Adolescent Community Reinforcement Approach (ACRA) was developed as a comprehensive treatment for cannabis use disorders in adolescents, but it is readily applied to a variety of AOD issues and related issues such as offending behaviour. The overarching aim of ACRA is to increase the family, social, educational and / or vocational reinforcers that make life without substance misuse attractive to the young person. Conversely, reinforcers of alcohol or other drug misuse are identified and time-out from these reinforcers is organised.
ACRA incorporates a range of strategies, mainly based on the principles of behaviour therapy. These include:
- Engagement and motivational strategies
- Functional analysis of problem behaviours and desired alternative behaviours
- Pro-social activity planning
- Communication skills training, problem solving skills training, anger management and relapse prevention skills training
- Family / caregiver engagement, support and skill building
ACRA was developed for the express purpose of managing events and circumstances in the client’s day-to-day environment. As such, the intervention is applied to the client’s unique situation. The manual that describes ACRA procedures (Godley et al., 2001) also contains strategies that assist the practitioner to individualise interventions.
The theoretical background of ACRA acknowledges the powerful role of environmental contingencies (or ‘reinforcers’) in encouraging or discouraging drug use, and uses these reinforcers to create conditions in which non-using is more rewarding than using drugs. ACRA uses operant techniques and skills training to teach and reinforce new ways of handling life without the use of substances (Godley et al., 2001).
Operant techniques include four basic types of approaches (Higgins & Silverman, 2008). The Adolescent Community Reinforcement Approach (ACRA) primarily aims to establish systems of positive reinforcement. However the other contingencies may be relevant in certain circumstances.
‘Positive reinforcement’ – or delivery of a positive consequence for meeting a specified treatment goal (e.g. reduced drug use or behaviours that are inconsistent with drug use).
‘Negative reinforcement’ - involves the removal or a reduction in the intensity of an aversive event contingent upon meeting a treatment goal (e.g. meeting the requirements of a Court Order will remove the threat of a penalty).
‘Positive punishment’ – or the delivery of an aversive event (e.g. social reprimand) as a consequence of a therapeutically undesirable behaviour (e.g. aggression or violent behaviour).
‘Negative punishment’ – which involves the removal of a positive condition (e.g. removal of a privilege) as a consequence of a therapeutically undesirable behaviour.
The intervention approach is modular – most of the procedures are relatively independent – and can therefore be introduced and reinforced at times and places that suit the individual needs of the client.
ACRA is an evidence-based treatment program with demonstrated effectiveness in treating substance misuse among adolescents including youth with multiple and complex needs manifest in experiences such as involvement in the youth justice system and homelessness (Slesnick, Prestopnik, Meyers, & Glassman, 2007).
ACRA is usually implemented in the form of 14 sessions, 2 of which are conducted with the parent or caregiver alone, and 2 of which are conducted with the young person and the caregiver together.
More information about ACRA in the context of youth AOD service provision can be found in Bruun and Mitchell (2012; Section 4.6, p97-102).
ACRA procedures not included in the youthAODtoolbox
ACRA has several other procedures that do not have elements in this toolbox. These procedures and further information about each can be found in Godley, Meyers et al, 2001. These procedures are:
- Dealing with failure to attend
- Job-seeking skills
- Medication adherence and monitoring
- Couples Relationship Skills
- Urine Testing
Other procedures in ACRA do not have specific elements as they are covered more comprehensively in modules included within this Toolbox. They are:
- Anger Management
- Treatment Closure
- Relapse Prevention