By Robert J. Meyers, William R. Miller
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Extra resources for A Community Reinforcement Approach to Addiction Treatment
How much do you feeling physically right usually drink? before you drink? &-*?. te&t. 2. What do you like about drinking (where)! 3. What are you usually feeling emotionally before you drink? 3. What do you like about drinking (when)? right 3. Over how long a period of time do you usually drink? b. Physi f 4fc*Va 4. Whatai pleasan 5. What aire the p k a « i it physic ftttog. you ha while drinking' 6. What aire the pleasar it emotit you ha1/e while 0? 2 CRA Functional Analysis for Drinking Behavior (Initial Assessment).
Since negative feelings toward disulﬁram could have been partially responsible for a lack of disulﬁram compliance, Azrin added motivational procedures to help clients view disulﬁram in a positive manner. While describing the disulﬁram program to clients, counselors made an eﬀort to describe the medication as a chemical time-delay device which gave the client time to think over a decision rather than to act impulsively. This description emphasized the positive aspect of disulﬁram and helped clients to realize that choosing to take the medication could help them take better control of their decisions.
Once a client agrees to sample sobriety, a reasonable period of time must be selected. We begin by suggesting a relatively lengthy period, such as 90 days, with the understanding that this will leave plenty of room for negotiation downward. The suggestion is backed by the rationale that the ﬁrst 90 days appears to be the time during which most relapses occur (Marlatt & Gordon, 1985). Perhaps not surprisingly, most clients report that they are unwilling or unable to make a 90-day commitment. We do not interpret this as resistance, but instead work with the client to select a shorter time period that appears challenging yet obtainable.