The Adolescent Community Reinforcement Approach

The Adolescent Community Reinforcement Approach (A-CRA) is a developmentally-appropriate behavioral treatment for youth and young adults ages 12 to 24 years old with substance use disorders. 

A-CRA seeks to increase the family, social, and educational/vocational reinforces 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.

The initial training workshop is designed for clinical staff who plan to implement A-CRA and/or provide clinical supervision to clinicians implementing A-CRA, as well as those in support and administrative roles for programs implementing A-CRA. The training uses demonstrations to model how A-CRA is used with individuals and their families, and trainees have an opportunity to practice procedures and receive feedback from the training team.

The A-CRA treatment manual is available in English, Dutch, French, Spanish, and Portuguese.

A-CRA has been implemented by more than 470 organizations in the United States and in several other countries. It is noted as one of the three interventions for adolescents described in Anne Fletcher’s book, Inside Rehab.