Adolescent community reinforcement approach

The adolescent community reinforcement approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth, young adults, and families improve access to interpersonal and environmental reinforcers to reduce or stop substance use.[1][2]

## Contents

* 1 Description
* 2 Evidence-based outcomes
* 3 Treatment cost
* 4 Treatment manual
* 5 Therapist fidelity to A-CRA treatment manual
* 6 See also
* 7 Notes
* 8 External links

## Description

A-CRA is a variant of the adult CRA model, which has a history of development and effectiveness research starting in the 1970s.[3] A-CRA was adapted to be developmentally appropriate for adolescents, which included adding sessions for parents/caregivers.[4] The goal of A-CRA is to improve or increase access to social, familial, and educational/vocational reinforcers for adolescents to achieve and sustain recovery. That is, therapists assist adolescents with learning how to lead an enjoyable and healthy life without using alcohol or other drugs.[5] The treatment manual describes an outpatient curriculum that is intended for adolescents (ages 12 to 17) and young adults (ages 18–25). with DSM-5 alcohol and/or other substance use disorders.[1][2] A-CRA also has been implemented in intensive outpatient and residential treatment settings.[6][7] A-CRA includes three types of clinical sessions: adolescent alone, parents/caregivers alone, and family (adolescent with parents/caregivers).[1][2] To address the adolescent's needs, goals for treatment, and reinforcers, clinicians select from 19 A-CRA procedures (e.g., communication skills, problem-solving, and participation in positive social activities), all with the goal of improving life areas and supporting abstinence from alcohol and other drugs.[8] Practicing skills during sessions is an important aspect of A-CRA counseling, and every clinical session ends with a homework assignment (mutually-agreed upon by adolescent and clinician) to apply skills learned during the session.[1][4] Clinicians practicing A-CRA are trained in all 19 procedures and complete an extensive certification process.[8] A-CRA has been widely implemented in the U.S.,[8] Canada,[9] and Brazil.[10]

## Evidence-based outcomes

As of 2017, five randomized clinical trials of A-CRA have been published. The Cannabis Youth Treatment (CYT) study, which was funded by the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT), was a randomized controlled study of five manual-guided treatment models for adolescents with cannabis-related disorders.[11] All five models demonstrated significant pre-post treatment improvements in number of days abstinent and the percent of adolescents in recovery during the 12-month follow-up period.[12] Within its study arm, A-CRA was the most cost-effective model; across both study arms, A-CRA was the most cost-effective model to involve parents in treatment.[12] Additional randomized clinical trials have shown A-CRA to be effective for homeless, street-living youth and young adults,[7] youth with juvenile justice involvement,[13] and as a continuing care approach for adolescents after residential treatment.[14][15] Secondary evaluation studies suggest that A-CRA shows potential to be an effective treatment for adolescents with co-occurring psychiatric disorders[16] and youth with opioid use problems.[17]

## Treatment cost

In a 2002 article assessing the economic costs of A-CRA, the average cost per completed treatment event was $1,237 at one site and $1,608 at another site.[18] Using U.S. Bureau of Labor Statistics data to adjust for inflation, the 2017 cost per A-CRA treatment episode ranges from $1,683 to $2,188.[19]

## Treatment manual

The original A-CRA treatment manual was published in 2001.[1] An updated version of the A-CRA manual was published in 2016.[2]

## Therapist fidelity to A-CRA treatment manual

Although therapist fidelity to an evidence-based treatment manual is believed to predict treatment outcome, this relationship has been difficult to prove.[20] A 2017 study found that higher ongoing fidelity (model competence) ratings of 91 A-CRA therapists' clinical sessions predicted improved adolescent substance use outcomes.[21] This finding suggests that the A-CRA model of clinical certification and supervision, which rates A-CRA counseling sessions using a standardized rubric, is a central part of model effectiveness.[21]

## See also

* Behavior therapy
* Behaviorism
* Cognitive behavioral therapy
* Community reinforcement and family training
* Drug rehabilitation
* Mental health disorders
* Opioid use disorder

## Notes

1. ↑ 1.0 1.1 1.2 1.3 1.4 Godley, S.H., Meyers, R.J., Smith, J.E., Godley, M.D., Titus, J.C., Karvinen, T., Dent, G., Passetti, L.L., & Kelberg, P. (2001). The Adolescent Community Reinforcement Approach (ACRA) for adolescent cannabis users (DHHS Publication No. (SMA) 01-3489, Cannabis Youth Treatment (CYT) Manual Series, Volume 4). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Retrieved from "Archived copy". http://www.chestnut.org/li/cyt/products/acra_cyt_v4.pdf.
2. ↑ 2.0 2.1 2.2 2.3 Godley, Susan H; Smith, Jane Ellen; Meyers, Robert J; Godley, Mark D (2016). The Adolescent Community Reinforcement Approach: A Clinical Guide for Treating Substance Use Disorders. Normal, IL: Chestnut Health Systems. ISBN 978-0998058009.
3. ↑ Meyers, Robert J.; Roozen, Hendrik G.; Smith, Jane Ellen (2011). "The community reinforcement approach: an update of the evidence". Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism 33 (4): 380–388. ISSN 1930-0573. PMID 23580022.
4. ↑ 4.0 4.1 Godley, S.H., Smith, J.E., Meyers, R.J., & Godley, M.D. (2009). Adolescent Community Reinforcement Approach (A-CRA). In D.W. Springer & A. Rubin (eds.), Substance abuse treatment for youth and adults (pp. 109–201). Hoboken, NJ: John Wiley & Sons.
5. ↑ Hunt, George M.; Azrin, N.H. (February 1973). "A community-reinforcement approach to alcoholism" (in en). Behaviour Research and Therapy 11 (1): 91–104. doi:10.1016/0005-7967(73)90072-7. PMID 4781962. https://linkinghub.elsevier.com/retrieve/pii/0005796773900727.
6. ↑ Godley, S.H., & Kenney, M. (2010). How to implement an outpatient evidence-based treatment in a residential program. The Counselor, 11, 10–16.
7. ↑ 7.0 7.1 Slesnick, Natasha; Prestopnik, Jillian L.; Meyers, Robert J.; Glassman, Michael (June 2007). "Treatment outcome for street-living, homeless youth" (in en). Addictive Behaviors 32 (6): 1237–1251. doi:10.1016/j.addbeh.2006.08.010. PMID 16989957.
8. ↑ 8.0 8.1 8.2 Godley, Susan H.; Garner, Bryan R.; Smith, Jane Ellen; Meyers, Robert J.; Godley, Mark D. (March 2011). "A large-scale dissemination and implementation model for evidence-based treatment and continuing care." (in en). Clinical Psychology: Science and Practice 18 (1): 67–83. doi:10.1111/j.1468-2850.2011.01236.x. ISSN 1468-2850. PMID 21547241.
9. ↑ Dave Smith Youth Treatment Centre. (2010). Clinical programs. Retrieved 6 March 2012, from "Clinical Programs - Dave Smith Youth Treatment Centre". http://www.davesmithcentre.org/clinical-programs.html.
10. ↑ Carvalho, R., Crepaldi, K., Oliveira, M., Anderson, L., Calfat, E., Mancilha, G., Nascimento, D., Katz, P., Filho, L., & Fraser, J. (April 2012). Strategies for A-CRA implementation in Brazil. Poster presentation at the 2012 Joint Meeting on Adolescent Treatment Effectiveness (JMATE), Washington, DC.
11. ↑ Dennis, Michael; Titus, Janet C.; Diamond, Guy; Donaldson, Jean; Godley, Susan H.; Tims, Frank M.; Webb, Charles; Kaminer, Yifrah et al. (December 2002). "The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans" (in en). Addiction 97 (s1): 16–34. doi:10.1046/j.1360-0443.97.s01.2.x. ISSN 0965-2140. https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.97.s01.2.x.
12. ↑ 12.0 12.1 Dennis, Michael; Godley, Susan H.; Diamond, Guy; Tims, Frank M.; Babor, Thomas; Donaldson, Jean; Liddle, Howard; Titus, Janet C. et al. (October 2004). "The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials" (in en). Journal of Substance Abuse Treatment 27 (3): 197–213. doi:10.1016/j.jsat.2003.09.005. PMID 15501373. https://linkinghub.elsevier.com/retrieve/pii/S074054720400087X.
13. ↑ Henderson, Craig E.; Wevodau, Amy L.; Henderson, Susan E.; Colbourn, Scholar L.; Gharagozloo, Laadan; North, Lindsey W.; Lotts, Vivian A. (April 2016). "An independent replication of the Adolescent-Community Reinforcement Approach with justice-involved youth" (in en). The American Journal on Addictions 25 (3): 233–240. doi:10.1111/ajad.12366. ISSN 1055-0496. PMID 26992083.
14. ↑ Godley, Mark D.; Godley, Susan H.; Dennis, Michael L.; Funk, Rodney R.; Passetti, Lora L. (January 2007). "The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders" (in en). Addiction 102 (1): 81–93. doi:10.1111/j.1360-0443.2006.01648.x. ISSN 0965-2140. PMID 17207126. https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2006.01648.x.
15. ↑ Godley, Mark D.; Godley, Susan H.; Dennis, Michael L.; Funk, Rodney R.; Passetti, Lora L.; Petry, Nancy M. (February 2014). "A randomized trial of assertive continuing care and contingency management for adolescents with substance use disorders." (in en). Journal of Consulting and Clinical Psychology 82 (1): 40–51. doi:10.1037/a0035264. ISSN 1939-2117. PMID 24294838.
16. ↑ Godley, Susan H.; Smith, Jane Ellen; Passetti, Lora L.; Subramaniam, Geetha (October 2014). "The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents with Substance Use Disorders and Co-Occurring Psychiatric Disorders" (in en). Substance Abuse 35 (4): 352–363. doi:10.1080/08897077.2014.936993. ISSN 0889-7077. PMID 25035906. Bibcode: 2014JPkR...35..352G. https://journals.sagepub.com/doi/10.1080/08897077.2014.936993.
17. ↑ Godley, Mark D.; Passetti, Lora L.; Subramaniam, Geetha A.; Funk, Rodney R.; Smith, Jane Ellen; Meyers, Robert J. (May 2017). "Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use" (in en). Drug and Alcohol Dependence 174: 9–16. doi:10.1016/j.drugalcdep.2016.12.029. PMID 28282523.
18. ↑ French, Michael T.; Roebuck, M. Christopher; Dennis, Michael L.; Diamond, Guy; Godley, Susan H.; Tims, Frank; Webb, Charles; Herrell, James M. (11 December 2002). "The economic cost of outpatient marijuana treatment for adolescents: findings from a multi-site field experiment" (in en). Addiction 97 (s1): 84–97. doi:10.1046/j.1360-0443.97.s01.4.x. ISSN 0965-2140. https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.97.s01.4.x.
19. ↑ U.S. Department of Labor Bureau of Labor Statistics. (2018). CPI Inflation Calculator. Retrieved on February 5, 2018 from https://www.bls.gov/data/inflation_calculator.htm
20. ↑ Webb, Christian A.; DeRubeis, Robert J.; Barber, Jacques P. (2010). "Therapist adherence/competence and treatment outcome: A meta-analytic review." (in en). Journal of Consulting and Clinical Psychology 78 (2): 200–211. doi:10.1037/a0018912. ISSN 1939-2117. PMID 20350031.
21. ↑ 21.0 21.1 Campos-Melady, Marita; Smith, Jane Ellen; Meyers, Robert J.; Godley, Susan H.; Godley, Mark D. (February 2017). "The effect of therapists' adherence and competence in delivering the adolescent community reinforcement approach on client outcomes." (in en). Psychology of Addictive Behaviors 31 (1): 117–129. doi:10.1037/adb0000216. ISSN 1939-1501. PMID 27736146. https://doi.apa.org/doi/10.1037/adb0000216.

## External links

* A-CRA/ACC
* Chestnut Health Systems
* RJM & Associates
* A-CRA on NREPP
* A-CRA on National Institute of Justice Crime Solutions
* The Rehab Intake Process

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