annual Review of Clinical Psychology; and
  • "Motivational interviewing:  A systematic review and meta-analysis," published in 2005 by Sune Rubak and four colleagues in the British Journal of General Practice.  

MI also appears on the federal government's NREPP website of proven treatments.

 

 

 

 

 

 

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