The Adolescent Community Reinforcement Approach (A-CRA)

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:

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/

Promising rating

WV Rating:
Promising
»WV Ratings Info

Rationale for Rating:

The research is promising; however, the outcome success seems to be short-lived and contingent upon clinician's skillset. More favorable outcomes were shown with males vs. females. More favorable outcomes were significant when caretakers were also included in the treatment. It was difficult to ascertain whether the intervention had a significant impact when the adolescent was involved with the legal system or if other factors such as legal supervision impacted success. Short-term success was significant; however, long-term success has not been promising.

Contraindications or Concerns:
None identified

Other Registries/Ratings

The California Evidence-Based Clearinghouse for Child Welfare:
Promising Research Evidence

Blueprints for Healthy Youth Development:
Not On Registry

Clearinghouse for Military Family Readiness:
Unclear 0

Office of Juvenile Justice and Delinquency Prevention Model Programs Guide:
Promising - More than one study

Washington State Institute for Public Policy:
Found on the registry. See link for more information.

Washington State Institute for Public Policy Registry Link:
http://wsippweb-prod.us-west-2.elasticbeanstalk.com/BenefitCost/Program/261