Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

Abstract

Background: This paper compares adolescents with primary opioid problem use (OPU) to those with primary marijuana or alcohol problem use (MAPU) who received up to six months of Adolescent Community Reinforcement Approach (A-CRA), an empirically supported treatment.

Methods: Intake clinical characteristics, treatment implementation measures, and clinical outcomes of two substance problem groups (OPU and MAPU) were compared using data from 1712 adolescents receiving A-CRA treatment. Data were collected at intake and 3, 6, and 12 months post-intake.

Results: At intake, adolescents in the OPU group were more likely than those in the MAPU group to be Caucasian, older, female, and not attending school; report greater substance and mental health problems; and engage in social and health risk behaviors. There was statistical equivalence between groups in rates of A-CRA treatment initiation, engagement, retention, and satisfaction. Both groups decreased significantly on most substance use outcomes, with the OPU group showing greater improvement; however, the OPU group had more severe problems at intake and continued to report higher frequency of opioid use and more days of emotional problems and residential treatment over 12 months.

Conclusions: The feasibility and acceptability of A-CRA for OPUs was demonstrated. Despite significantly greater improvement by the OPU group, they did not improve to the level of the MAPU group over 12 months, suggesting that they may benefit from A-CRA continuing care up to 12 months, medication to address opioid withdrawal and craving, and the inclusion of opioid-focused A-CRA procedures.

Keywords: Adolescent; Adolescent community reinforcement approach; Opioid; Outcomes; Substance use treatment.

Conflict of interest statement

Conflict of interest

Mark D. Godley, PhD oversees A-CRA training of clinicians and supervisors in the U.S. and other countries for Chestnut Health Systems, a not-for-profit organization.

Robert J. Meyers, PhD has a consulting business in which he conducts training in A-CRA and related protocols. Jane E. Smith, PhD participates in this business as well.

Copyright © 2017 Elsevier B.V. All rights reserved.

Figures

Figure 1

Results of HLM growth models showing the percent of days using A) alcohol, B) opioids, C) marijuana and D) other drug use by problem use groups. A) OPU > MAPU at baseline, p MAPU at baseline, p MAPU at baseline, p

Figure 2

Results of HLM growth model showing A) SUD symptoms, B) days of emotional problems, C) days incarcerated and D) days in residential treatment by problem use groups. A) OPU > MAPU at baseline, p MAPU at baseline, p MAPU at baseline, p MAPU at baseline, p