1. Adolescent Community Reinforcement Approach
A-CRA
Robert J. Meyers, Ph.D.
Jane Ellen Smith, Ph.D.
University of New Mexico
and
Chestnut Health Systems
Presented by:
Jennifer Smith Ramey, LPC, LMHP

2. Meet Gage…… 17 year old male Abused alcohol, marijuana, heroin
Family history of mental illness (father committed suicide)
Strained relationship with mother

3. First CRA Therapist Manual

4. Adolescent Community Reinforcement Approach (A-CRA)
CYT
Godley, S.H., Meyers*, R.J., Smith*, J.E., Godley, M.D., Titus, J.C., Karvinen, T., Dent, G., Passetti, L.L., & Kelberg, P. (2001).
Chestnut Health Systems
Bloomington, IL USA, and
*University of New Mexico
Albuquerque, NM USA
Cannabis Youth Treatment Experiment
Treatment Series
Volume 4

5. Percent of Days Abstinent from Alcohol or Other Drugs
Discussion points from manuscript:
Adolescents with COD have greater rates and greater magnitudes of increase in abstinence
Adolescents with COD maintain their treatment gains out to 12 months
Results of HLM growth model analyzing group differences percent of days abstinent 5

6. Conclusion: Abstinence
Adolescents with COD have greater magnitudes of increase in abstinence than non-comorbid youth
Adolescents with COD maintain their treatment gains out to 12 months

7. Emotional Problems Scale
Discussion points from the manuscript:
Adolescents with COD have greater rates and greater magnitudes of decrease in Emotional problems
Figure 3. Results of HLM growth models analyzing group differences for the Emotional Problems Scale. 7

8. Conclusion: Emotional Problems
Adolescents with COD have greater magnitudes of decrease in emotional problems than non-comorbid youth
Youth with both externalizing and internalizing MH problems show the greatest reduction of emotional problems.

9. A-CRA at Horizon Behavioral Health
“Effectiveness of A-CRA/ACC in Treating Adolescents with Cannabis-Use Disorder” published in Community Mental Health Journal, November 2012
Enrolled 147 adolescents ages 12-18
Assessed at baseline, 3, 6, and 12 months
More than two-thirds reported quitting marijuana by 12 months
Days of marijuana use in the last 90 days decreased significantly from the first follow-up
Grade completed in school increased one grade comparing baseline and 12 months
Average days of missing school decreased significantly from baseline to end of treatment

10. If punishment worked, there would be few, if any, alcoholics or drug addicts…
Meyers & Smith, 2006

11. What is the goal of CRA?
“…to rearrange the vocational, family, and social reinforcers of the alcoholic such that time-out from these reinforcers would occur if he began to drink.” (Hunt & Azrin, 1973)
Meyers & Smith, 2006

12. A-CRA’s General Goals Goals: Sessions with clients
Abstinence
Participation in pro-social activities
Positive relationships with family
Positive relationships with peers
Goals: Sessions with caregivers
Motivate their participation
Promote the client’s abstinence
Provide information about effective caregiving

13. A-CRA Session Structure
10 individual sessions with the adolescent
4 sessions with the caregiver
2 individual sessions with the caregiver
2 sessions with the caregiver and the adolescent
In the office or home and community

14. Positive Reinforcer What is a reinforcer? How do I find one?
Does everyone have reinforcers?
How can I use them to help?
Meyers & Smith, 2006

15. Adolescent Caregiver sessions
Goal is to improve relationship
Tools used: Happiness Scale, Communication Skills, Problem Solving Skills
Positive Focus (3 Positive Things exercise, Daily Reminder To Be Nice homework assignment)

16. Caregiver-Adolescent (Family) Sessions
3 Positive Things Exercise
Relationship Happiness Scales
Practice communication and problem-solving skills
Daily Reminder To Be Nice form

17. Four Critical Parenting Practices
Positive Communication
Getting involved in adolescent’s life outside the home
Be a good role model
Know the adolescent’s whereabouts
Explain how to introduce these in the session
Research based on prevention, but make sense for recovery as well

18. Communication Skills Foundational in A-CRA model
Used in adolescent only sessions, caregiver only sessions, family session
3 parts
Role-plays

19. Treatment Planning
Two parts: Adolescent Happiness Scale and Goals of Counseling
Ask the client what she/he wants
Use a positive approach
Keep in mind the client’s reinforcers

20. Adolescent Happiness Scale

21. Goals of Counseling: Setting Goals
Goals of Counseling contains the categories on the Happiness Scale
Guide the client’s selection of a category
In general, set short-term goals that are scheduled to be completed in about a month
Develop a step-by-step weekly strategy for reaching each goal
Addressed obstacles to completing the goals
The strategy = the “homework” for the week
Meyers & Smith, 2006

22. After Happiness Scales

23. Guidelines for Goal Setting
Goals and weekly strategies should be:
Brief (uncomplicated)
Positive (what will be done)
Specific behaviors (measurable)
Reasonable
Under the client’s control
Based on skills the client already has
Meyers & Smith, 2006

24. What’s wrong with these goals & strategies?
I don’t want to drink anymore
I’ll get my friend to come into treatment
I’ll apply for 10 jobs tomorrow
I’ll get a higher-paying job this month
I’ll try harder to save money this month
I’ll go out on a date with three different women next week
Meyers & Smith, 2006

25. What’s wrong with this strategy?
I am going to attend one AA meeting next week, at St. Agnes Church at 8:00 pm on Tuesday night.
Meyers & Smith, 2006

26. Demonstration

27. Skills Training Communications Skills Problem Solving
Drink/Drug Refusal
Job-Finding Skills
Anger Management

28. A-CRA Certification Recording/uploading A-CRA sessions
Will receive narrative review and rating (1 to 5 scale)
Must pass 9 core procedures for first level certification

29. Now, back to Gage Improved communication with mother Goals:
completion of high school
military enrollment

30. References
Dennis, M.L., Godley, S.H., Diamond, G.S., Tims, F.M., Babor, T., Donaldson, J., Liddle, H.A., Titus, J.C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R.R. (2004). The Cannabis Youth Treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, doi: /j.jsat
Godley, S.H., Hedges, K., & Hunter, B. (2011). Gender and racial differences in treatment process and outcome among participants in the Adolescent Community Reinforcement Approach. Psychology of Addictive Behaviors, 25, doi: /a
Godley, S.H., Hunter, B.D., Artamendi, S.F., Smith, J.E., Meyers, R.J., & Godley, M.D. (2014). A comparison of treatment outcomes for Adolescent Community Reinforcement participants with and without co-occurring disorders. Journal of Substance Abuse Treatment, 46(4), doi: /j.jsat
Godley, S.H., Meyers, R.J., Smith, J.E., Godley, M.D., Titus, J.C., Karvinen, T., Dent, G., Passetti, L.L., & Kelberg, P. (2001). The Adolescent Community Reinforcement Approach (ACRA) for adolescent cannabis users (DHHS Publication No. (SMA) , Cannabis Youth Treatment (CYT) Manual Series, Volume 4). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Retrieved from PDF_Documents/Lighthouse/CYT/Products/ACRA_CYT_v4.pdf.
McGarvey, E.L., Leon-Verdin, M., Bloomfield, K., Wood, S., Winters, E., & Smith, J. (2012). Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders. Community Mental Health Journal, 50(2), doi: /s
Meyers, R.J., & Miller W.R. (Eds.). (2001). A Community Reinforcement Approach to Addiction Treatment. Cambridge, UK: University Press.
Meyers, R. J., & Smith, J. E. (1995). Clinical guide to alcohol treatment: The Community Reinforcement Approach. New York: Guildford Press.