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1. Adolescent Community Reinforcement Approach (A-CRA) and Assertive Continuing Care (ACC)

Godley, Susan H., Meyers, Robert J., Smith, Jane Ellen, Karvinen, Tracy, Titus, Janet C., Godley, Mark D., Dent, George, Passetti, Lora, Kelbert, Pamela. (Chestnut Health Systems)

The Adolescent Community Reinforcement Approach (A-CRA) is a comprehensive substance abuse treatment intervention that involves the adolescent and his or her family. It seeks to support the individual's recovery by increasing family, social, and educational/vocational reinforcers. After assessing the adolescent's needs and levels of functioning, the therapist chooses from among 17 A-CRA procedures to address problem-solving, coping, and communication skills and to encourage active participation in positive social and recreational activities. A-CRA skills training involves role-playing and behavioral rehearsal.

Assertive Continuing Care (ACC) is a home-based continuing-care approach to preventing relapse. Weekly home visits take place over a 12- to 14-week period after an adolescent is discharged from residential, intensive outpatient, or regular outpatient treatment. Using positive and negative reinforcement to shape behaviors, along with training in problem-solving and communication skills, ACC combines A-CRA and assertive case management services (e.g., use of a multidisciplinary team of professional, round-the-clock coverage, assertive outreach) to help adolescents and their caregivers acquire the skills to engage in positive social activities.

The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users.

Godley SH, Meyers RJ, Smith JE, et al. Cannabis Youth Treatment Series, vol. 4, DHHS Pub. No. (SMA) 01–3489. Rockville, MD: SAMHSA, 2001.

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Intervention Details:

Population studied:Adolescents
Drug studied:Applicable to most drug problems
Therapy format:Family
Therapy type:Cognitive-behavioral; Social/Coping skills
Delivery mode:Manual-driven
Outcomes:In a comparison of A-CRA, Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT) for adolescents, and Multi-Dimensional Family Therapy (MDFT), A-CRA participants were more likely to report total substance abstinence in the prior month and have a negative urine screen (24%) than MDFT participants (16%) and MET/CBT5 participants (21%) at 30-month follow-up. A-CRA was also found to be more cost-effective than either MET/CBT or MDFT ($4,460 per patient compared to 6,611 for MET/CBT and $11,775 for MDFT) (Dennis M et al, 2004).


Supporting References:

  1. McGarvey EL, Leon-Verdin M, Bloomfield K, Wood S, Winters E, Smith J. Effectiveness of A-CRA/ACC in Treating Adolescents with Cannabis-Use Disorders. Community Ment Health J 2012 (in press).
  2. Godley MD, Godley SH, Dennis ML et al. The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction 2007;102(1):81-93.
  3. Slesnick N., Prestopnik JL, Meyer RJ, Glassman M. Treatment outcome for street-living, homeless youth. Addictive Behaviors 2007;32(6):1237-1251.
  4. Dennis M, Godley SH, Diamond G, et al. The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment 2004;27(3):197-213.
  5. Godley MD, Godley SH, Dennis ML, et al. Preliminary outcomes from the Assertive Continuing Care experiment for adolescents discharged from residential treatment. Journal of Substance Abuse Treatment 2002;23:21-32.
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