Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

Abstract

Background This paper compares adolescents with primary opioid problem use (OPU) to those with primary marijuana or alcohol problem use (MAPU) who received up to six months of Adolescent Community Reinforcement Approach (A-CRA), an empirically supported treatment. Methods Intake clinical characteristics, treatment implementation measures, and clinical outcomes of two substance problem groups (OPU and MAPU) were compared using data from 1,712 adolescents receiving A-CRA treatment. Data were collected at intake and 3, 6, and 12 months post-intake. Results At intake, adolescents in the OPU group were more likely than those in the MAPU group to be Caucasian, older, female, and not attending school; report greater substance and mental health problems; and engage in social and health risk behaviors. There was statistical equivalence between groups in rates of A-CRA treatment initiation, engagement, retention, and satisfaction. Both groups decreased significantly on most substance use outcomes, with the OPU group showing greater improvement; however, the OPU group had more severe problems at intake and continued to report higher frequency of opioid use and more days of emotional problems and residential treatment over 12 months. Conclusions The feasibility and acceptability of A-CRA for OPUs was demonstrated. Despite significantly greater improvement by the OPU group, they did not improve to the level of the MAPU group over 12 months, suggesting that they may benefit from A-CRA continuing care up to 12 months, medication to address opioid withdrawal and craving, and the inclusion of opioid-focused A-CRA procedures.

Playing with Fire: The Relationship between Mental Disorders and Prescription Opioid Abuse in a Rural Juvenile Court Sample

“…Such findings are consistent with previous research that indicates that adolescents who abuse prescription opioids are more likely than their peers to have mental health problems (Godley et al, 2017), as well as to have specific mental health problems including depression (Edlund et al, 2015;Monnat & Rigg, 2015) and anxiety disorders (Welsh et al, 2017). An important implication of this research is that opioid abuse and mental health problems should not be considered separate issues because the two variables co-occur.…”

“…The misuse of these drugs is a gateway or stepping-stone to eventual heroin use (Carlson, Nahhas, Martins, & Daniulaityte, 2016). The vast majority of heroin users first abuse prescription opioids (Compton, Boyle, & Wargo 2015;Maxwell, 2015), and individuals who abuse prescription opioids are several times more likely than their peers to turn to heroin use (Vosburg et al, 2016).Unfortunately, the misuse of prescription opioids by secondary school students nationally is on the rise, and it has almost doubled over the course of the last decade (Godley et al, 2017).…”

“…Although there has not been a great deal of research focusing specifically on the relationship between adolescent opioid abuse and mental health problems, the limited body of literature on the subject suggests that the two are related. For instance, Godley et al (2017) found that young people who abuse prescription opioids generally have a greater degree of mental health problems than youths who abuse other substances, such as marijuana. Moreover, according to Monnat and Rigg (2015), the misuse of prescription opioids by juveniles is positively associated with experiencing a major depressive episode, as well as having a history of hospitalization for emotional problems.…”

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

“…In A-CRA, clinicians deliver tailored modules to the adolescent based on presenting concerns with the goal of helping adolescents develop a rewarding, non-substance use lifestyle [42]. It is feasible for adolescents with alcohol, cannabis, and/or opioid use disorders [43]. One study examined the utility of 10 weeks of A-CRA versus individualized CBT for adolescents who do not achieve abstinence during an initial 7 week MET/CBT treatment protocol [44].…”

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

“…In 2007, as part of a broad effort to improve the quality of care delivered within the USA (including greater implementation of EBTs), the Institute of Medicine recommended pay-for-performance (P4P) as a promising strategy to improve implementation of high-quality care [ 11 ]. This recommendation, combined with the limited empirical research evidence supporting P4P as a method to improve quality of care, motivated an experimental test of the effectiveness and cost-effectiveness of P4P as a strategy to improve the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA)—an EBT shown to be effective and cost-effective in treating SUDs for adolescents [ 12 – 18 ]. The rationale for using a cluster randomized trial design was that primary interest was to examine P4P as an organizational-level strategy, as well as that validity threats are possible from the randomization of patients within therapists (e.g., contamination) or of therapists within treatment organizations (e.g., compensatory rivalry and resentful demoralization).…”