Adolescent community reinforcement approach

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The adolescent community reinforcement approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth and families improve access to environmental reinforcers to reduce or stop an adolescent's substance use.

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Description

A-CRA is a variant of the adult CRA model, which has a history of development and effectiveness research starting in the 1970s. A-CRA was adapted to be developmentally appropriate for adolescents, which included adding sessions for parents/caregivers. 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. 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. A-CRA also has been implemented in intensive outpatient and residential treatment settings. A-CRA includes three types of clinical sessions: adolescent alone, parents/caregivers alone, and family (adolescent with parents/caregivers). 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. 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. Clinicians practicing A-CRA are trained in all 19 procedures and complete an extensive certification process. A-CRA has been widely implemented in the U.S., Canada, and Brazil.

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Evidence-based outcomes

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. 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. Within its study arm, A-CRA was the most cost-effective model. Additional randomized clinical trials have shown A-CRA to be effective for homeless, street-living youth and young adults, youth with juvenile justice involvement, and as a continuing care approach for adolescents after residential treatment.

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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.

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Treatment manuals

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

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See also

• Behavior therapy
• Behaviorism
• Cognitive behavioral therapy
• Community reinforcement and family training

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Notes

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External links

• A-CRA/ACC
• Chestnut Health Systems
• RJM & Associates
• A-CRA on NREPP
• A-CRA on CEBC

Source of the article : Wikipedia