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A-CRA

A-CRA. Adolescent - Community Reinforcement Approach CH 3 Substance Abuse Treatment for Youth and Adults. History of CRA. CRA – Community Reinforcement Approach First tested on state-funded-in-patient adults with severe alcohol dependence starting in the 1970s

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A-CRA

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  1. A-CRA Adolescent - Community Reinforcement Approach CH 3 Substance Abuse Treatment for Youth and Adults

  2. History of CRA • CRA – Community Reinforcement Approach • First tested on state-funded-in-patient adults with severe alcohol dependence starting in the 1970s • An “adolescent” version was tested in 1997 as part of the CYT (Cannabis Youth Treatment) study • It was one of 5 interventions compared in the study • A manual was created from Meyers and Smith’s book (that was for adult treatment) • Additional skill training components were added in problem-solving, communication and relating with parents.

  3. History - continued • 2006-07: 3-year Implementation grants for A-CRA and its continuing care component, ACC awarded (on-going into 2010) covering 6,700 youth! • Training • Initial 3 ½ day centralized training • Recorded sessions are uploaded to website • Trained evaluators rate A-CRA procedures and give written feedback to counselors • Basic Certification awarded when satisfactory competence is gained across 9 procedures • Full Certification awarded when competent in all procedures. • Supervisor training also available .

  4. Substance Use and Readiness for Treatment • Youth who had symptoms of alcohol and/or marijuana abuse or dependence • Little other regular (weekly) drug use reported, (unless homeless) • Age of onset: 10-14 • Less than 25% perceived drug use as problem upon entering treatment (few physical symptoms) • 80%+ enter treatment from legal, school or parental pressure

  5. Other Youth Qualities • No prior treatment for substance abuse • Most frequently used in out-patient programs • Beginning to be implemented in residential programs as well • Works well in Aftercare (after residential) when combined with Assertive Case Management procedures

  6. Co morbidity • Youth usually (70%) present with additional mental diagnoses: • 40% - Major Depression • 14% - Generalized Anxiety • 28% - Posttraumatic Stress (PTSD) • 51% - Conduct Disorder • 50% - ADHD • History of victimization* • Common in homeless with greater severity of drug disorder • Suicidal thought/actions – prevalent (24%)* *Assessment may indicate need for psychiatric evaluations and trauma-focused interventions

  7. Overview of Session Flow • Partly nondirective, partly directive • Behavioral and procedure-based • 17 Procedures from which to choose • Counselor judgment used to decide what and when to introduce a procedure • Flexible and sequenced, in general way • What motivates (reinforces) this adolescent? • Need to find alternatives to the reinforcing functions of drug use

  8. Basic Session Guidelines • This model encourages discovering what is reinforcing (motivating) client’s drug behavior • Rather than confronting • Providing verbal reinforcement (positive and supportive) • Solid general skills – warmth, understanding, non-judgmental, guiding (staying focused) • Progressing through the skills, logically. • Balance between time counselor and client talk.

  9. How much, how long? • 10 x 1-hour sessions with adolescent • 2 x 1-hour sessions with parent(s) and • 2 x 1+ - hour sessions with adolescent and parent(s) together • Over 12 – 14 weeks • Minimum, for effectiveness • Additional sessions added, depending upon client needs

  10. A-CRA Procedures • 1st session – engagement, orientation • Goal of finding healthy, fun, enjoyable alternatives to drug use is discussed • Positive expectations of helpfulness (based on science) expressed • Task of identifying REINFORCERS for this adolescent begins

  11. Early Procedures • Functional Analysis of Substance Use • Adolescent chooses a common episode of use • A. describes internal and external triggers • Counselor obtains details (see form A-1 or fig 3.1) • Both positive and negative consequences of use are discussed. • Counselor describes ways the analysis can help: • Identify triggers • Identify other ways to find the positive reinforcers that come from drug use

  12. Let’s Read the Case Example • Starting on p. 124… • Rationale and Overview of Common Episode • Triggers: External and Internal • Substance Use behavior – when, how much, with whom, how long (pattern) • Short-term Positive Consequences • Long-term Negative Consequences • Treatment Implications and homework (identifying motivation to build on)

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