Adolescent Community Reinforcement Approach

Substance Use Prevention or Treatment Promising

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 Review Process page or download the Handbook.

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.

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.

Contact Information for Developers

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

Phone: (309) 451-7800

Email: mgodley@chestnut.org    

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
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.

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
-
Henderson, 2016
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.

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.

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


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

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10907

Kaminer, Y., Ohannessian, C., & Burke, R. (2019). Retention and treatment outcome of youth with cannabis use disorder referred by the legal system. Adolescent Psychiatry, 9(1), 4-10. https://doi.org/10.2174/2210676608666181102145040

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10908

Slesnick, N., Erdem, G., Bartle-Haring, S., & Brigham, G. S. (2013). Intervention with substance-abusing runaway adolescents and their families: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 81(4), 600-614. https://doi.org/10.1037/a0033463

Slesnick, N., Guo, X., & Feng, X. (2013). Change in parent-and child-reported internalizing and externalizing behaviors among substance abusing runaways: The effects of family and individual treatments. Journal of Youth and Adolescence, 42(7), 980-993. https://doi.org/10.1007/s10964-012-9826-z

Guo, X., Slesnick, N., & Feng, X. (2014). Reductions in depressive symptoms among substance-abusing runaway adolescents and their primary caretakers: A randomized clinical trial. Journal of Family Psychology, 28(1), 98-105. https://doi.org/10.1037/a0035380

Guo, X., Slesnick, N., & Feng, X. (2016). Changes in family relationships among substance abusing runaway adolescents: A comparison between family and individual therapies. Journal of Marital and Family Therapy, 42(2), 299-312. https://doi.org/10.1111/jmft.12128

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10909

Slesnick, N., Guo, X., Brakenhoff, B., & Bantchevska, D. (2015). A comparison of three interventions for homeless youth evidencing substance use disorders: Results of a randomized clinical trial. Journal of Substance Abuse Treatment, 54, 1-13. https://doi.org/10.1016/j.jsat.2015.02.001

Zhang, J., & Slesnick, N. (2018). Substance use and social stability of homeless youth: A comparison of three interventions. Psychology of Addictive Behaviors, 32(8), 873-884. https://doi.org/10.1037/adb0000424

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).

Study 10911

Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32(6), 1237-1251. https://doi.org/10.1016/j.addbeh.2006.08.010

This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).