The Adolescent Community Reinforcement Approach (A-CRA) is a developmentally-appropriate behavioral treatment for youth and young adults ages 12 to 24 years old with substance use disorders. A-CRA seeks to increase the family, social, and educational/vocational reinforces to support recovery. This intervention has been implemented in outpatient, intensive outpatient, and residential treatment settings. A-CRA includes guidelines for three types of sessions: individuals alone, parents/caregivers alone, and individuals and parents/caregivers together. According to the individual’s needs and self-assessment of happiness in multiple life areas, clinicians choose from a variety of A-CRA procedures that address, for example, problem-solving skills to cope with day-to-day stressors, communication skills, and active participation in positive social and recreational activities with the goal of improving life satisfaction and eliminating alcohol and substance use problems. Practicing new skills during sessions is a critical component of the skills training used in A-CRA. Every session ends with a mutually-agreed-upon homework assignment to practice skills learned during sessions. Often these homework assignments include participation in pro-social activities. Likewise, each session begins with a review of the homework assignment from the previous session.
Last reviewed: 2023
Intended Outcomes:
The goals of the Adolescent Community Reinforcement Approach (A-CRA) are:
- Promote abstinence from alcohol, marijuana, and other drugs
- Promote positive social activity
- Promote positive peer relationships and improved relationships with family
- Motivate caregiver participation in the A-CRA treatment process
- Promote the caregiver's support of the adolescent's abstinence from alcohol, marijuana, and other drugs
- Provide information to the caregiver about effective parenting practices
- Help the adolescent and caregiver(s) create a home and community environment conducive to recovery
- Teach the adolescent problem-solving, communication, and other important skills through the use of role-playing
Continuum of Care:
Treatment
Topic Areas:
Behavioral Health/Mental Health, Disruptive Behaviors, Substance Use
Ages:
Teen/Adolescent (13-18), Young Adult (19-24)
Geographic Locations:
Rural, Urban
Delivery Settings:
Community-Based, Congregate Care Facility, School-Based
Cultural Considerations:
A balanced amount of the research involved diverse populations
Audience:
This program is intended for youth and young adults ages 12 to 24 years old with substance use disorders.
Credentials:
In general, clinicians should have at least a Bachelor's degree in a clinical field, but those with Master's degrees and more clinical experience, especially in cognitive behavioral approaches, may have better preparation to learn the model. The quality of a clinician's general counseling skills (e.g., empathy, genuineness, etc.) and their willingness to learn a manualized approach, record their sessions, and receive and respond to feedback on their performance are critical to achieving model certification. Those pursuing certification as clinical supervisors in the model should have a Master's degree.
Manuals:
Yes
Is Training Required?
Yes, see developer info
Who can provide the required training?
Training is provided for both clinicians and supervisors via in-person and online formats. Please see program website for more information.
Program Costs (materials, training, etc.):
Yes, refer to program website
Program/Practice Website:
https://www.chestnut.org/ebtx/treatments-and-research/treatments/a-cra/
Relevant Published, Peer-Reviewed Research:
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Godley, S. H., Hedges, K., & Hunter, B. (2011). Gender and racial differences in treatment process and outcome among participants in the adolescent community reinforcement approach. Psychology of Addictive Behaviors, 25(1), 143.
Campos-Melady, M., Smith, J. E., Meyers, R. J., Godley, S. H., & Godley, M. D. (2017). The effect of therapists’ adherence and competence in delivering the adolescent community reinforcement approach on client outcomes. Psychology of Addictive Behaviors, 31(1), 117.
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.
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.
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.
Additional Sources:
https://www.cebc4cw.org/program/adolescent-community-reinforcement-approach/
https://www.chestnut.org/ebtx/treatments-and-research/treatments/a-cra/