Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004). The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27(3), 197–213. https://doi.org/10.1016/j.jsat.2003.09.005

Type of Study: Randomized controlled trial
Number of Participants: 600

Population:

• Age — 13–18 years
• Race/Ethnicity — 61% Caucasian/White, 30% African American/Black, 6% Other/Mixed, and 4% Hispanic/Latino
• Gender — 83% Male
• Status — Participants were adolescents and their families recruited from sequential admissions to 4 treatment sites.

Location/Institution: Farmington, CT/University of Connecticut Health Center, Madison County, IL/Chestnut Health Systems, Philadelphia, PA/Children's Hospital of Philadelphia, and St. Petersburg, FL/Operation PAR

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to present the main outcome findings from two interrelated randomized trials conducted at 4 sites to evaluate the effectiveness of 5 short-term outpatient interventions for adolescents with cannabis use disorders. Participants in Trial 1 (at UCHC and PAR) were randomly assigned to one of three treatment conditions: Motivational Enhancement Treatment/Cognitive Behavior Therapy 5 Sessions (MET/CBT5), Motivational Enhancement Treatment/Cognitive Behavior Therapy 12 Sessions (MET/CBT12), or Family Support Network (FSN). Participants in Trial 2 (at CHS and CHOP) were randomly assigned to MET/CBT5, Adolescent Community Reinforcement Approach (A-CRA), or Multidimensional Family Therapy (MDFT). Measures utilized include the Global Appraisal of Individual Needs (GAIN). Results indicate that all 5 Cannabis Youth Treatment (CYT) interventions demonstrated significant pre-post treatment improvements during the 12 months after random assignment to a treatment intervention in the 2 main outcomes: Days of abstinence, as measured by self-reports using Global Appraisal of Individual Needs (GAIN) (a standardized semi-structured interview), and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions. Limitations include reliance on participant self-report and the lack of a no-treatment control group.

Length of controlled postintervention follow-up: 38–46 weeks.

Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32(6), 1237–1251. https://doi.org/10.1016/j.addbeh.2006.08.010

Type of Study: Randomized controlled trial
Number of Participants: 180

Population:

• Age — 14–22 years
• Race/Ethnicity — 41% Anglo, 30% Hispanic, 13% Native American, 12% Other, 3% African American, and 1% Asian
• Gender — 64% Male and 34% Female
• Status — Participants were all engaged through the only drop-in center for homeless youth in Albuquerque, had all been living in the metropolitan area for at least 3 months, met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for Alcohol or other Psychoactive Substance Use Disorders, and met criteria for homelessness.

Location/Institution: Albuquerque, NM

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the efficacy of the Adolescent Community Reinforcement Approach (A-CRA) program. Participants were assigned to either the A-CRA or treatment as usual (TAU) condition. Measures utilized include the Form 90, the National Youth Survey Delinquency Scale (NYSDS), the Youth Self-Report (YSR) of the Child Behavior Checklist (CBCL), the adolescent version of the Coping Inventory for Stressful Situations (CISS), and the Beck Depression Inventory (BDI-II). Results indicate that youth assigned to the A-CRA condition, compared to TAU, reported significantly reduced substance use and depression, and increased social stability. In both conditions, youth improved in other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task-oriented coping. Limitations include participants were only assessed at posttreatment, were recruited conveniently from a sample already accessing a drop-in center indicating they might be more amenable to change or respond differently to treatment efforts than youth who do not access drop-in centers, the research assistants were not blinded to the treatment condition that youth were assigned, and youth were aware of the possible treatment conditions.

Length of controlled postintervention follow-up: 3 months or less.

Godley, S. H., Hedges, K., & Hunter, B. (2011). Gender and racial differences in treatment process and outcome among participants in the Adolescent Community Reinforcement Approach. Psychology of Addictive Behaviors, 25(1), 143–154. https://doi.org/10.1037/a0022179

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 1,819

Population:

• Age — 10–18 years
• Race/Ethnicity — 33% Caucasian, 32% Hispanic, 15% African American, 15% Multiracial, 2% Asian, 2% Native American/Alaska Native, and 1% Other
• Gender — 73% Male and 27% Female
• Status — Participants were adolescents enrolled in outpatient substance abuse treatment programs.

Location/Institution: 27 sites across the U.S.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether initiation, engagement, dosage, treatment satisfaction, or outcomes for adolescents who received the Adolescent Community Reinforcement Approach (A-CRA) in a large implementation effort were equivalent by gender or racial group. Participants at various sites were enrolled in A-CRA based upon whether they were in an outpatient, school-based, home-based, residential, or a mixture of settings. Measures utilized include the Global Appraisal of Individual Needs (GAIN) and the Treatment Satisfaction Scale (TxSS). Results indicate that nearly all adolescents in the sample reported being satisfied with treatment; however, male adolescents had significantly higher rates of treatment satisfaction than female adolescents, and African American adolescents had significantly higher rates of treatment satisfaction than Caucasian adolescents. All racial groups had significant increases in days abstinent from alcohol and other drugs and in the percentage in recovery across the measurement period, but did not differ from one another at the six-month follow-up. Female adolescents had a higher percentage of days abstinent from alcohol and other drugs and were more likely to be in recovery at the six-month follow-up than male adolescents. Limitations include approximately 15% of the participants were dropped from the outcome analyses because of low follow-up rates at their sites or missing outcome data; outcome data were based on self-report and were limited to six months after treatment admission; there were not sufficient numbers of Asians or Native Americans to examine the response of these groups separately; and there also were cultural factors that were not measured that might have moderated the relationships found in this study, including acculturation, ethnic identity, and therapist/participant ethnic match.

Length of controlled postintervention follow-up: 6 months.

Smith, D. C., Godley, S. H., Godley, M. D., & Dennis, M. L. (2011). Adolescent Community Reinforcement Approach outcomes differ among emerging adults and adolescents. Journal of Substance Abuse Treatment, 41(4), 422–430. https://doi.org/10.1016/j.jsat.2011.06.003

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 303

Population:

• Age — Mean=17.1 years
• Race/Ethnicity — 30% Caucasian, 26% Hispanic, 22% African American, 20% Other/Biracial, and 3% Native American
• Gender — 71.7% Male
• Status — Participants were adolescents and emerging adults with substance use disorders.

Location/Institution: 28 SAMHSA-funded outpatient treatment sites

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare outcomes between adolescents and emerging adults with substance use disorders who received the Adolescent Community Reinforcement Approach (A-CRA). Participants were assigned based upon propensity score matching to create a weighted comparison group of adolescents who had similar demographic characteristics, clinical severity, and treatment retention as the group of emerging adults (ages 18–25). Measures utilized include the Global Appraisal of Individual Needs (GAIN). Results indicate that emerging adults and adolescents both reduced their substance use at follow-up. However, emerging adults were less likely to be abstinent and in remission and had more days of alcohol use when compared with adolescents. Limitations include that the effects observed are for emerging adults that were admitted to predominantly adolescent programs; the statistical analyses used did not fully account for the nesting of clients within therapists and within sites; and less than 25% of the emerging adult sample was age 19 or older, limiting generalizability to the entire emerging adult group.

Length of controlled postintervention follow-up: 3 or 6 months.

Hunter, B. D., Godley, S. H., Hesson-McInnis, M. S., & Roozen, H. G. (2013). Longitudinal change mechanisms for substance use and illegal activity for adolescents in treatment. Psychology of Addictive Behaviors, 28(2), 507–515. https://doi.org/10.1037/a0034199

Type of Study: Multisite pretest-posttest design
Number of Participants: 1,467

Population:

• Age — Mean=15.8 years
• Race/Ethnicity — 35% Caucasian, 29% Hispanic, 16% Mixed, 14% African American, and 6% Other
• Gender — 25% Female
• Status — Participants were adolescents who presented to substance use treatment and reported past-year engagement in illegal activity.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate: (a) The relationships of exposure to the Adolescent Community Reinforcement Approach (A-CRA) with reductions in substance use, illegal activity, and juvenile justice system involvement in adolescents diagnosed with a substance use disorder, and (b) The pathways by which reductions in the target behaviors were achieved. This study is a secondary data analysis of longitudinal data from a large-scale implementation effort for A-CRA. Measure utilized include the Global Appraisal of Individual Needs (GAIN), The Illegal Activity Scale, and the A-CRA Exposure Scale. Results indicate that participation in A-CRA had a significant, direct association with reduced substance use; a significant, indirect association with reduced illegal activity through reductions in substance use; and a significant indirect association with reduced juvenile justice system involvement through reductions in both substance use and illegal activity. In addition, post hoc analyses using a bootstrapping strategy provided evidence that reductions in substance use partially mediated the relationship between A-CRA and illegal activity. Limitations include reliance on self-reported measures, and nonrandomization of subjects.

Length of controlled postintervention follow-up: 6 and 12 months.

Godley, S. H., Hunter, B. D., Fernández-Artamendi, S., Smith, J. E., Meyers, R. J., & Godley, M. D. (2014). A comparison of treatment outcomes for Adolescent Community Reinforcement Approach participants with and without co-occurring disorders. Journal of Substance Abuse Treatment, 46(4), 463–471. https://doi.org/10.1016/j.jsat.2013.10.013

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 2,484

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were adolescents enrolled in outpatient substance abuse treatment programs with psychiatric problems.

Location/Institution: Northeast/Mid-Atlantic, Northeast/New England, Southeast/South Atlantic, Midwest, Southwest, West/Mountain, and West/Pacific

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants were classified into four mutually exclusive groups based on their endorsement of DSM-IV-R symptoms in the Global Appraisal of Individual Needs (GAIN) intake interview. Measures utilized include the Global Appraisal of Individual Needs (GAIN) and the Treatment Satisfaction Scale. Results indicate that at the 12-month follow-up, adolescents classified as externalizers or those with both externalizing and internalizing problems had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only. Additionally, adolescents reporting symptoms of internalizing, externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with substance use disorder only. Limitations include five treatment agencies were dropped from the analysis for having 12-month follow-up rates less than 50%, and an additional 10% of the sample was dropped due to uncompleted 12-month follow-up interviews; reliance on self-reported measures; and may not be generalizable to adolescents receiving substance use treatment other than A-CRA.

Length of controlled postintervention follow-up: 12 months.

Garner, B. R., Hunter, B. D., Smith, D. C., Smith, J. E., & Godley, M. D. (2014). The relationship between child maltreatment and substance abuse treatment outcomes among emerging adults and adolescents. Child Maltreatment, 19(3–4), 261–269. https://doi.org/10.1177/1077559514547264

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 3,555 (2,697 Adolescents and 858 Emerging Adults)

Population:

• Age — Adolescents: 12–17 years; Emerging Adults: 18–25 years
• Race/Ethnicity — Adolescents: 43% Hispanic, 27% Caucasian, 12% African American, 12% Mixed, and 6% Others; Emerging Adults: 41% Hispanic, 23% Caucasian, 20% African American, 14% Mixed, and 3% Other
• Gender — Adolescents: 22% Female; Emerging Adults: 25% Female
• Status — Participants were adolescents and emerging adults enrolled in outpatient substance abuse treatment programs with psychiatric problems.

Location/Institution: Northeast/Mid-Atlantic, Northeast/New England, Southeast/South Atlantic, Midwest, Southwest, West/Mountain, and West/Pacific

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the relationship between a broad measure of child maltreatment and several key outcomes for a large clinical sample of emerging adults and adolescents. Participants were enrolled in either Adolescent Community Reinforcement Approach (A-CRA) or Assertive Continuing Care (ACC). The secondary aim was to examine the extent to which the relationship between child maltreatment and treatment outcomes differed between emerging adults and adolescents. Measures utilized include the Global Appraisal of Individual Needs (GAIN) and the A-CRA Procedures Checklist. Results indicate that emerging adults and adolescents who experienced child maltreatment reported significantly greater reductions over time on several treatment outcomes (e.g., substance use, substance-related problems, and emotional problems). Overall, analyses did not support differential relationships between child maltreatment and changes over time in these substance use disorder treatment outcomes for emerging adults and adolescents. The one exception was that although emerging adults with child maltreatment did reduce their HIV risk over time, their improvements were not as great as were the improvements in HIV risk reported by adolescents who had experienced child maltreatment. Limitations include nonrandomization of participants, lack of generalizability due to ethnicity, study data were based on participant self-report, and length of follow-up.

Length of controlled postintervention follow-up: 3 and 6 months.

Godley, M. D., Passetti, L. L., Subramaniam, G. A., Funk, R. R., Smith, J. E., & Meyers, R. J. (2017). Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use. Drug and Alcohol Dependence, 174, 9–16. https://doi.org/10.1016/j.drugalcdep.2016.12.029

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 1,712

Population:

• Age — Mean=15.65–15.85 years
• Race/Ethnicity — Not specified
• Gender — 979 Female
• Status — Participants were adolescents with substance use disorders.

Location/Institution: 27 sites across the U.S.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare 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). Participants were classified into two mutually exclusive substance problem groups at A-CRA treatment intake based on adolescents’ responses to questions administered as part of the Global Appraisal of Individual Needs (GAIN) upon treatment entry. Measures utilized include the Global Appraisal of Individual Needs (GAIN) and the Treatment Satisfaction Scale (TxSS). Results indicate that 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; to report greater substance and mental health problems; and to 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. Limitations include adolescents reporting at least weekly use within the MAPU and OPU groups also described substance use and other psychosocial problems consistent with or more severe than their counterparts with abuse and dependence substance use was self-reported rather than corroborated through tests of biological specimens or collateral reports, and in this research design, there is no control group of OPU adolescents that did not receive A-CRA.

Length of controlled postintervention follow-up: 3, 6 and 12 months.

The following studies were not included in rating A-CRA on the Scientific Rating Scale...

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (2007). The effect of assertive continuing care on continuing care linkage, adherence, and abstinence following residential treatment for substance use disorders in adolescents. Addiction, 102(1), 81–93. https://doi.org/10.1111/j.1360-0443.2006.01648.x

The purpose of the study was to compare assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Participants were randomly assigned to receive either usual continuing care (UCC) available at outpatient clinics in the 11-county study area, or assertive continuing care (ACC) involving case management and the Adolescent Community Reinforcement Approach (A-CRA) via home visits. Measures utilized include the Global Appraisal of Individual Needs (GAIN), self-reported interview data collected at intake, 3, 6, and 9 months post-residential discharge, urine test data, and interviews with a caregiver conducted at baseline and 3 months. Results indicate that ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC also resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. Limitations include the lack of statistical power to reliably measure the direct effect of ACC on abstinence, long-term outcomes were limited to 9 months post-residential discharge, reliance on self-reported measures, and the findings are from a single residential program site. Note: This study was not used in the rating of A-CRA due to the model being offered with additional case management services.

Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., Passetti, L. L., & Petry, N. M. (2014). A randomized trial of Assertive Continuing Care and contingency management for adolescents with substance use disorders. Journal of Consulting and Clinical Psychology, 82(1), 40–51. https://doi.org/10.1037/a0035264

The purpose of the study was to report the results of a randomized trial to assess the degree to which three experimental approaches were successful at engaging youth in post residential continuing care and maintaining alcohol and other drug (AOD) abstinence during the 12 months following residential discharge relative to a Usual Community Care (UCC) alone condition: (a) Contingency Management (CM); (b) ACC, a multicomponent intervention combining Adolescent Community Reinforcement Approach (A-CRA) with behavioral, CBT, and case management elements; and (c) CM + ACC, a combination of both approaches. Participants were randomized to UCC, CM, ACC, A-CRA + CBT, CM, or CM + ACC. Measures utilized include the Global Appraisal of Individual Needs (GAIN). Results indicate that both the CM and ACC conditions resulted in significantly more days of abstinence from alcohol and illicit drug use than UCC over a 12-month period, and participants in both conditions were more likely to be in remission at the 12-month follow-up. In addition, CM and ACC resulted in significantly fewer days spent in residential treatment, juvenile detention, and hospitals over the 12-month period. Limitations include lack of generalizability due to small number of Hispanic participants and small sample size. Note: This study was not used in the rating of A-CRA due to the model being offered with additional case management services.