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]

## Description

[edit]

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

[edit]

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

[edit]

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

[edit]

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

[edit]

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

[edit]

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

## Notes

[edit]

1. ^ a b c d e 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" (PDF). Archived from the original (PDF) on 17 November 2011. Retrieved 9 June 2012.`{{cite web}}`: CS1 maint: archived copy as title (link)
2. ^ a b c d 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. PMC 3860533. PMID 23580022.
4. ^ a b 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". Behaviour Research and Therapy. 11 (1): 91–104\. doi:10.1016/0005-7967(73)90072-7. PMID 4781962.
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. ^ a b Slesnick, Natasha; Prestopnik, Jillian L.; Meyers, Robert J.; Glassman, Michael (June 2007). "Treatment outcome for street-living, homeless youth". Addictive Behaviors. 32 (6): 1237–1251\. doi:10.1016/j.addbeh.2006.08.010. PMC 1894944. PMID 16989957.
8. ^ a b c 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". Clinical Psychology: Science and Practice. 18 (1): 67–83\. doi:10.1111/j.1468-2850.2011.01236.x. ISSN 1468-2850. PMC 3086782. PMID 21547241.
9. ^ Dave Smith Youth Treatment Centre. (2010). Clinical programs. Retrieved 6 March 2012, from "Clinical Programs - Dave Smith Youth Treatment Centre". Archived from the original on 20 June 2012. Retrieved 9 June 2012.
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; Babor, Thomas; Roebuck, M. C.; Godley, Mark D.; Hamilton, Nancy; Liddle, Howard; Scott, Christy K.; The C. Y. T. Steering Committee (December 2002). "The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans". Addiction. 97 (s1): 16–34\. doi:10.1046/j.1360-0443.97.s01.2.x. ISSN 0965-2140.
12. ^ a b Dennis, Michael; Godley, Susan H.; Diamond, Guy; Tims, Frank M.; Babor, Thomas; Donaldson, Jean; Liddle, Howard; Titus, Janet C.; Kaminer, Yifrah; Webb, Charles; Hamilton, Nancy; Funk, Rod (October 2004). "The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials". Journal of Substance Abuse Treatment. 27 (3): 197–213\. doi:10.1016/j.jsat.2003.09.005. PMID 15501373.
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". The American Journal on Addictions. 25 (3): 233–240\. doi:10.1111/ajad.12366. ISSN 1055-0496. PMC 4918901. 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". Addiction. 102 (1): 81–93\. doi:10.1111/j.1360-0443.2006.01648.x. ISSN 0965-2140. PMID 17207126.
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". Journal of Consulting and Clinical Psychology. 82 (1): 40–51\. doi:10.1037/a0035264. ISSN 1939-2117. PMC 3938115. 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". Substance Abuse. 35 (4): 352–363\. Bibcode:2014JPkR...35..352G. doi:10.1080/08897077.2014.936993. ISSN 0889-7077. PMID 25035906.
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". Drug and Alcohol Dependence. 174: 9–16\. doi:10.1016/j.drugalcdep.2016.12.029. PMC 5400724. 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". Addiction. 97 (s1): 84–97\. doi:10.1046/j.1360-0443.97.s01.4.x. ISSN 0965-2140.
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". Journal of Consulting and Clinical Psychology. 78 (2): 200–211\. doi:10.1037/a0018912. ISSN 1939-2117. PMC 4246504. PMID 20350031.
21. ^ a b 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". Psychology of Addictive Behaviors. 31 (1): 117–129\. doi:10.1037/adb0000216. ISSN 1939-1501. PMID 27736146.

## External links

[edit]

* 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