Program Goals/Target Population
The Adolescent Community Reinforcement Approach (A-CRA) is a behavioral intervention that aims to replace structures supportive of drug and alcohol use with ones that promote a clean and healthy lifestyle. A-CRA has three different protocols and guidelines, depending upon the population it is serving, but the overall goals are to reduce substance use and dependence, increase social stability, improve physical and mental health, and improve life satisfaction.
A-CRA is designed to include sessions with adolescents, parents/caregivers, and adolescents and parents/caregivers together during the course of treatment. It has also been adapted for use with Assertive Continuing Care, which provides home visits to youth following residential treatment for alcohol and/or substance dependence, and for use in a drop-in center for street-living, homeless youth. A-CRA is appropriate for youth between 13 and 18 years of age and young adults between 18 and 25 years of age suffering from substance addiction or dealing with substance abuse issues, though this same type of program has been used for adults dealing with substance abuse and dependence since the 1970s. (Additionally, early forms of A-CRA have been used with youth 18 years and younger since the early 1990s.)
Adolescents undergo a needs assessment and are asked to complete a self-assessment of happiness and functioning in multiple areas. Based upon these evaluations, therapists can choose from 19 A-CRA protocols that address problematic areas. These include building problem-solving, stress-reducing, and communication skills, as well as participating in prosocial activities. Role-playing and behavioral rehearsal is a crucial element of the skills training used in A-CRA. It is during these exercises that adolescents learn better communication and relapse-prevention skills. After therapy sessions, participants are given homework assignments where they practice skills learned during sessions and are encouraged to be part of positive leisure activities.
A-CRA is derived from a social ecological/systems model that believes behavioral trajectories and outcomes are the result of activities defined by or in response to the demands of specific social systems: people—in this case, adolescents—behave in accordance to the setting or environment they inhabit. This includes their friends and family, as well as the actual physical location where they live. Following this ecological framework, there are two ways to change a person’s negative behavior: change the settings in which individuals conduct everyday activities or change the way individuals respond to influences from that particular setting. A-CRA aims to remove youth from negative environments, such as living on the street or associating with substance using peers, and place them in positive settings that promote a healthy lifestyle and safe behavior.