Adolescent Community Reinforcement Approach

The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral intervention that aims to support adolescents and young adults with substance use disorders. The treatment aims to support adolescents’ substance use recovery by encouraging positive family and peer relationships and helping adolescents engage in prosocial activities. A-CRA includes guidelines for three types of sessions: adolescents alone, caregivers alone, and adolescents and caregivers together. In accordance with the adolescent’s needs and self-assessment of happiness in multiple life areas, A-CRA sessions typically focus on increasing engagement in pre-recovery activities, developing problem-solving, communication, and other important skills with the goal of improving life satisfaction and eliminating alcohol and substance use problems. As part of these sessions, clinicians and participants mutually agree on homework assignments to practice and review skill development.

A-CRA is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.

Date Research Evidence Last Reviewed: Dec 2020

Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, the program or service developer’s website, the program or service manual, and the studies reviewed.

This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the download the Handbook of Standards and Procedures, Version 1.0

Target Population

A-CRA is designed to support adolescents and young adults between the ages of 12 and 24 years old with substance use disorders.

Program or Service Delivery and Implementation

Dosage

At a minimum, A-CRA treatment is usually delivered in weekly hour-long sessions over 12 to 14 weeks. Clinicians may also contact participants in between sessions to offer encouragement. Participants typically participate in at least 10 individual sessions that last for 60-minutes each. They also participate in 2 or more 90-minute sessions with their parent(s)/caregiver(s). The parent(s)/caregiver(s) also typically attend at least 2 or more hour-long sessions without the adolescent present. Additional individual, family, or caregiver sessions can be added as clinically indicated or desired by client and caregivers. When appropriate, other significant people in the adolescent/young adult’s life may join the sessions (e.g., other caregivers, friends, and partners).

Location/Delivery Setting

Recommended Locations/Delivery Settings

A-CRA is typically delivered in outpatient, intensive outpatient, and residential treatment sessions. A-CRA is frequently implemented in participants’ homes or community based sites such as juvenile detention centers, group homes, and schools.

Location/Delivery Settings Observed in the Research

Home
Juvenile Probation Office

Education, Certifications and Training

Clinicians and supervisors are required to complete a 2.5 day training workshop to become certified in A-CRA. Supplemental training courses are also available online. Clinicians and supervisors who are seeking certification participate in periodic coaching calls. Model experts review clinicians’ video-recorded sessions uploaded to a secure web-based system and provide feedback on model fidelity.

To implement A-CRA, it is recommended that clinicians should have either (1) a bachelor’s degree in counseling or a related field and at least two years of experience, or (2) a master’s degree in counseling or a related field. It is also recommended that clinicians have experience with behavioral and/or cognitive behavioral treatment approaches, working with adolescents/young adults, and/or treating individuals with substance abuse problems.

Program or Service Documentation

Book/Manual/Available documentation used for review

Godley, S. H., Smith, J. E., Meyers, R. J., & Godley, M. D. (2016). The Adolescent Community Reinforcement Approach: A clinical guide for treating substance use disorders. Chestnut Health Systems.

Available languages

Manuals for A-CRA are available in English, Dutch, French, Portuguese, and Spanish.

For More Information

Website: http://ebtx.chestnut.org/Treatments-and-Research/Treatments/A-CRA

Phone: (309) 451-7800

Email: mgodley@chestnut.org

Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Extent of Evidence

Results of Search and Review	Number of Studies Identified and Reviewed for Adolescent Community Reinforcement Approach
Identified in Search	10
Eligible for Review	2
Rated High	0
Rated Moderate	1
Rated Low	1
Reviewed Only for Risk of Harm	0

Summary of Findings

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings
Child well-being: Substance use	0.49 18	1 (4)	124	Favorable: 3 No Effect: 1 Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Individual Study Findings

Outcome	Effect Size and Implied Percentile Effect	N of Studies (Findings)	N of Participants	Summary of Findings	Months after treatment when outcome measured
Child well-being: Substance use	0.49 18	1 (4)	124	Favorable: 3 No Effect: 1 Unfavorable: 0	-
Study 10904 - Adolescent-Community Reinforcement Approach (A-CRA) vs. Services As Usual (Henderson, 2016 - Not conducted in a usual care or practice setting)
Global Appraisal of Individual Needs: Substance Problem Scale	0.46 * 17	-	124	-	0
Global Appraisal of Individual Needs: Substance Problem Scale (% No Substance Problems)	0.53 * 20	-	124	-	0
Global Appraisal of Individual Needs: Substance Frequency Scale (% No Substance Use)	0.69 * 25	-	124	-	0
Global Appraisal of Individual Needs: Substance Frequency Scale	0.29 11	-	124	-	0

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Study Participant Characteristics

The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.

The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.

For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.

Characteristics of the Participants in the Studies with Moderate or High Ratings
Study Location	Study Year	Age or Grade-level	Race, Ethnicity, Nationality	Gender	Populations of Interest*	Household Socioeconomic Status
Study 10904 - Adolescent-Community Reinforcement Approach (A-CRA) vs. Services As Usual
Characteristics of the Children and Youth
Texas, USA	2008	Average age: 15 years; Age range: 12-17 years	79% White, Non-Hispanic 76% Caucasian/White 14% Hispanic 6% Black/African American 4% Other 1% Asian	76% Male 24% Female	100% Youth were under community supervision of the local juvenile probation department; 88% Alcohol and/or other drug abuse/dependence, 54% Conduct disorder, 44% ADHD, 43% Depressive disorder, 14% Generalized anxiety disorder (GAD)	--

“--” indicates information not reported in the study.

* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.

Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.

Studies Reviewed

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Moderate

Study 10904

Henderson, C. E., Wevodau, A. L., Henderson, S. E., Colbourn, S. L., Gharagozloo, L., North, L. W., & Lotts, V. A. (2016). An independent replication of the Adolescent‐Community Reinforcement Approach with justice‐involved youth. The American Journal on Addictions, 25(3), 233-240. https://doi.org/10.1111/ajad.12366

Some contrasts that received a moderate or high design and execution rating in this study were not from research conducted in a usual care or practice setting (Handbook Section 6.2.2) [see Individual Study Findings section above for additional information on contrasts that did or did not meet this criterion]

Studies Rated Low

Study 10901

Davis, J. P., Prindle, J. J., Eddie, D., Pedersen, E. R., Dumas, T. M., & Christie, N. C. (2019). Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design. Journal of Consulting and Clinical Psychology, 87(10), 941-951. https://doi.org/10.1037/ccp0000406

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.

Studies Not Eligible for Review

Study 10902

Dennis, M., Titus, J. C., Diamond, G., Donaldson, J., Godley, S. H., Tims, F. M., Webb, C., Kaminer, Y., Babor, T., Roebuck, M. C., Godley, M. D., Hamilton, N., Liddle, H., Scott, C. K., & C. Y. T. Steering Committee. (2002). The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans. Addiction, 97, 16-34. https://doi.org/10.1046/j.1360-0443.97.s01.2.x

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(3), 197-213. https://doi.org/10.1016/j.jsat.2003.09.005

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10903

Garner, B. R., Godley, S. H., Funk, R. R., Dennis, M. L., Smith, J. E., & Godley, M. D. (2009). Exposure to adolescent community reinforcement approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome. Journal of Substance Abuse Treatment, 36(3), 252-264. https://doi.org/10.1016/j.jsat.2008.06.007

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10905

Hunter, B. D., Godley, S. H., Hesson-McInnis, M. S., & Roozen, H. G. (2014). Longitudinal change mechanisms for substance use and illegal activity for adolescents in treatment. Psychology of Addictive Behaviors, 28(2), 507-515. https://doi.org/10.1037/a0034199

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10906

Kaminer, Y., Ohannessian, C. M., & Burke, R. H. (2017). Adolescents with cannabis use disorders: Adaptive treatment for poor responders. Addictive Behaviors, 70, 102-106. https://doi.org/10.1016/j.addbeh.2017.02.013