The degree of methodological control in Nathan Azrin's early studies and the surprisingly large treatment effects that were obtained established the Community Reinforcement Approach (CRA) as one of the more promising interventions for alcohol problems. With a larger sample of clients, the authors tested CRA in an ongoing public outpatient treatment program, the University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (CASAA), the largest public provider of addiction treatment services in New Mexico. A range of outcome measures was included to document drinking, alcohol-related problems and dependence, psychological adjustment, employment, and institutionalization. The authors have replicated Azrin's outpatient study by reproducing the same three treatment conditions: traditional treatment alone, traditional treatment plus disulfiram compliance, and full CRA. To these they added another group, who received CRA without disulfiram, in order to determine the extent to which disulfiram contributes to the overall effectiveness of the CRA.

In the early 1970s, George Hunt and his advisor, Nathan Azrin, developed a theory for describing the etiology and maintenance of alcohol problems and a therapy approach for addressing how to treat them. Azrin and his colleagues designed a series of subsequent studies, testing the relative effectiveness of specific treatment components in order to refine the approach. Community Reinforcement Approach (CRA) was first tested on alcohol-dependent individuals in an inpatient setting, then tailored for use with outpatient populations who might have required residential treatment. As Azrin noted when conducting the 1976 study, disulfiram compliance difficulties were a significant barrier in alcohol treatment programs. The major contribution of the study that followed was a test of the relative importance of the disulfiram compliance procedures and the behavioral CRA components introduced in the previous trial. The effectiveness of the CRA procedures has now been demonstrated with a broader range of participant groups.