Adolescent Community Reinforcement Approach - Assertive Continuing Care (ACRA-ACC)

Adolescent Community Reinforcement Approach / Assertive Continuing Care (ACRA-ACC).  Note:  Model is used for youth with Co-Occurring substance abuse and mental health disorder.  Youth receiving these services must have received a substance abuse and mental health assessment.

The Adolescent Community Reinforcement Approach (A-CRA) is a developmentally-appropriate behavioral treatment for youth and young adults 12 to 24 years old with substance use disorders. A-CRA seeks to increase the family, social and educational/vocational rein forcers to support recovery. This intervention has been implemented in outpatient, intensive outpatient, and residential treatment settings. A-CRA includes guidelines for three types of sessions: individuals alone, parents/caregivers alone, and individuals and parents/caregivers together. According to the individual’s needs and self-assessment of happiness in multiple life areas, clinicians choose from a variety of A-CRA procedures that address, for example, problem-solving skills to cope with day-to-day stressors, communication skills, and active participation in positive social and recreational activities with the goal of improving life satisfaction and eliminating alcohol and substance use problems. Practicing new skills during sessions is a critical component of the skills training used in A-CRA. Every session ends with a mutually-agreed upon homework assignment to practice skills learned during sessions. Often these homework assignments include participation in pro-social activities. Likewise, each session begins with a review of the homework assignment from the previous session.

A-CRA procedures also are used as part of Assertive Continuing Care (ACC), which includes home visits and case management following a primary treatment episode for substance abuse or dependence. ACC is primarily used as continuing care. As such, it stresses rapid initiation of services after discharge from residential, intensive outpatient, or regular outpatient treatment in order to prevent or reduce the likelihood of relapse. In clinical trials research, ACC was evaluated for a 90-day period, but it can be extended for additional weeks or months as needed.

Eligibility Criteria

  • Diagnosis of Substance Use Disorder
  • Diagnosis of Co-occurring Substance Use and Mental Health disorder
  • Parole eligibility
  • 4 months Institution service before release and 6 months parole