Program

Aug 13, 2013

OVERVIEW

The Adolescent Community Reinforcement Approach (A-CRA) is an outpatient, behavioral intervention for providing continuing care for adolescents, youth, and young adults who have received residential treatment for substance use disorders.  The goal of the program is patient recovery from the disorder.  In an evaluation of the program, adolescents in the A-CRA condition experienced significantly greater linkage to and retention in continuing care, significantly better adherence to care criteria, and longer abstinence from marijuana than did adolescents receiving usual care.  However, there were no differences in abstinence from alcohol or other drugs. In another evaluation, youth in the A-CRA condition had significant declines in drug use, depression, and internalizing behavior.  No differences were found in coping, alcohol use, risk behaviors, or externalizing behavior.

DESCRIPTION OF PROGRAM

Target population:  Individuals between the ages of 12 and 22 in residential treatment for substance use disorders

The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral, outpatient intervention for adolescents, youth, and young adults who have completed a residential care program for substance use disorders.  The program is designed to encourage recovery and abstinence from substance use, and to promote linkage to, and participation in, continuing care services.

In the A-CRA program, the patient’s therapist selects procedures and treatments that are tailored to the individual’s needs.  Seventeen different skills-training topics are available, including problem-solving, coping with day-to-day stressors, communication skills, and active participation in pro-social activities.  Role-playing and behavioral rehearsal are critical components of the skills-training sessions.

The average cost of implementing the treatment is between $1,200 and $1,600 per person.  The cost includes personnel, materials and supplies, contracted services, buildings and facilities, equipment, and miscellaneous items.  The program manual can be found here: www.bhrm.org/guidelines/CRAmanual.pdf.

EVALUATIONS OF PROGRAM

Dennis, M., Godley, S.H., Diamond, G., Tims, F.M., Babor, T., Donaldson, J., Liddle, H., Titus, J.C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004). The cannabis youth treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197-213.

Evaluated Population: Adolescents aged 12 to 18 were eligible for recruitment if they self-reported one or more DSM-IV criteria for cannabis abuse or dependence, had used cannabis in the past 90 days and were appropriate for outpatient treatment. Six-hundred adolescents met these criteria and, with the consent of their parents, participated. The participants were 83 percent male, 61 percent white, and 30 percent African American. The interventions took place in treatment provider centers in Florida, Pennsylvania, and Illinois.

Approach: The participants were divided into five treatments based on random selection. One-hundred two participants were placed in the Motivational Enhancement Treatment/Cognitive Behavior Therapy (MET/CBT5). This five-session treatment seeks to show adolescents that the costs of using cannabis outweigh the benefits. Ninety-six participants were placed in Motivational Enhancement Treatment/Cognitive Behavior Therapy (MET/CBT12). This treatment added seven additional sessions to the MET/CBT5 in hopes of teaching adolescents coping skills as well as addressing problem-solving, anger management, and communication skills. One-hundred two participants were placed in the Family Support Network (FSN). This treatment aims to educate parents on adolescent problems and family functioning as well as proving adolescents with substance abuse treatment. One-hundred participants were selected to the Adolescent Community Reinforcement Approach (ACRA) using operant conditioning, skills training and a social systems approach with both the adolescent and the caregiver. The final 100 adolescents were selected to Multidimensional Family Therapy (MDFT) which lasted 12 to 15 sessions and was focused on the link between drug and problem behavior and changes in parenting practices.

Data were collected on (list the outcomes measured rather than the methods used). The data was collected at intake, and at 3-, 6-, 9- and 12-months post-baseline.

Results: No significant difference was found between treatments in terms of total days of abstinence. MET/CBT5 had the highest percent in recovery (27 percent), but this was not statistically significant. When comparing cost with results, MET/CBT5 was found to be the most effective and least expensive.

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (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, 81-93.

Evaluated population: A total of 183 adolescents between the ages of 12 and 17 receiving residential treatment for substance use or dependence disorders and residing in Central Illinois served as the sample for this study.  Seventy-one percent were male, 73 percent  were Caucasian, 18 percent were African-American, 45 percent were between the ages of 17 and 18, 37 percent had not completed school beyond the eighth grade, 89 percent were unemployed, 33 percent were from two-parent families, and 82 percent had prior involvement with the juvenile justice system.

Approach:  Prior to discharge from residential treatment, participants were randomly assigned to receive one of the following two treatments:  Assertive Continuing Care (ACC) with an A-CRA component (N=?), or 2) Usual Continuing Care (UCC), which served as the control condition (N=?).  At discharge, adolescents in the UCC condition received referrals to outpatient providers of continuing care.  Adolescents in the ACC condition received the same continuing care referrals as the adolescents in the UCC condition.  Additionally, these adolescents were assigned to a case manager for a 90-day period following residential treatment discharge.  During this 90-day period, the case managers met weekly with the adolescents and/or their caregivers.

The case managers used both standard case management techniques and the A-CRA therapy techniques in their intervention for the adolescents in the ACC condition.  Case management services included the following: 1) home visits, 2) help linking the adolescents to necessary services, 3) transportation to needed services, 4) advocacy for the client to access services when needed, 5) monitoring lapse cues and attendance at other needed services and activities, and 6) social support for coping with a lapse or other challenging issue.

Data were collected on (list the outcomes measured) at three, six, and nine months after residential treatment discharge.

Results:  Results indicated that adolescents in the ACC condition experienced significantly greater continuing care linkage and retention, significantly better adherence to continuing care criteria, and longer abstinence from marijuana than adolescents receiving usual care (ES=0.32).  However, there were no differences in abstinence from alcohol or other drugs between the two groups of adolescents.

Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth.  Addictive Behaviors, 32, 1237-1251.

Evaluated population:  A total of 180 street-living, homeless youth between the ages of 14 and 22 in the Albuquerque metropolitan area who met the drug, alcohol, and psychosis criteria served as the sample for this study.  The average age of youth was 19.2 years; 66 percent were male, 41 percent were Caucasian, 30 percent were Hispanic/Latino, 13 percent were Native American, 12 percent were mixed ethnicity/race, three percent were African American, and one percent were Asian. At baseline, only 12 percent of youth were enrolled in school, and 39 percent reported accessing any type of shelter or mission services within the prior three months.

Approach:  Youth at a drop-in center for homeless youth were randomly assigned to Community Reinforcement Approach, CRA, (N=96), or the control group, who received treatment as usual (N=84). .

Youth assigned to the CRA intervention were offered 12 therapy sessions, and four sessions that covered AIDS education and assessment of risk, risk reduction, and skills practice. These sessions were adapted from Becoming a Responsible Teen. Youth assigned to the control group were offered the standard services provided at the drop-in center, which included a place to rest, obtain food, access showers and laundry facilities, and to obtain support from case management who linked the youth with community resources at their request.

Youth were evaluated at six months after the baseline assessment. Initially, the intervention was designed to be completed in three months, but due to the instability in the lives of the youth participating in the study, the time frame for the intervention was increased to six months. The wider time frame enabled most youth to complete the intervention.

The outcomes assessed at baseline and six-month follow-up were alcohol and drug use, high-risk behaviors, depression, coping, internalizing and externalizing problems, delinquency, and social stability (days in work, education, housing, and medical care). Youth in the control group and the intervention group did not differ in any demographic characteristics at baseline, except for number of other substance use diagnoses: the control group had a higher number of diagnoses than did those in the CRA intervention.

Results:  Youth in the CRA condition had greater declines in drug use (ES=0.35), depression (ES=0.35), and internalizing behavior (ES=0.41) than those in the control group. They also had a marginally greater increase in social stability, and a decrease in delinquency, though these differences were not statistically significant. There were no differences in coping, alcohol use, risk behaviors, or externalizing behavior.

SOURCES FOR MORE INFORMATION

References

Dennis, M., Godley, S.H., Diamond, G., Tims, F.M., Babor, T., Donaldson, J., Liddle, H., Titus, J.C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004). The cannabis youth treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197-213.

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (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, 81-93.

Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth.  Addictive Behaviors, 32, 1237-1251.

Contact Information

Brandi Barnes

EBT Coordinator

Chestnut Health Systems, Inc.

720 West Chestnut Hill St.

Bloomington, IL 61701

bbarnes@chestnut.org

(309) 820-3543

KEYWORDS: Adolescence (12-17), Youth (16+), Young Adults (18-24), Males and Females (Co-ed), High Risk, Clinic/Provider-based, Cost Information is Available, Manual is Available, Counseling/Therapy, Skills Training, Substance Use, Alcohol Use, Marijuana/Illicit/Prescription Drugs, Depression/Mood Disorders, Other Mental Health, Other Behavior Problems

Program information last updated on 8/13/2014.