Community Mental Health Journal

, Volume 50, Issue 2, pp 150–157 | Cite as

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

  • Elizabeth L. McGarvey
  • MaGuadalupe Leon-Verdin
  • Karen Bloomfield
  • Sharon Wood
  • Esther Winters
  • Jennifer Smith
Original Paper

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.

Keywords

Adolescents Substance abuse Treatment A-CRA/ACC SAMHSA Community mental health 

References

  1. APA, American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR) (4th rev ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3, 1–16.CrossRefGoogle Scholar
  3. Borders, T. F., & Booth, B. M. (2007). Research on rural residence and access to drug abuse services: Where are we and where do we go? The Journal of Rural Health, 23, 79–83.PubMedCrossRefGoogle Scholar
  4. Budney, A. J., Vandrey, R. G., & Stanger, C. (2010). Pharmacological and psychosocial interventions for cannabis use disorders. Revista Brasileira de Psiquitria, 1, 546–555.CrossRefGoogle Scholar
  5. Condon, T. P., Miner, L. L., Balmer, C. W., & Pintello, D. (2008). Blending addiction research and practice: Strategies for technology transfer. Journal of Substance Abuse Treatment, 35, 156–160.PubMedCrossRefGoogle Scholar
  6. Crome, I., & Bloor, R. (2005). Substance misuse and psychiatric comorbidity in adolescence. Current Opinion in Psychiatry, 18, 435–439.PubMedCrossRefGoogle Scholar
  7. Danovitch, I., & Gorelick, D. A. (2012). State of the art treatments for cannabis dependence. Psychiatric Clinics of North American, 35(2), 309–326.CrossRefGoogle Scholar
  8. Dennis, M. L., Babor, R. F., Roebuck, M. C., & Donaldson, J. (2002). Changing the focus: The case for recognizing and treating cannabis use disorders. Society for the Study of Addiction to Alcohol and Other Drugs, 97, 4–15.CrossRefGoogle Scholar
  9. Dennis, M. L., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., et al. (2004). The cannabis youth treatment (CYT) study: Main findings from two randomized trials. Journal of Substance Abuse Treatment, 27, 197–213.PubMedCrossRefGoogle Scholar
  10. Dennis, M. L., Titus, J. C., White, M. K., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. Version 5. Bloomington, IL: Chestnut Health Systems.Google Scholar
  11. Diamond, G., Godley, S. H., Liddle, H. A., Sampl, S., Webb, C., Tims, R. M., et al. (2002). Five outpatient treatment models for adolescent marijuana use: A description of the cannabis youth treatment intervention. Addiction, 97, 70–83.PubMedCrossRefGoogle Scholar
  12. Friedman, A. S., Glickman, N. W., & Morrissey, M. R. (1986). Prediction to successful treatment outcome by client characteristics and retention in treatment in adolescent drug treatment programs: A large scale cross validation study. Journal of Drug Education, 16, 149–165.PubMedCrossRefGoogle Scholar
  13. Garner, B. R., Godley, S. H., Funk, R. R., Dennis, M. L., Smith, J. E., & Godley, M. D. (2009). Exposure to adolescent community reinforcement approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome. Journal of Substance Abuse Treatment, 36, 252–264.PubMedCentralPubMedCrossRefGoogle Scholar
  14. Godley, S. H., Barner, B. R., Passetti, L. L., Funk, R. R., Dennis, M. L., & Godley, M. D. (2010). Adolescent outpatient treatment and continuing care: Main findings from a randomized clinical trial. Drug and Alcohol Dependence, 110, 44–54.PubMedCentralPubMedCrossRefGoogle Scholar
  15. Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R., & Passetti, L. (2002). Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment. Journal of Substance Abuse Treatment, 23, 21–32.PubMedCrossRefGoogle Scholar
  16. Godley, M. D., Godley, S. H., Funk, R. R., & Passetti, L. L. (2007). The effect of assertive continuing care of continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction, 102, 81–93.PubMedCrossRefGoogle Scholar
  17. Godley, S. H., Myers, R. J. Smith, J. E., Godley, M. D., Titus, J. C., Karvinen, R. D., et al. (2001). Cannabis youth treatment series volume 4: The adolescent community reinforcement approach (DHHS Publication No. (SMA) 01-3489). Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental health Services Administration.Google Scholar
  18. Godley, S. H., Risberg, R. A., Adams, L., & Sodetz, A. (2003). Chestnut health systems’ bloomington outpatient and intensive outpatient treatment model. Bloomington, Il: Chestnut Health Systems.Google Scholar
  19. Hall, W., & Babor, T. F. (2000). Cannabis use and public health: Assessing the burden. Addiction, 95, 485–490.PubMedCrossRefGoogle Scholar
  20. Hall, J. A., Smith, D. C., Easton, S. D., An, H., Williams, J. K., Godley, S. H., et al. (2008). Substance abuse treatment with rural adolescents: Issues and outcomes. Journal of Psychoactive Drugs, 40, 109–120.PubMedCrossRefGoogle Scholar
  21. Hardin, J. W., & Hilbe, J. (2003). Generalized estimation equations. Boca Raton, FL: Chapman & Hall/CRC.Google Scholar
  22. Healthy People 2020 Objectives. (2010). http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=40. Accessed 27 Dec 2010.
  23. Hiller, M. L., Leukefeld, C. G., Garrity, T. F., Godlaski, T., Schoeneberger, M., Townsend, M., et al. (2007). Client outcomes from rural substance abuse treatment. Journal of Psychoactive Drugs, 39, 59–68.PubMedCrossRefGoogle Scholar
  24. Hser, Y. I., Grella, C. E., Hubbard, R. L., Hsieh, S. C., Fletcher, B. W., Brown, B. S., et al. (2001). An evaluation of drug treatment for adolescents in four U.S. cities. Archives of General Psychiatry, 58, 689–695.PubMedCrossRefGoogle Scholar
  25. Jackson, J. E., Doescher, M. P., & Hart, L. G. (2006). Problem drinking: Rural and urban trends in America, 1995/1997 to 2003. Preventive Medicine, 43, 122–124.PubMedCrossRefGoogle Scholar
  26. Martino, S. C., Ellickson, P. L., & McCaffrey, D. F. (2008). Developmental trajectories of substance use from early to late adolescent: A comparison of rural and urban youth. Journal of Studies on Alcohol and Drugs, 69, 340–440.Google Scholar
  27. Myers, R. J., Miller, W. R., Hill, D. E., & Tonigan, J. S. (1999). Community reinforcement and family training (CRAFT): Engaging unmotivated drug users in treatment. Journal of Substance Abuse, 10, 291–308.CrossRefGoogle Scholar
  28. Myers, R., & Smith, J. E. (1995). Clinical guide to alcohol treatment: The community reinforcement approach. New York: Guilford Press.Google Scholar
  29. NIDA (National Institute on Drug Abuse). (2011). Topics in Brief: Marijuana-December 2011. http://www.drugabuse.gov/drugs-abuse/marijuana. Accessed 30 Sep 2012, 1 Oct 2012.
  30. Pantalon, M. V., Chawarski, M. C., Falcioni, J., Pakes, J., & Schottenfeld, R. S. (2004). Linking process and outcome in the community reinforcement approach for treating cocaine dependence: A preliminary report. American Journal of Drug and Alcohol Abuse, 30, 353–367.PubMedCrossRefGoogle Scholar
  31. Piontek, D., Kraus, L., Legleye, S., & Buhringer, G. (2011). The validity of DSM-IV cannabis abuse and dependence criteria in adolescents and the value of additional cannabis use indicators. Addiction, 106, 1137–1145.PubMedCrossRefGoogle Scholar
  32. Rigter, H., Pelc, I., Tossmann, P., Phan, O., Grichting, E., Hendriks, V., et al. (2010). INCANT: A transnational randomized trial of multidimensional family therapy versus treatment as usual for adolescents with cannabis use disorder. BMC Psychiatry, 10, 28.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Riley, K. J., Rieckmann, R., & McCarty, D. (2008). Implementation of MET/CBT 5 for adolescents. Journal of Behavioral Health Services & Research, 35(3), 304–314.CrossRefGoogle Scholar
  34. SAMHSA (Substance Abuse and Mental Health Services Administration). (2011). http://www.samhsa.gov/.
  35. Shannon, L. M., Havens, J. R., Oser, C., Crosby, R., & Leukefeld, C. (2011). Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky. American Journal of Drug and Alcohol Abuse, 37, 98–104.PubMedCentralPubMedCrossRefGoogle Scholar
  36. Shoeneberger, M., Leukefeld, C., Hiller, M., & Godlaski, T. (2006). Substance abuse among rural and very rural drug users at treatment entry. The American Journal of Drug and Alcohol Abuse, 32, 87–110.CrossRefGoogle Scholar
  37. Webster, J. M., Pimentel, J. H., Harp, K. L., Clark, D. B., & Staton-Tindall, M. (2009). Substance abuse problem severity among rural and urban female DUI offenders. American Journal of Drug and Alcohol Abuse, 35, 24–27.PubMedCrossRefGoogle Scholar
  38. Young, S. E., Corley, R. P., Stallings, M. C., Rhee, S. H., Crowley, T. J., & Hewitt, J. K. (2002). Substance use, abuse and dependence in adolescence: Prevalence, symptom profiles and correlates. Drug and Alcohol Dependence, 68, 309–322.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Elizabeth L. McGarvey
    • 1
  • MaGuadalupe Leon-Verdin
    • 1
  • Karen Bloomfield
    • 1
  • Sharon Wood
    • 2
  • Esther Winters
    • 1
    • 2
  • Jennifer Smith
    • 2
  1. 1.Department of Public Health Sciences, School of MedicineUniversity of VirginiaCharlottesvilleUSA
  2. 2.Central Virginia Community Services Board, Child and Family ServicesLynchburgUSA

Personalised recommendations