Treatment Retention and Outcomes with the Adolescent Community Reinforcement Approach in Emerging Adults with Opioid Use

ABSTRACT

Treatment retention and engagement of emerging adults with opioid use disorders can be particularly challenging. This study compares treatment outcomes of young adults with primary opioid use (OU) to those with primary marijuana or alcohol use (MAU), who received the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based therapy for the treatment of substance use. The MAU and OU groups were comprised of an outcome sample of 419 young adults ages 18–25. Groups were compared on intake demographics, clinical characteristics, and measures of treatment retention and other associated factors, including treatment initiation and engagement. Outcome measures were administered at A-CRA intake and at 3, 6, and 12 months post-intake. Both groups were similar in treatment retention, initiation, and engagement. Both groups showed a similar decrease in alcohol (p < .001) and marijuana use (p < .001). The OU group had significantly less opioid use at 3 months (p < .001) and maintained this decrease, but did not improve to the level observed in the MAU group at the 12-month follow-up. The Adolescent Community Reinforcement Approach merits further study as a behavioral treatment for young adults with opioid use.

KEYWORDS:

• Adolescent community reinforcement approach
• opioid
• substance use
• emerging adults
• young adults
• treatment retention

Acknowledgments

The authors wish to thank the SAMHSA Center for Substance Abuse Treatment grantees and

their patients for participation in this project.

Disclosure statement

Justine Welsh has received training fees from Chestnut Health Systems. Chestnut Health Systems, employer of Mark D. Godley, Lora L. Passetti, and Rodney R. Funk receives fees for training and fidelity assessment related to A-CRA. Robert J. Meyers and Jane Ellen Smith receive fees for presentations on topics related to the Community Reinforcement Approach. They also received royalties for books on related treatments.

Additional information

Funding

Support for this study was provided by HHSS270201200001C, No. 270-12-0397 and R01 AA021118 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Preparation for this manuscript was also financially supported by grant R21 DA046738 from the National Institute on Drug Abuse (NIDA). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or the National Institutes of Health.