Community Reinforcement Approach (CRA) for cocaine dependence in the Spanish public health system: 1 year outcome


Roberto Secades-Villa PhD, Professor, Emilio Sánchez-Hervás PhD, Clinical Psychologist, Francisco Zacarés-Romaguera MA, Assistant Professor, Olaya García-Rodríguez PhD, Assistant Professor, Francisco J. Santonja-Gómez PhD, Assistant Professor, Gloria García-Fernández MA, Assistant Professor. Dr Roberto Secades-Villa, Facultad de Psicología, Plaza Feijoo s/n, 33003 Oviedo, Spain. Tel: +34 985 10 41 39; Fax: +34 985 10 41 44; E-mail:


Introduction and Aims.The development and dissemination of effective treatments for cocaine dependence is an important public health priority in Europe, and especially in Spain, given the increase in treatment demand over recent years. The aim of this study was to determine the effectiveness of the Community Reinforcement Approach (CRA) for cocaine dependents at an outpatient clinic within the Spanish public health system.

Design and Methods.A total of 82 cocaine-dependent patients were randomly assigned to one of two treatment conditions: Standard Treatment (n = 35) or CRA (n = 47). Dependent variables were treatment retention, cocaine abstinence and composite scores from the European version of the Addiction Severity Index at 12 month follow up.

Results.Of the patients who received CRA, 55% completed 6 months of treatment, versus 40% who received Standard Treatment. At the 12 month follow up, patients assigned to the CRA condition achieved higher rates of abstinence (95.2%) by comparison with Standard Treatment (69.2%). In the CRA group, 27% of the patients achieved continuous cocaine abstinence, versus 21% in the Standard Treatment group. The CRA group also obtained lower scores than the Standard Treatment group in all Addiction Severity Index composite scores.

Discussion and Conclusions.This study showed that CRA is a feasible treatment for cocaine addiction in a public community setting in Spain.[Secades-Villa R, Sánchez-Hervás E, Zacarés-Romaguera F, García-Rodríguez O, Santonja-Gómez FJ, García-Fernández G. Community Reinforcement Approach (CRA) for cocaine dependence in the Spanish public health system: 1 year outcome. Drug Alcohol Rev 2010;30:606–612]