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1 Article reviews Student’s Name Institutional Affiliation Instructor Course Date

2 Article 1: Garner et al. (2009) - Exposure to A-CRA Treatment Procedures as a Mediator: Purpose and Participants: The study's purpose is to uncover whether engagement with A-CRA treatment procedures serves as a mediator in the connection between treatment retention and the subsequent outcomes of the treatment (Meisel et al., 2022). This study's participants consisted of adolescents undergoing substance abuse treatment within the context of the A-CRA model. Methodology: Employing a longitudinal data analysis approach, the study examined the mediating effect of exposure to A-CRA treatment procedures on the link between treatment retention and treatment outcomes (Hsia et al., 2022). This involved investigating how the extent of engagement with A-CRA procedures influenced the duration of treatment retention and the ultimate results of the treatment. This methodology allowed the researchers to track participants' progress over time and decipher the potential mediating role of A-CRA treatment procedures in shaping treatment outcomes. Results and Implications: The study's findings revealed a significant mediation effect. Exposure to A-CRA treatment procedures mediated the relationship between the length of treatment retention and the achievement of positive treatment outcomes (Hsia et al., 2022). In essence, the study suggests that the more extensively adolescents engage with A-CRA treatment procedures, the more likely they are to experience favorable treatment outcomes (Meisel et al., 2022). This underscores the pivotal role of these procedures in determining the success of the treatment process. Limitations and Recommendations: However, it's important to acknowledge certain limitations in this study. The research primarily centered on the mediation effect, meaning potential confounding variables were not thoroughly considered (Hsia et al., 2022). These variables could

3 influence treatment outcomes independently of the mediating factor being studied. Moreover, the generalizability of the findings could be restricted by the specific treatment setting under the A- CRA framework. For future research endeavors, a more comprehensive approach is recommended. This could involve a broader exploration of additional factors that independently affect treatment outcomes. These factors could encompass psychological, social, and environmental variables contributing to treatment success (Meisel et al., 2022). Furthermore, extending the research to diverse treatment environments would enhance the generalizability of the findings, offering insights into how the mediating effect of A-CRA treatment procedures operates across various settings. Article 2: Godley et al. (2009) - Adolescent Community Reinforcement Approach (A-CRA): Purpose and Participants: The central purpose of the article is to provide a comprehensive overview of the A-CRA treatment model. The intended audience includes researchers, clinicians, and practitioners who seek a foundational understanding of the A-CRA approach (Archer et al., 2020). The participants in the context of this article are adolescents grappling with substance use disorders. Methodology: Unlike traditional empirical research, this article does not adopt a conventional methodology involving data collection, analysis, and interpretation. Instead, the authors adopt an expository approach, aiming to elucidate the essence of the A-CRA treatment model (Hinckley & Riggs, 2019). They delve into the intricacies of its core components and techniques, shedding light on its theoretical underpinnings. Introduction to A-CRA Model: The article offers readers an insight into the A-CRA model, introducing the core principles that distinguish it as a promising treatment intervention for

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4 adolescent SUDs. The approach hinges on reinforcing pro-social behaviors and diminishing the allure of substance use through systematic behavioral interventions (Archer et al., 2020). It emphasizes building a supportive community and harnessing positive reinforcement to motivate adolescents toward healthier choices. Potential Impact on Adolescent Substance Use Disorders: While the article refrains from presenting empirical results, it offers a glimpse into the potential impact of the A-CRA model on treating adolescent substance use disorders (Hinckley & Riggs, 2019). By building a foundation of positive reinforcement and addressing the underlying factors contributing to substance use, A- CRA holds promise in reshaping the trajectories of affected adolescents. Its holistic approach aims not only to alleviate the symptoms of SUDs but also to enhance the individual's overall well-being. Limitations and Future Directions: However, it's essential to acknowledge the limitations of this article. As an exposition, it does not offer empirical evidence to validate the efficacy of the A-CRA model. The absence of empirical data restricts our ability to gauge the real-world effectiveness of the approach (Archer et al., 2020). To address this limitation, future research endeavors should concentrate on empirical studies that measure the outcomes of A-CRA interventions on adolescent substance use disorders (Hinckley & Riggs, 2019). Rigorous research methodologies, such as randomized controlled trials, could provide valuable insights into the intervention's tangible impact. Article 3: Godley et al. (2011) - Gender and Racial Differences in A-CRA Treatment Process and Outcome:

5 Purpose and Participants: The central aim of the study is to uncover gender and racial differences within the A-CRA treatment process and its outcomes. The participants under investigation are adolescents actively engaged in the A-CRA treatment, reflecting the targeted population of the intervention. Methodology: The study adopts a quantitative analysis methodology to explore the potential variations across genders and races within the A-CRA treatment process (Davis et al., 2019). Quantitative analysis involves the systematic collection and statistical analysis of data, enabling researchers to derive meaningful patterns and relationships from the data pool. Gender and Racial Differences: The study's results unearth significant gender and racial differences in the treatment engagement and the response to the A-CRA intervention. These differences imply that adolescents' experiences within the A-CRA treatment may vary based on gender and racial backgrounds (DiLuigi et al., 2023). This finding underscores the imperative of designing treatment approaches considering the unique needs and dynamics of different demographics. Importance of Tailored Approaches: Identifying gender and racial disparities within the A- CRA treatment process underscores the necessity of tailored treatment approaches (Davis et al., 2019). A one-size-fits-all approach might not yield optimal outcomes for all individuals, especially considering the diverse experiences and challenges that adolescents of different genders and races may face. By acknowledging and accommodating these differences, treatment providers can enhance the overall effectiveness of interventions like A-CRA. Limitations and Scope: While the study highlights the significance of gender and race, it's important to acknowledge its limitations (DiLuigi et al., 2023). Focusing solely on these

6 demographic factors might inadvertently overlook other substantial influencers of treatment outcomes. Socioeconomic status, family dynamics, and cultural backgrounds can also play pivotal roles in shaping an adolescent's response to treatment. Additionally, the scope of the study might limit the depth of analysis, potentially missing out on nuanced interactions between different variables. Recommendations for Future Research: In light of the limitations, future research endeavors should aim for a more comprehensive analysis. This involves considering broader factors that influence treatment outcomes (DiLuigi et al., 2023). Delving into variables like socioeconomic status and family dynamics would provide a more holistic understanding of the complexities involved. Moreover, examining how these factors interact with gender and race could unveil intricate intersections that further inform tailored treatment strategies. Article 4: Godley et al. (2014) - A-CRA for Adolescents with Co-occurring Psychiatric Disorders: Purpose and Participants: The central purpose of the article is to discuss the applicability of the A-CRA model for adolescents navigating both substance use and psychiatric disorders. The participants under consideration are adolescents who are contending with the complex challenges of co-occurring disorders encompassing both SUDs and psychiatric conditions. Methodology: Unlike empirical studies that involve data collection and analysis, this article follows a different approach. The authors provide an overview of the A-CRA model and outline its potential adaptation to address co-occurring psychiatric disorders (Spencer et al., 2021). Instead of quantitative or qualitative methodologies, the article leans toward a conceptual exploration.

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7 Integration of A-CRA with Psychiatric Treatment: Though the article does not present empirical results, it illuminates how A-CRA can be intertwined with psychiatric treatment to manage adolescents grappling with co-occurring disorders. Combining both approaches' strengths creates a conceptual framework (Spencer et al., 2021). The framework centers on leveraging A-CRA's behavioral reinforcement strategies to target substance misuse while concurrently addressing individuals with psychiatric disorders' unique needs. Conceptual Framework and Implications: The conceptual framework unveiled in the article underscores the potential synergy between A-CRA and psychiatric treatment (Meisel et al., 2022). The holistic approach acknowledges the multifaceted nature of co-occurring disorders and endeavors to provide a comprehensive intervention that addresses both substance use and mental health concerns. This is particularly important given the intricate interplay between these domains and the potential for each to exacerbate the other. Limitations and the Call for Empirical Exploration: While the conceptual framework offers a promising avenue for intervention, the article does have its limitations. It lacks empirical data demonstrating the effectiveness of the adapted A-CRA model for co-occurring disorders. The absence of concrete results restricts our ability to ascertain the practical impact of the proposed integration (Spencer et al., 2021). To address this limitation, the article points toward an essential direction for future research. The recommendation is clear: Further empirical studies are needed to explore the outcomes of implementing the adapted A-CRA model for adolescents with co- occurring disorders (Meisel et al., 2022). Empirical investigations would provide much-needed evidence on the actual efficacy of this intervention strategy in real-world scenarios. Article 5: Godley et al. (2017) - A-CRA Implementation for Youth with Opioid Problem Use:

8 Purpose and Participants: The crux of the study's purpose is to delve into implementing A- CRA to address opioid problem use among youth. The participants in focus are the very youth grappling with opioid misuse who receive A-CRA treatment as part of their intervention. Methodology: While the article doesn't provide an explicit outline of the methodology employed, the nature of the study suggests using a mixed-methods approach (Roozen & Smith, 2020). This likely encompasses qualitative and quantitative methods to comprehensively assess A-CRA implementation for youth struggling with opioid problem use. The implication of A-CRA in Managing Opioid Problem Use: Although the article refrains from sharing detailed empirical results, it highlights the potential of A-CRA in managing opioid problem use among youth (Welsh et al., 2019). The underlying implication is that A-CRA's multifaceted approach, which combines reinforcement strategies and behavioral interventions, holds promise in addressing the complexities associated with opioid misuse in this demographic. Emphasis on Program Implementation: The article prioritizes the implementation aspect of A- CRA for youth with opioid problem use. While the lack of specific empirical results might be a limitation, the focus on program implementation aligns with the practical realities of translating interventions into real-world settings (Welsh et al., 2019). Implementation insights are crucial for understanding how interventions fare when implemented and can offer valuable lessons for refining approaches. Limitations and Future Directions: However, it's essential to recognize the limitations of the article. The absence of specific empirical findings and data presentation restricts a comprehensive assessment of the study's insights (Roozen & Smith, 2020). To overcome this limitation, the article directs us toward a crucial avenue for future research: incorporating

9 empirical findings. By conducting studies that showcase the outcomes of implementing A-CRA for youth dealing with opioid problem use, researchers can offer a clearer understanding of its effectiveness in real-world scenarios. References

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10 Archer, M., Harwood, H., Stevelink, S., Rafferty, L., & Greenberg, N. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. Addiction , 115 (6), 1024–1037. https://doi.org/10.1111/add.14901 Davis, J. P., Prindle, J. J., Eddie, D., Pedersen, E. R., Dumas, T. M., & Christie, N. C. (2019). Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design. Journal of Consulting and Clinical Psychology , 87 (10), 941–951. https://doi.org/10.1037/ccp0000406 DiLuigi, M., Hagel, N., Finkelman, M. D., Irusa, K., White, R., & Zandona, A. F. (2023). Assessment of implementation of the caries management by risk assessment philosophy in a dental school. Journal of Dental Education . https://doi.org/10.1002/jdd.13297 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(3), 252-264. 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 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 Godley, S. H., Smith, J. E., Meyers, R. J., & Godley, M.D. (2009). Adolescent Community Reinforcement Approach (A-CRA)

11 Godley, S. H., Smith, J. E., Passetti, L. L., & Subramaniam, G. (2014). The Adolescent Community Reinforcement Approach (A-CRA) as a model paradigm for the management of adolescents with substance use disorders and co-occurring psychiatric disorders. Substance Abuse, 35(4),352-363. Hinckley, J. D., & Riggs, P. (2019). Integrated treatment of adolescents with co-occurring depression and substance use disorder. Child and Adolescent Psychiatric Clinics of North America , 28 (3), 461–472. https://doi.org/10.1016/j.chc.2019.02.006 Hsia, T.-I., Huang, P.-C., Chen, H.-C., Lo, Y.-T. C., Chang, W.-T., Jou, Y.-Y., & Huang, H.-B. (2022). Relationships among phthalate exposure, oxidative stress, and insulin resistance in young military soldiers: A cumulative risk assessment and mediation approach. Environment International , 165 , 107316. https://doi.org/10.1016/j.envint.2022.107316 Meisel, S. N., Pielech, M., Magill, M., Sawyer, K., & Miranda, R. (2022). Mechanisms of behavior change in adolescent substance use treatment: A systematic review of treatment mediators and recommendations for advancing future research. Clinical Psychology: Science and Practice . https://doi.org/10.1037/cps0000089 Roozen, H. G., & Smith, J. E. (2020). CRA and CRAFT: Behavioral treatments for both motivated and unmotivated substance-abusing individuals and their family members. In Textbook of Addiction Treatment (pp. 475–492). Springer International Publishing. http://dx.doi.org/10.1007/978-3-030-36391-8_33 Spencer, A. E., Valentine, S. E., Sikov, J., Yule, A. M., Hsu, H., Hallett, E., Xuan, Z., Silverstein, M., & Fortuna, L. (2021). Principles of care for young adults with co-occurring

12 psychiatric and substance use disorders. Pediatrics , 147 (Supplement 2), 229–239. https://doi.org/10.1542/peds.2020-023523f Welsh, J. W., Mataczynski, M. J., Nguyen, M. D., & McHugh, R. K. (2020). A review of behavioral therapies in adolescents with opioid use disorder. Harvard Review of Psychiatry , 28 (5), 305–315. https://doi.org/10.1097/hrp.0000000000000272 Welsh, J. W., Passetti, L. L., Funk, R. R., Smith, J. E., Meyers, R. J., & Godley, M. D. (2019). Treatment retention and outcomes with the adolescent community reinforcement approach in emerging adults with opioid use. Journal of Psychoactive Drugs , 51 (5), 431– 440. https://doi.org/10.1080/02791072.2019.1613585

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