CRA was designed by Nate Azrin in the early 1970s: “The most influential behaviorist of all times, B. F. Skinner, largely considered punishment to be an ineffective method for modifying human behavior (Skinner 1974). Thus it was no surprise that, many years later, research discovered that substance use disorder treatments based on confrontation were largely ineffective in decreasing the use of alcohol and other substances (Miller and Wilbourne 2002, Miller et al. 1998). Nate Azrin already was convinced of this back in the early 1970s, when he designed an innovative treatment for alcohol problems: the Community Reinforcement Approach (CRA). Azrin believed that it was necessary to alter the environment in which people with alcohol problems live so that they received strong reinforcement for sober behavior from their community, including family, work, and friends. As part of this strategy, the program emphasizes helping clients discover new, enjoyable activities that do not revolve around alcohol, and teaching them the skills necessary for participating in those activities.”Community reinforcement has both efficacy and effectiveness data. Started in the 1970s, community reinforcement approach is a comprehensive program using operant conditioning based on a functional assessment of a client's drinking behavior and the use of positive reinforcement and contingency management to achieve a goal of non-drinking. When combined with disulfiram (a prescribed substance acting as Aversion therapy) community reinforcement was particularly effective. A notable component of the program is the non-drinking club. As of 2007, applications of community reinforcement to public policy has become a focus of study."The Community Reinforcement Approach has also been found to be effective in outpatient setting. In one study, clients treated with CRA and the disulfiram compliance component were abstinent an average of 97% of the days during the last month of the 6-month followup, whereas clients treated with a combination of a 12-step program and the CRA disulfiram compliance training were