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The degree of methodological control in Nathan Azrin's early studies and the surprisingly large treatment effects that were obtained established the Community Reinforcement Approach (CRA) as one of the more promising interventions for alcohol problems. With a larger sample of clients, the authors tested CRA in an ongoing public outpatient treatment program, the University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (CASAA), the largest public provider of addiction treatment services in New Mexico. A range of outcome measures was included to document drinking, alcohol-related problems and dependence, psychological adjustment, employment, and institutionalization. The authors have replicated Azrin's outpatient study by reproducing the same three treatment conditions: traditional treatment alone, traditional treatment plus disulfiram compliance, and full CRA. To these they added another group, who received CRA without disulfiram, in order to determine the extent to which disulfiram contributes to the overall effectiveness of the CRA.
This chapter contains the primary report of findings from the comparison of the Community Reinforcement (CRA) and traditional approaches. Study participants completed a comprehensive assessment at intake that included measurement of numerous demographic characteristics, motivation for change, psychological functioning, drinking history, and current drinking practices. The taking and monitoring of disulfiram were important distinguishing aspects of the treatment groups. The a priori treatment contrasts were made at proximal and distal follow-up points using three primary dependent measures. The three outcome measures were total standard drinks consumed during the assessment period, number of drinking days per week, and estimated peak blood alcohol concentration (BAC) for the assessment period. Traditional and CRA groups also had similar outcomes among the disulfiram-ineligible clients. The chapter concludes with a confessional litany of some errors the authors made along the way, in the hope of saving colleagues from similar pitfalls.
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