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Adolescent Community Reinforcement Approach
The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral treatment for alcohol and other substance use disorders that helps youth and families improve access to environmental reinforcers to reduce or stop an adolescent’s substance use.〔Godley, S.H., Meyers, R.J., Smith, J.E., Godley, M.D., Titus, J.C., Karvinen, T., Dent, G., Passetti, L.L., & Kelberg, P. (2001). The Adolescent Community Reinforcement Approach (ACRA) for adolescent cannabis users (DHHS Publication No. (SMA) 01-3489, Cannabis Youth Treatment (CYT) Manual Series, Volume 4). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Retrieved from http://www.chestnut.org/li/cyt/products/acra_cyt_v4.pdf〕
==Description of A-CRA==
A-CRA is a variant of the adult CRA model, which has a history of development and effectiveness research starting in the 1970s.〔Meyers, R.J., Roozen, H.G., & Smith, J.E. (2011). The Community Reinforcement Approach: An update of the evidence. Alcohol Research and Health, 33(4), 380-388.〕 A-CRA was adapted to be developmentally appropriate for adolescents, which included adding sessions for parents/caregivers.〔Godley, S.H., Smith, J.E., Meyers, R.J., & Godley, M.D. (2009). Adolescent Community Reinforcement Approach (A-CRA). In D.W. Springer & A. Rubin (eds.), Substance abuse treatment for youth and adults (pp. 109-201). Hoboken, NJ: John Wiley & Sons.〕 The goal of A-CRA is to improve or increase access to social, familial, and educational/vocational reinforcers for adolescents to achieve and sustain recovery. That is, therapists assist adolescents with learning how to lead an enjoyable and healthy life without using alcohol or other drugs.〔Hunt, G.M., & Azrin, N.H. (1973). A community-reinforcement approach to alcoholism. Behavior Research and Therapy, 11, 91-104.〕 The treatment manual describes an outpatient curriculum that is intended for adolescents from 12 to 18 years of age with DSM-IV alcohol and/or other substance use disorders.〔 A-CRA also has been implemented in intensive outpatient and residential treatment settings.〔Godley, S.H., & Kenney, M. (2010). How to implement an outpatient evidence-based treatment in a residential program. The Counselor, 11, 10-16.〕〔Slesnick, N., Prestopnik, J.L., Meyers, R.J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32, 1237-1251.〕 A-CRA includes three types of clinical sessions: adolescent alone, parents/caregivers alone, and family (adolescent with parents/caregivers).〔 To address the adolescent’s needs, goals for treatment, and reinforcers, clinicians select from 18 A-CRA procedures (e.g., communication skills, problem-solving, and participation in positive social activities), all with the goal of improving life areas and supporting abstinence from alcohol and other drugs.〔Godley, S.H., Garner, B.R., Smith, J.E., Meyers, R.J., & Godley, M.D. (2011). A large-scale dissemination and implementation model. Clinical Psychology: Science and Practice, 18, 67-83.〕 Practicing skills during sessions is an important aspect of A-CRA counseling, and every clinical session ends with a homework assignment (mutually-agreed upon by adolescent and clinician) to apply skills learned during the session.〔〔 Clinicians practicing A-CRA are trained in all 18 procedures and complete an extensive certification process.〔 A-CRA has been widely implemented in the U.S.,〔 Canada,〔Dave Smith Youth Treatment Centre. (2010). Clinical programs. Retrieved March 6, 2012, from http://www.davesmithcentre.org/clinical-programs.html〕 and Brazil.〔Carvalho, R., Crepaldi, K., Oliveira, M., Anderson, L., Calfat, E., Mancilha, G., Nascimento, D., Katz, P., Filho, L., & Fraser, J. (2012, April). Strategies for A-CRA implementation in Brazil. Poster presentation at the 2012 Joint Meeting on Adolescent Treatment Effectiveness (JMATE), Washington, DC.〕
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