Adaptation of Community Reinforcement Approach for the Treatment of Drug Addiction
Phase: NA
Conditions: Substance Use Disorders, Comorbidities and Coexisting Conditions
Sponsor: Muhammad Saghir

ADAPTATION OF COMMUNITY REINFORCEMENT APPROACH FOR 
THE TREATMENT OF DRUG ADDICTION 
 
 
 
 
MUHAMMAD SAGHIR 
74-FSS/PHDPSY/F-18 
DR. MAZHAR IQBAL BHATTI 
Associate Professor (supervisor) 
 
 
 
 
 
 
 
 
 
Department of Psychology 
Faculty of Social Sciences 
International Islamic University Islamabad 
July 10, 2024 
 
 
 

Background of the study 
The aim of the present study was to adapt the CRA Islamically because it is very important 
to add the cultural and religious aspects which are fundamentally important for the treatment of 
SUD. In CRA, face to face interaction is required for intervention including eight sessions for 
focuses on the reality of client’s social environment so that for learning real life opportunities could 
be focused as per client needs to enhance engagement and learning (Godley, 2001).  
 
For internal motivation and involvement in CRA, adaptations were added to enhance 
CRA’s effectiveness. There were two major adaptations in CRA to make it accord with the 
cultural relevant with the targeted population. First adaptation is based on religion Islam. It 
includes several sections, and these sections are adapted in CRA’s counseling goals. In first 
section morality was adapted with CRA, morality is about the Islamically integrated ways about 
hygiene, sleep, eating, clothes, meeting others, physical health, happiness and sadness related 
(Abbass, 2017). Second section was related to internal framework of human psyche, which 
comprises of Cognition (Aql), Behavioral inclinations (Nafs), Spirit (Ruh), Emotions (Ihsaas) 
and Heart (Qalb) (Keshavarzi & Khan, 2018). In third section principle of change, behavioral 
modification and tazkia-e-nafs were added along with three stages in principle of change: 
Inkishaf, itidal and Itehad (Keshavarzi & Khan, 2018). 
Objectives:  
• To investigate whether IICRA has the better efficacy in treating substance dependence 
along with comorbidities than the indoor conventional treatment for substance dependence. 
• To adapt the IICRA treatment strategy grounded in Pakistani culture and religious values 
for the treatment of drug addicts in Pakistan. 

• To determine whether IICRA treatment is more effective in treating poly drug addicts and 
drug addicts with or without comorbidities.  
• To determine whether IICRA treatment is more effective for those addicts who were treated 
for one or more treatment previously as compare to those having first treatment. 
Research Method and Design: 
A randomized control trial was used as research method on indoor residential patients and 
guidelines of good clinical practices were followed (Guideline, 2001). The sample size for this 
clinical trial was 60 in total (30 for control group and 30 for treatment group) in order to maintain 
this number, the sample size was extended to 34 for each group in order to get adequate retention 
of the sample. The retention number of sample was 68 at the time of pre assessment and closed at 
59 at the time of last follow up assessment. All participants who were admitted for treatment of 
SUD with or without comorbid mental disorders were recruited for research. Intervention was 
administered after the 21 days of detoxification. For recruitment and randomization, it was not 
applicable to control extraneous variables in a single facility so two sites were selected for this 
purpose. Selection of sites were based on minimizing extraneous variables by selecting identical 
residential treatment sites. One site such as Islamabad Rehab Clinic (IRC) was willing to give 
permission for implementation of IICRA based intervention. Hence, IRC was selected for 
recruiting treatment group.  
Second site was considered for recruiting control group where they were giving traditional 
treatment in residential setting based on disease model. The site is named as Hayat Rehab Clinic 
(HRC). The permission for conducting research and recruiting participants were sought out from 
the authorities. Traditional treatment was termed as treatment as usual which includes 
detoxification of drugs and duration of detoxification from acute withdrawal consisted on 21 days, 

during these early days focus was on adjustment to residential treatment along with hygiene and 
routine related compliance. Afterwards, the focus was on general counselling for drug addiction 
prevention, twelve steps program, habit formation based on seven habits for highly effective 
people and life skills training which is mainly delivered through group classes and lectures. 
Patients’ individual sessions are also scheduled with psychologists once weekly, the focus of these 
individual sessions is to maximized the interaction with family through relationship building and 
relapse prevention skills. Duration of residential treatment is between 90-120 days. 
The treatment group received interventions based on Islamically Integrated CRA (IICRA). 
These sessions were divided into daily goals including counseling related to hygiene, physical 
activities, psychotherapy of mental disorders and drug addiction related management. After 
discharge from residential treatment, they were followed up for six months to check the 
effectiveness of IICRA in the context of relapse and recovery from SUD as well as from 
comorbidities. These six months follow up was consist of further three follow up sessions; first 
session was conducted on the discharge date from the facility, second was on fifth month and third 
was on sixth month following discharge.  
Sample in the present study for clinical trial was based on those diagnosed individuals 
who were hospitalized in rehab for the treatment of SUD. Age of the sample was varying from 
16 years to 60 years, where 24% individuals were from late adolescence, 39% from early 
adulthood and finally 37% were from middle adulthood. The chronicity of disease in the sample 
varies 78% of them were abusing substance between from one year to 10 years and 22% were 
abusing more than 10 years. Similarly, the rate of relapse or number of treatments within sample 
was computed as 54% individuals were hospitalized first time and 46% were hospitalized two 
and more than two times. Additionally, the type of substance abuse was also varying cross the 

sample which included cannabis, alcohol, pills, heroin, Ice and multiple substance abuse 
(Alcohol, cannabis and prescribed substances) as well. The gender was mainly male in sample 
which was 98% and only one participant was female in the sample. Moreover, 75% individuals 
of the sample were diagnosed with SUDs and 25% were also having comorbid mental illness. 
Hence, the representativeness of the sample was limited to clinical population diagnosed with 
SUDs as well as comorbidities with SUDs.  
Secondly, the professionals who were providing treatment were not aware of the 
allocation of the individual in control and treatment group as well as the recruited individuals for 
the clinical trial. They were responsible for conducting sessions and recording those sessions 
through treatment forms as well as monitoring the goals whether desired goal is achieved or not. 
They were also given the treatment protocol schedule for effective treatment adherence. 
Additionally, panel assessments were planned at both sites for reviewing and addressing 
treatment related issues faced by professionals as well as the achievement of desired goals of the 
treatment. These panel assessments were carried out by weekly to ensure the engagement of the 
patients, adherence and fidelity to the treatment protocols. This committee was comprised of four 
professionals having experience in the treatment planning and execution with the minimum 
educational level of MS in Clinical Psychology.  
Moreover, for the purpose of comparability of results and to control the extraneous 
variables, two treatment sites were selected for clinical trial.  Both sites were equal in terms of 
organizational structure which includes residential treatment facility for mental health, same 
geographical region with outdoor areas, hierarchy of professionals, daily routine of the patients, 
psychiatrist consultation, outdoor and indoor activities of the patients and length of residential 

treatment. The professionals engaged in the clinical trial has similar qualification and experience 
at both facilities. 
During this clinical trial, 28 out of 34 participants were retained in control group and 
successfully completed the duration of clinical trial. Three participants had withdrawn the 
treatment after 40 days of hospitalization and one individual passed away after discharge from 
rehab. Remaining two participants did not continue the follow up sessions.  
Similarly, in experimental group 31 participants out of 34 had successfully completed the 
Treatment duration for clinical trial. Two participants had withdrawn the treatment after a month 
of admission and one participant did not continue after the discharge from the facility.