Exposure to Adolescent Community Reinforcement Approach (A-CRA) treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome

摘要

Data from 399 adolescents, who participated in one of four randomly controlled trials of the A-CRA intervention, were used to examine the extent to which exposure to Adolescent Community Reinforcement Approach (A-CRA) procedures mediated the relationship between treatment retention and outcomes. Although zero-order correlations indicated that retention in treatment was a significant predictor of AOD use (r = -.18, p < .001), this relationship was reduced to non-significance (p = .39) when exposure to A-CRA procedures was included in the model. Overall, the final model evidenced a very good fit (RMSEA=.00; NFI = .99; CFI = 1.00), and explained 29% and 43% of the variance in adolescents’ post-treatment AOD use and AOD-related problems, respectively. Additionally, CHAID analysis was used to derive a target level of A-CRA exposure, which was found to be significantly related to being in recovery at follow-up. The current findings are useful, as little research to date has identified significant mediators of the relationship between retention and treatment outcomes or identified target thresholds of treatment exposure.