Topic: Alcohol/Drugs/Tobacco, Social Competency
Target Population: Adolescents, Young Adults
Sector: Community-Based
This program is for adolescents and young adults who are 12 to 24 years old and have substance use and/or abuse disorders and their parents or caregivers.
Adolescent Community Reinforcement Approach (A-CRA), a community-based program, is designed to promote youth’s abstinence from substance use and assist them in the recovery from substance-use disorders by strengthening family, social, and educational or vocational supports.
Results from trials of A-CRA have been mixed. In a randomized trial that compared A-CRA with two other treatment programs for adolescents with cannabis disorders, A-CRA was found to lead to an increased number of days abstinent from cannabis and an increased number of individuals in recovery. However, another study that examined latency to first episode of opioid use among adolescents and young adults found that, overall, those receiving A-CRA had a significantly greater hazard rate for latency to opioid use compared with youth assigned to motivational enhancement therapy combined with cognitive behavioral therapy (MET/CBT), CBT alone, or treatment as usual (TAU). Specifically, adolescent males receiving TAU or A-CRA had greater hazard rates for latency to opioid use, compared to those receiving MET/CBT or CBT alone, and young adult males receiving A-CRA had a higher hazard rate than those receiving TAU, MET/CBT, or CBT alone. In a randomized controlled trial of homeless youth with a substance-use disorder, adolescents who participated in the program demonstrated greater decreases in drug use, depression, and internalizing behavior and greater increases in social stability than adolescents in the control group. However, another study was conducted in which stably housed and homeless youth with a substance-use disorder completed A-CRA, MET/CBT, or TAU, and results indicated small but significant increases in substance use in the 9 months after treatment for homeless youth who had completed A-CRA.
A-CRA intends to promote youth abstinence, encourage positive social experiences, foster healthy peer and family relationships, enhance life satisfaction, create a home environment that promotes and sustains recovery, and teach parents/caregivers how to support their child's recovery and abstinence. Three types of sessions can be implemented with the A-CRA program:
Therapists select from various A-CRA procedures that address multiple areas of functioning based on the participant's needs and level of happiness. For example, role-playing or behavioral rehearsal is an important component of A-CRA and is utilized during sessions to practice refusal, problem-solving, anger-management, and communication skills. Homework activities are assigned at the end of every session and provide youth with additional practice of the skills addressed during sessions. Homework activities are agreed upon by the therapist and participant and are reviewed at the beginning of every session.
Treatment manuals are available in English, Dutch, French, Spanish, and Portuguese.
Since the early 2000s, A-CRA has been delivered by over 470 organizations in the United States and internationally.
This program is facilitated by clinicians who have a minimum of a bachelor's degree in a clinical field. An initial, mandatory, 2.5-day workshop is offered to clinical staff and supervisors. Certification is also required via online courses and coaching calls. For more information on training and costs, please visit https://www.chestnut.org/ebtx-contact-us
Considerations for implementing this program include acquiring participant buy-in and commitment, recruiting therapists who have a suitable background and ensuring they receive training, and locating space to hold sessions.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing A-CRA, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
The program consists of weekly 50- to 90-minute sessions that are delivered over 3 months.
Implementation costs include personnel salaries, materials and supplies, contracted services, buildings and facilities, equipment, and miscellaneous items. French et al. (2002) assessed costs and found that cost per completed treatment episode was $1,237 at one site and $1,608 at another site.
To move A-CRA to the Promising category on the Clearinghouse Continuum of Evidence, one to two additional evaluations must be conducted that demonstrate sustained, positive effects with no negative outcomes.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact the EBTxProject Coordination Team by phone 1-309-451-7700, email ebtxquestions@chestnut.org, or visit https://www.chestnut.org/ebtx-contact-us
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