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Adolescent Community Reinforcement Approach (ACRA). “An Evidence Based Model and Beyond” The Center for Drug-Free Living, Inc. December 13, 2010 Rick Hankey Jeremy Long Angie Maldonado. Adolescent Community Reinforcement Approach Basic Model (ACRA).
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Adolescent Community Reinforcement Approach (ACRA) “An Evidence Based Model and Beyond” The Center for Drug-Free Living, Inc. December 13, 2010 Rick Hankey Jeremy Long Angie Maldonado
Adolescent Community Reinforcement Approach Basic Model (ACRA) • Interventions are focused on rearranging environmental contingencies so that sober behavior is more rewarding than using behavior. • Therapists teach adolescents how to find new reinforcers or enhance existing ones • Adolescents taught to use existing community resources that support positive change • Adolescents encouraged to develop a positive support system with their family and peers • 6-Month Program
Target Population • Adolescents • Between the ages of 12 and 18 • Cannabis/Alcohol Abuse or Dependence • Facing disciplinary action in school and/or are involved in the Juvenile Justice System • Experiencing emotional, physical, legal, social or academic problems associated with marijuana and/or alcohol
ACRA and Beyond – The How • In-Home/community based treatment • Innovative sessions with the youth via phone and texting • Family, Parent and Significant other counseling sessions where convenient for the client • Involving the youth in community-based activities • Sobriety Sampling • Involving school and probation in client activities • Follow-up interviews at 3,6, and 12-months post treatment
CORE F/A of substance use F/A of pro-social behavior Happiness scale Goals of counseling Problem solving Communication skills Caregiver/adolescent relationship skills Homework ADDITIONAL Overview of ACRA Sobriety sampling Drink/Drug refusal skills Anger management Caregiver overview Systematic encouragement Relapse prevention Increasing pro-social recreation Job seeking skills ACRA Procedures
ACRA Procedures: Examples • Happiness Scale • Sobriety Sampling
Happiness Scale • Introduce scale to client and provide a rationale: • Scale aids them in seeing how satisfied they are in particular areas of their life. • Aids client in identifying what areas of life they wish to address in treatment. • Allows the therapist and client to monitor client’s progress over time.
Happiness Scale • After providing rationale for why you and client are using the scale, give instructions (tell them to circle use/ non-use) • Review some ratings with them.
Substance use Relationship w/ girlfriend/ boyfriend Relationship w/ friends Relationship w/ caregivers School (or work) School activities Social life/ recreation Personal habits Legal issues Money management Feelings Communication Job General happiness Other Happiness Scale
Why is it important? • Client to pick current satisfaction in each area • Counselor investigates which areas client wishes to work on • Set goals to increase happiness
Sobriety Sampling • Chose which reinforcer is most important for your client: • This allows client to set goals that are reasonable and attainable • Once they reach the goal it teaches client self-efficacy • The period of non-use allows client to experience the sensation of being sober
Sobriety Sampling • Old habits are disrupted, allows for replacing them with positive coping skills • Aids in building family support and builds trust • Aids in identifying areas where relapse may occur and allows client and counselor to address those areas
Sobriety Sampling • Next step: The Negotiation • Start with suggesting a LONG period (90 Days ) • Connect reasons for a long period such as client’s reinforcers or a high relapse time • Expect client to negotiate for less time • Compromise on a period of time • Be sure that time period extends at least to the next session
Sobriety Sampling • Final Step: Plan for time-limited sobriety • Aid client in identifying biggest threats to them maintaining their sobriety • Select alternative coping strategies • Develop back-up plans with client • Load up on sessions after sobriety contract is reached • Text as often as necessary to check on client and goals
Assertive Continuing Care (ACC) • Is a continuing care intervention specifically designed for adolescents following a period of residential or outpatient treatment • Clinicians rather then adolescents are responsible for making sure sessions occur • Face-to-face sessions are in places convenient to the client • Case management functions include advocacy, barrier reduction, and follow-up to assure clients are linked to needed services
Our own ACC… • Offered Transportation for client and families for appointments • Pro-social Activities continue… • Offered snacks and more… • Job seeking skills • Paid for GED test/classes • Securing other resources for clients and their families (food, bus pass, clothes)
Our ingredients for success • Ropes Training • High/low elements • Kayaking/canoeing/surfing • Connectedness • Client and counselor engagement • Successful retention—87% • Partners to include: • School counselors and teachers • Probation officers and others
How Do We Know ACRA Worked? • Reduction in school/employment issues • Increase in family/social relationships • Decrease in risky behaviors • Increase in abstinence • Increase in GAF Scores • Overall improvement in several domains (legal, housing, health (behavioral and physical), and increase in prosocial activities
Resources for ACRA • The adolescent Community Reinforcement Approach for Adolescent Cannabis Users Manual is available to download for free at: • http://www.health.org • Other Websites with relevant information can be found at: • http://www.chestnut.org
