A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction

The community reinforcement approach (CRA) has been applied in the treatment of disorders resulting from alcohol, cocaine and opioid use. The objectives were to review the effectiveness of (1) CRA compared with usual care, and (2) CRA versus CRA plus contingency management. Studies were selected through a literature search of RCTs focusing on substance abuse. The search yielded I I studies of mainly high methodological quality. The results of CRA, when compared to usual care: there is strong evidence that CRA is more effective with regard to number of drinking days, and conflicting evidence with regard to continuous abstinence in the alcohol treatment. There is moderate evidence that CRA with disulfiram is more effective in terms of number of drinking days, and limited evidence that there is no difference in effect in terms of continuous abstinence. Furthermore, there is strong evidence that CRA with 'incentives' is more effective with regard to cocaine abstinence. There is limited evidence that CRA with 'incentives' is more effective in an opioid detoxification program. There is limited evidence that CRA is more effective in a methadone maintenance program. Finally, there is strong evidence that CRA with abstinence-contingent 'incentives' is more effective than CRA (non-contingent incentives) treatment aimed at cocaine abstinence. (C) 2004 Elsevier Ireland Ltd. All rights reserved