The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents With Substance Use Disorders and Co-Occurring Psychiatric Disorders

Abstract

ABSTRACT. Background: Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. Methods: This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). Results: There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. Conclusions: In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatments can then be adapted as needed based on an individual youth's set of problems. Further research is needed to test treatments for various combinations of SUDs and psychiatric disorders (i.e., depression, trauma-related problems, conduct disorder/behavior problems, and attention-deficit/hyperactivity disorder [ADHD]).

Keywords:

• Adolescent
• Adolescent Community Reinforcement Approach
• integrated treatment
• co-occurring disorders
• co-occurring psychiatric disorders
• substance use treatment

ACKNOWLEDGMENTS

We thank the following individuals for their feedback and/or editorial work on this paper: Dianna Chu, Mark Godley, Stephanie Kerns, and Robert J. Meyers.

FUNDING

Preparation of the manuscript was supported by funding from the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), and the US Department of Health and Human Services (DHHS) (contract no. 270-07-0191). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

AUTHOR CONTRIBUTIONS

Dr. Godley developed the concept of this paper, led the review of the literature and interpretation of results, wrote major sections, and served as the main editor. Dr. Smith helped develop the concept of this paper, wrote sections on adapting A-CRA components for use in the treatment of co-occurring psychiatric disorders, and edited revisions. Ms. Passetti conducted the literature review, wrote initial drafts of the paper about that literature, created the table, and edited revisions. Dr. Subramaniam helped develop the concept for the manuscript, wrote sections of the initial draft, and edited revisions.