Six Month Outcomes of a Peer-Enhanced Community Reinforcement Approach for Emerging Adults with Substance Misuse: A Preliminary Study

Abstract

Little substance use disorder (SUD) treatment research with emerging adults ages 18–25 has been done in community settings, and it is well-known that peers influence emerging adult substance use. The purpose of this study was to develop and test the feasibility of a peer-enhanced behavioral treatment for emerging adults with substance use problems. Emerging adults (n = 35) received a peer-enhanced version of the Community Reinforcement Approach (Peer-CRA), in which their peers (n = 34) were trained to provide alcohol-specific social support. Both identified clients and peers were interviewed at treatment intake, and again three and six months later. Six month outcomes included days of abstinence adjusted for controlled environment days, social costs due to substance use, and binge drinking days in the past 90 days. Treatments were delivered with high fidelity, and a high proportion of participants were retained in treatment and follow-up assessments. Growth curve analyses revealed that emerging adults and their peers significantly increased their days of abstinence and reduced their binge drinking over time. Larger randomized trials should a) test whether peer-enhanced treatments are efficacious relative to treatment as usual, b) investigate whether secondary benefits exist for non-treatment seeking peers supporting another’s treatment, and c) examine whether proposed mechanisms of change (i.e., peer support and peer reductions in substance use) account for any differences in outcomes.

Effects of Social Support and 12-Step Involvement on Recovery among People in Continuing Care for Cocaine Dependence

“…One empirical study by Smith and colleagues (2016) tested the efficacy of a CRAFT-based treatment for peers of emerging adults receiving SUD treatment (Peer-CRA). The program incorporates motivational interviewing, cognitivebehaviorally based individual and joint sessions, and specific information for the peer regarding skills to reengage the individual with substance use problems in treatment (Smith et al, 2016). Findings revealed increased days of abstinence and decreased binge drinking compared to baseline reports for both the patient and the peer, suggesting the benefit of this emerging adult program (Smith et al, 2016).…”

“…The program incorporates motivational interviewing, cognitivebehaviorally based individual and joint sessions, and specific information for the peer regarding skills to reengage the individual with substance use problems in treatment (Smith et al, 2016). Findings revealed increased days of abstinence and decreased binge drinking compared to baseline reports for both the patient and the peer, suggesting the benefit of this emerging adult program (Smith et al, 2016). Another model to enhance social support in adult populations with SUDs employed a "Community Support Group" which incorporated drug-free friends and family members into an outpatient methadone program to help build sober social support (Kidorf, Brooner & King, 1997).…”

Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study

“…In 2 prior studies, the authors adapted the CRAFT model for use with peer dyads [ 21 , 22 ]. At its core, CRAFT is a behavioral family therapy model for the CSOs of individuals with substance use disorders [ 7 ], and most research on CRAFT targets spouses.…”

“…Thus, the peer dyad version of CRAFT, called the Peer-Enhanced Community Reinforcement Approach (Peer-CRA), de-emphasized this feature, which appears more suitable for those in romantic and cohabitating relationships. In addition, in a preliminary study, both peers and EAs with substance use problems who received Peer-CRA significantly reduced their substance use [ 22 ]. Despite promising findings, one issue in a previous face-to-face study was that most peers only attended 1 session and did not receive the full CRAFT model as planned.…”

Mobilizing community support in people receiving opioid-agonist treatment: A group approach

“…Because many people with opioid use disorder do not have drug-free romantic partners, perhaps a more practical strategy for including drug-free support is a community reinforcement approach (CRA; Azrin, Sisson, Meyers, & Godley, 1982). CRA utilizes available network support to increase social reinforcement through participation in family interactions and community activities (Meyers et al, 2011), and recent work with adolescents and emerging adults is encouraging (Godley et al, 2017; Kirby et al, 2017; Smith, Davis, Ureche, & Dumas, 2016).…”