Effectiveness of the Community Reinforcement Approach (Miller, PI)

The proposed study is a randomized clinical trial to assess the effectiveness of two alcoholism treatment interventions first developed and evaluated by Nathan Azrin. The Disulfiram Compliance (DC) intervention involves a supporting and reinforcing "monitor" to ensure patient medication compliance. The Community Reinforcement Approach (CRA) is a broad- spectrum treatment procedure. Both have been found, in Azrin's work, to be substantially superior standard alcoholism treatment methods. The present study will replicate and extend Azrin's research, studying a culturally diverse population treated in a metropolitan public outpatient treatment facility. Disuliram- eligible patients will be assigned randomly to one of four groups: representative "generic" alcoholism treatment with or without the DC component, or the full CRA program with or without disulfiram. In a separate randomization, disulfiram-ineligible patients will be assigned to either generic treatment or CRA (without disulfiram). Methodological improvements over prior CRA research include: (1) extension of follow-up to 3 years; (2) specification of generic treatment components; (3) delivery of generic treatment by therapists committed to this approach; (4) double-blind intake assessment and single-blind follow-up assessment; (5) inclusion of a broader range of pretreatment assesement measures to enable the development of treatment matching schemas; (6) inclusion of a disulfiram-ineligible population and greter cultural diversity; and (7) evaluation of the contribution of disulfirma to the CRA program. CRA procedures are highly compatible with and exportable to traditional alcoholism treatment settings, and show promise of substantially improving overall therapeutic effectiveness, reducing long-term relapse risk and improving health and social functioning of recovering alcoholics.