Roozen Hendrik G, Boulogne Jiska J, van Tulder Maurits W, van den Brink Wim, De Jong Cor A J, Kerkhof Ad J F M
Department of Clinical Psychology, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
Drug Alcohol Depend. 2004 Apr 9;74(1):1-13. doi: 10.1016/j.drugalcdep.2003.12.006.
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 11 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.
社区强化法（CRA）已应用于酒精、可卡因和阿片类药物使用所致障碍的治疗。目标是回顾以下两方面的有效性：（1）CRA与常规护理相比；（2）CRA与CRA加应急管理相比。通过对关注药物滥用的随机对照试验进行文献检索来选择研究。检索得到11项主要具有高方法学质量的研究。与常规护理相比，CRA的结果如下：有强有力的证据表明，CRA在饮酒天数方面更有效，而在酒精治疗中持续戒酒方面存在相互矛盾的证据。有中等强度的证据表明，CRA联合双硫仑在饮酒天数方面更有效，而在持续戒酒效果方面无差异的证据有限。此外，有强有力的证据表明，带“激励措施”的CRA在可卡因戒断方面更有效。有有限的证据表明，带“激励措施”的CRA在阿片类药物脱毒项目中更有效。有有限的证据表明，CRA在美沙酮维持治疗项目中更有效。最后，有强有力的证据表明，带禁欲应急“激励措施”的CRA比旨在实现可卡因戒断的CRA（非应急激励措施）治疗更有效。
