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:
Two more studies of CRA with larger groups of problem drinkers, completed after 1995, also found that CRA works. These studies are:
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:
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
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:
MI also appears on the federal government's NREPP website of proven treatments.
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