Effectiveness of A-CRA/ACC in Treating Adolescents with Cannabis-Use Disorders

Abstract

An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.

Substance use in rural Central Appalachia: Current status and treatment considerations.

“…CRA includes motivational enhancement, monitoring of pharmacotherapy such as OSTs, functional analysis of substance use patterns, skills training (including drug refusal, communication skills, problem solving skills, and relapse prevention), help with employment, relationship counseling, and social recreational counseling (Smith & Meyers, 1995). CRA has been used successfully to treat cocaine, opioid, and cannabis dependence (Abbott, 2009; Abbott, Moore, Weller, & Delaney, 1998; Bickel, Amass, Higgins, Badger, & Esch, 1997; Budney & Higgins, 1994; McGarvey et al, 2014; Roozen, Kerkhof, & Van den Brink, 2003; Schottenfeld, Pantalon, Chawarski, & Pakes, 2000; Smith, Meyers, & Miller, 2001) and, in combination with OSTs, it is associated with a reduction in opioid use, reduction in other drug use, improvements in legal status, improvement in employment status, and improvement in social functioning (Abbott, 2009; Abbott et al, 1998; Roozen et al, 2003). …”

The dynamics of cannabis use and dependence

“…Another issue that should be noted when interpreting the results is that all measures were based on self-report. While self-report has been accepted as a suitable method for obtaining information about population behaviours, over-or under-reporting due to deliberate concealment or unconscious memory effects cannot be precluded [38,48,49].…”

“…DSM-IV cannabis dependence was measured with the Composite International Diagnostic Interview (CIDI) version 3.0 [48], and required the presence of three or more of seven symptoms within the 12-month period since the previous interview (without requiring the presence of all symptoms at the same time). It should be noted that the CIDI includes a withdrawal symptom, which is not included in the DSV-IV manual.…”

“…Second, two types of adversity during childhood were evaluated: (i) the presence of one or more of the following childhood "family adversities" before age 16: parental divorce, parental death, and not being brought up by both parents; and (ii) a history of any "child abuse" before age 16: emotional, psychological, physical, and sexual abuse [44][45][46][47]. Because these abuse experiences may not always occur in isolation and may have an additive effect, the cumulative number of these four types of child abuse was used as the main predictor [48]. Third, the personality characteristic impulsivity was measured with the Dutch version of the Barratt Impulsiveness Scale (BIS-15).…”

“…In addition, they may facilitate treatment seeking as patients perceived more social pressure to seek treatment, or could benefit from support dealing with dependent users as patients reported less social support even though they asked more support from friends/family. Proven effective examples are the use of Community Reinforcement And Family Training (CRAFT [47]), Adolescent Community Reinforcement Approach with Assertive Continuing Care (A-CRA/ACC [48]), and Multidimensional Family Therapy (MDFT [49;50]). Cognitive Behaviour Therapy (CBT) has also shown to effectively reduce cannabis involvement of adults [51].…”