Adolescent Community Reinforcement Approach (A-CRA)

Intervention Basics

Adolescent Community Reinforcement Approach (A-CRA) is a behavioral intervention that uses a clinician and seeks to replace environmental contingencies that have supported alcohol or drug use with pro-social activities and behaviors that support recovery. A-CRA therapists choose from fifteen procedures that address the adolescent’s needs and self-assessment in multiple areas of functioning.

Goals of treatment sessions are as follows:

Adolescent Sessions

  • Promote abstinence
  • Promote positive social activities
  • Promote positive peer relationships
  • Promote improved familial relationships

Caregiver Sessions

  • Encourage participation in the recovery process
  • Promote the adolescent’s abstinence
  • Provide information on effective parenting

There are twelve standard procedures and three optional procedures. Delivery of the intervention is flexible based on the individual’s needs, although the manual provides guidelines regarding the general order of procedures.

Standard Procedures: 

  • Functional Analysis of Substance Use
  • Analysis of Pro-Social Behavior
  • Happiness Scale & Goals
  • Increasing Pro-Social Recreation
  • Relapse Prevention Skills
  • Communication Skills
  • Problem-Solving Skills
  • Urine Testing
  • Caregiver Overview, Rapport Building & Motivation
  • Caregiver Communication Skills
  • Caregiver-Adolescent Relationship
  • Treatment Closure

Optional Procedures: 

  • Dealing with Failure to Attend
  • Job-Seeking Skills
  • Anger Management
Expectation of Sessions:
Fourteen sessions (60 minutes each) over a three-month period, ten individual sessions with adolescent, two individual sessions with caregiver and two joint sessions. Community contact is added on a case-by-case basis. 

Recommended Populations

  • Youth ages 12 – 18 
  • Girls & Boys
  • American Indian or Alaska Native; Asian; Black or African American; Hispanic or Latino; and White
  • Outpatient; Home; Other community settings
  • Urban; Suburban; Rural and/or frontier

Special Considerations for Juvenile Drug Courts

A-CRA may be helpful in engaging/involving the family in juvenile drug court because the intervention itself relies on family involvement. The judge should be clear about this element of the approach and encourage the treatment provider to use these sessions to reinforce family involvement with the youth in the juvenile drug court.  A-CRA, along with MET/CBT 5, produced the lowest cost per youth in recovery at 12 months post-intake. If this intervention is chosen, it will be useful to consider also incorporating Assertive Continuing Care (ACC), which will help the JDC team to incorporate case management in a meaningful and seamless way. Advantages to this approach have been demonstrated in several clinical trials and reduce early relapse which in turn increases the chances of abstinence at 12 months post-intake. For information, visit Chestnut Health Systems' website. 
 
The A-CRA protocol calls for a very regimented and rigorous training program for therapists to achieve certification. The treatment organization should engage in a "readiness for change" evaluation to measure the readiness of the program and the therapists to adopt this approach. The training and skill level of the therapists should be assessed to ensure a good fit with the model. 

Engagement Strategies 

Throughout the process, JDC team members should continue to engage youth regarding any goals associated with their treatment plans. Because A-CRA generally lasts three months, it is recommended that the judge and other team members continually speak with the youth about the ongoing commitment to the goals they have achieved. 
 
While there are sessions for family/caregivers incorporated in the protocol, it is imperative that the court make family engagement a priority, as well. Remove barriers (i.e., alleviate any transportation issues) and provide incentives for family/caregivers to participate in treatment sessions. Families/caregivers who do engage, report satisfaction with the program and their engagement has led to better outcomes for youth in juvenile drug courts.  

Implementation and Training

Visit Chestnut Health Systems to research costs and training opportunities.
 
 
 
For more detailed information regarding research and replications associated with A-CRA, visit: