A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

Abstract

This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classiFIed as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.

Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes

“…Dennis et al, 2004; Garner, Godley, et al, 2009; Godley et al, 2001), which is one of the most widely disseminated and implemented EBPs for adolescent substance use (Godley, Garner, Smith, Meyers, & Godley, 2011; Hunter, Ayer, Han, Garner, & Godley, 2014). A-CRA is a behavioral treatment based on a menu of 19 procedures (e.g., Happiness Scale, Goals, Communication, Problem-Solving, Caregiver Involvement), which therapists are trained to deliver during treatment sessions (Godley et al, 2001). As noted previously, research to develop EBMIs is quite limited, but the current study complements prior research by Keith and colleagues (2010), which developed and tested an organizational-level Fidelity of Implementation (FOI) measure for a nurse practitioner case management intervention.…”

“…Given that A-CRA is an EBP used for addressing adolescent substance use, the primary client outcome of interest was improvements in substance use. We also examined, however, improvements in emotional problems because A-CRA has also been shown to help with adolescents’ co-occurring emotional problems (Godley et al, 2014). …”

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change

“…Several highly innovative and effective practices and therapies for adolescents have emerged, including Multi-Dimensional Family Therapy (MDFT; Liddle, Rodriguez, Dakof, Kanski, & Marvel, 2005; Rowe & Liddle, 2006), Adolescent Contingent Reinforcement Approach (A-CRA; Godley et al, 2001; Dennis et al, 2004), Cognitive-Behavioral Therapy (CBT; Kaminer, Blitz, Burleson, & Sussman, 1998; Kaminer, Burleson, & Goldberger, 2002; Waldron et al, 2001), and Multisystemic Therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). These are often stand-alone, manualized interventions and are designed to be transportable with adequate training (Schoenwald & Hoagwood, 2001).…”

Racial matching and adolescent self-disclosure of substance use and mental health symptoms

“…Participants were assessed at baseline using the Global Appraisal of Individual Needs (Dennis et al, 2003) and had scheduled follow up sessions at 3, 6, and 12 months. Adolescents eligible for treatment received the Adolescent Community Reinforcement Approach (A-CRA) (Godley et al, 2001), and for those that needed on-going support to stay drug free after the initial 12 sessions, participants were offered A-CRA’s companion aftercare model, called Assertive Continuing Care (Godley, Godley, Dennis, Funk, & Passetti, 2007). This study was approved and monitored by the Institutional Review Board at the lead author’s institution.…”