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Adolescent Community Reinforcement Approach (A-CRA)

Substance Use Disorders: Treatment for Youth
  Literature review updated September 2018.

Adolescent Community Reinforcement Approach (A-CRA) is a behavioral intervention that aims to support recovery from substance use disorders. A-CRA targets youth aged 12 to 25 years old with clinical diagnosis of a substance use disorder. The A-CRA model has guidelines for three types of sessions: adolescents alone, caregivers alone, and adolescents and caregivers together. A participant’s specific needs are determined and then inform which among the 17 A-CRA components a youth would receive. These components encourage problem-solving skills to cope with stressors, communication skills, and participation in positive social and recreational activities.

In the included study, participants were homeless youth who received 12 weekly individual sessions with a trained provider. The comparison youth were referred to usual services found in a community drop-in center.
 
ALL
META-ANALYSIS
CITATIONS

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 19 1 81 -0.275 0.193 19 -0.275 0.154
Substance use disorder
A non-specified alcohol or drug use disorder. Typically, a collection of different types of disorders reported by study authors. 
 19 1 81 -0.396 0.226 19 -0.396 0.080
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 19 1 81 -0.405 0.194 19 -0.405 0.037
Externalizing behavior symptoms
Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.
 19 1 81 -0.097 0.193 19 -0.097 0.615
Internalizing symptoms
Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.
 19 1 81 -0.362 0.194 19 -0.362 0.062

Citations Used in the Meta-Analysis

Slesnick, N., Prestopnik, J.L., Meyers, R.J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32(6), 1237-1251.