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Substance Use DisordersNCT05081934

Feasibility, Acceptability and Preliminary Treatment Effects of A-CRA for Youth in Compulsory Institutional Care

A study testing A-CRA and TAU in people with Substance Use Disorders and Criminal Behavior, run by Karolinska Institutet at 1 site in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Substance abuse and criminal behavior are increasing among adolescents in Sweden. The Swedish National Board of Institutional Care, SiS, provides institutional care on basis of the Swedish laws Care of Young Persons (Special Provisions) Act, LVU, Care of Substance Abusers (Special Provisions) Act, LVM, Secure Youth… Read more about this study

Who is it for?
Ages 16 to 21 years
Conditions the study is for
Substance Use Disorders, Criminal Behavior
What is being tested?
A-CRA and TAU
Could I receive a placebo?
No, everyone receives an active treatment
How many people
42 participants
Where
1 siteSweden
Study dates
16 Feb 2022to 31 Dec 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 21 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Age 16-21, placed in institutional care (SiS), with substance use disorder and criminal, violent or destructive behavior, willing and able to undergo A-CRA during their placement.
  • Ability to read and understand informed consent.

Who cannot join

  • Severe cognitive or psychiatric condition that obstructs ability to provide informed consent or to undergo assessment or interventions.
  • Serious somatic condition requiring acute medical attention.

Trial locations and contacts

1 site in 1 country.

Sweden1 site
  • Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet.

    Stockholm, Stockholm County

Other trials in Sweden

About this study

Official title: Feasibility, Acceptability and Preliminary Treatment Effects of Adolescent Community Reinforcement Approach, A-CRA, for Youth in Compulsory Institutional Care

Substance abuse and criminal behavior are increasing among adolescents in Sweden. The Swedish National Board of Institutional Care, SiS, provides institutional care on basis of the Swedish laws Care of Young Persons (Special Provisions) Act, LVU, Care of Substance Abusers (Special Provisions) Act, LVM, Secure Youth Care Act, LSU. Treatment is provided at locked youth residential homes. The Adolescent Community Reinforcement Approach, A-CRA, an empirically supported substance use treatment, promotes long-term abstinence, increases social stability and decreases depression and other co-morbid psychiatric problems. However, A-CRA has mostly been delivered and evaluated within outpatient care. It is unclear whether A-CRA is as effective when delivered in compulsory care where many adolescents with severe substance use disorder and criminal behavior receive treatment. This study is the first part of a larger project with the overall objective to evaluate and adjust A-CRA to the compulsory care provided at National Board of Institutional Care (Statens institutionsstyrelse, SiS) for justice-involved youth. The aim of this first part is to examine feasibility, acceptability and preliminary effects of A-CRA when provided in institutional care (SiS). Furthermore, to explore experiences of undergoing and delivering A-CRA in the institutional setting. Data collected from this study will be used for improvement of a coming full scale randomized controlled trial planned for 2022. Expected results are that A-CRA is feasible in the institutional environment, that A-CRA is perceived as helpful and acceptable by therapists and adolescents, that planned procedures are feasible and data collection and recruitment works satisfactorily.

Read the detailed description

The primary objective of this study is to evaluate the feasibility, acceptability and preliminary effects of the empirically supported treatment A-CRA when adjusted to, and delivered in, the institutional care of SiS. Furthermore, to increase pro-social behavior/attitudes and psychological flexibility, to improve mental health and to decrease criminal behavior and substance abuse in youth suffering from substance use disorder and/or disruptive behaviors. This study consists of a qualitative and a quantitative part 1) semi-structured interviews with adolescents and therapists involved in treatment to explore experiences 2) a pilot study to evaluate acceptability, feasibility and preliminary effects of A-CRA. Treatment type and dose (number of sessions received and length of sessions) are registered to enable future analyzes. Acceptability (perceived helpfulness and comprehensibility) is measured using a 7-point Likert-scale, ranging from 1 (not at all helpful) to 7 (very helpful).

Adolescents are randomized to either standard care alone or standard care with the addition of A-CRA. Standard care is defined as the interventions and treatments adolescents are usually offered and undergo in institutional care. These are Motivational Interviewing, MI, Cognitive Behavioral Therapy, CBT, Aggression Replacement Therapy, ART or Acceptance and Commitment Therapy, ACT. This will be further specified and registered in the initial phase of the study, in collaboration with SiS. Randomization takes place at the individual level with even allocation to the groups. Quantitative measurements take place before, during and after treatment as well as follow up once a month for six months. Potential adverse events will be collected after treatment completion using open questions.

Being tested
A-CRA, TAU
Medical subject headings
Substance-Related Disorders, Criminal Behavior

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • A-CRABehavioural

    12-14 weekly sessions of A-CRA, a behavioral treatment for youth suffering from substance use disorder and co-occurring problems. The average time for a placement within SiS is for boys 5,9 months and for girls 4,5 months. To further adjust A-CRA to the closed institutional care, frequency of sessions may be increased to twice a week. This is to facilitate maintaining of focus in treatment and closely follow treatment progress. Treatment consists of 18 procedures that aim to reduce problematic behaviors and increase constructive behaviors. Example of procedures are functional analysis of substance use behavior, functional analysis of prosocial behavior, increasing prosocial activities, drink/drug refusal, relapse prevention, anger management and caregiver sessions. Procedures are combined and tailored to youth individual goals and needs.

  • TAUBehavioural

    Standard care is defined as the interventions and treatments adolescents are usually offered and undergo in institutional care. These are Motivational Interviewing, MI, Cognitive Behavioral Therapy, CBT, Aggression Replacement Therapy, ART or Acceptance and Commitment Therapy, ACT. This will be further specified and registered in the initial phase of the study, in collaboration with SiS.

Study groups in NCT05081934
Study groupRoleWhat they receive
Treatment as usual, TAUActive comparatorTAU: Interventions and treatments usually offered and delivered in institutional care. For example, Motivational Interviewing, MI, Cognitive Behavioral Therapy, CBT, Aggression Replacement Therapy, ART or Acceptance and Commitment Therapy, ACT. Further specification of TAU will be made in collaboration with the institutions included in the trial.
Receives: Behavioral: TAU
TAU + A-CRAExperimentalBehavioral: A-CRA, a 12-14 weekly sessions long behavioral treatment for youth (ages 12-25) suffering from substance use disorder and co-occurring problems, i.e. criminal behavior. The aim is to increase constructive behavior that reduces the need of substances and creates a context where it is rewarding to stay sober. Individual functional analyses, goals and needs guides treatment planning and interventions. TAU: interventions and treatments usually offered and delivered in institutional care. For example, Motivational Interviewing, MI, Cognitive Behavioral Therapy, CBT, Aggression Replacement Therapy, ART or Acceptance and Commitment Therapy, ACT. Further specification of TAU will be made in collaboration with the institutions included in the trial.
Receives: Behavioral: A-CRA; Behavioral: TAU

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Attrition

    Attrition defined as participants discontinuing treatment and assessments.

    Measured: During treatment and at follow up 6 months.

  2. Inclusion rate.

    Proportion of youth accepting to participate after being informed about randomization and offered treatment.

    Measured: 0 weeks.

  3. Treatment completion.

    Percentage of treatment completers defined as participants who underwent all planned A-CRA modules.

    Measured: Immediately after completion.

Secondary outcomes (14)
  1. Completed treatment sessions

    Proportion of treatment sessions completed in TAU + A-CRA compared to TAU.

    Measured: Registered weekly

  2. Length of treatment sessions

    Average length of treatment sessions in TAU + A-CRA compared to TAU.

    Measured: Registered after every session

  3. Treatment period

    Defined as number of weeks from treatment initiation to treatment completion.

    Measured: 0 weeks to treatment completion.

  4. Acceptability of treatment

    Acceptability is measured using a 7-point Likert-scale, ranging from 1 (not at all helpful) to 7 (very helpful).

    Measured: Post treatment.

  5. Depression, anxiety and stress

    Depression Anxiety Stress Scale-21 (DASS-21; Antony, Bieling, Cox, Enns, \& Swinson, 1998), a self-assessment scale with three subscales.

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  6. Pro-social behavior

    Prosocial Tendencies Measure (PTM; Carlo \& Randall, 2002), a self-assessment scale measuring pro-social behavior in six domains, such as altruistic, emotional, public and private behavior.

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  7. Ongoing alcohol/drug cravings

    VAS Single Item Craving Question (Reid, Flammino, Starosta, Palamar, \& Franck, 2006), a self-assessment VAS-scale ranging from 0 (no craving) to 100 (maximum craving).

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  8. Emotion regulation

    Difficulties in Emotion Regulation Scale-16 (DERS-16; Bjureberg et al., 2016), a self-assessment scale measuring problems with emotion regulation in five domains, ability to control impulses in when distressed, non-acceptance of negative emotions, goal orientation when distressed, limited access to emotion regulation strategies perceived as effective and emotional clarity. Consists of 16 items, answers on a Likert-scale ranging from 1 (almost never) to 5 (almost always).

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  9. Goal directed behavior, engagement in goal behaviors and obstacles to prosocial and healthy behavioral patterns

    Bull's-Eye Values Survey (BEVS; Lundgren et al., 2012). Therapist guided. The scale ranges from 0-7 and is illustrated with a physical metaphor of a dartboard.

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  10. Psychological flexibility

    Avoidance and Fusion Questionnaire Short Version (AFQ-Y8; Livheim et al.,2016) a self-assessment scale measuring psychological flexibility in adolescents. Consists of 8 items.

    Measured: 0 weeks, 7 weeks, 14 weeks and at follow up 6 months after treatment.

  11. Negative effects of treatment

    Negative Effects Questionnaire (NEQ; Rozental, Kottorp, Boettcher, Andersson, \& Carlbring, 2016) NEQ-20 investigate participants' negative effects of psychological treatments. Total range is 0-80, with higher values representing a worse outcome.

    Measured: 7 weeks, 14 weeks and at follow up 6 months after treatment.

  12. Level of Service/Case Management Inventory

    Level of Service/Case Management Inventory (LS/CMI; Andrews, Bonta, \& Wormith, 2000) is a clinician administered instrument to evaluate the risks and needs in youthful offenders and is often used to guide case management. Involves antisocial and pro-criminal attitudes.

    Measured: 0 weeks, 14 weeks and at follow up 6 months after treatment.

  13. Alcohol Use Disorders Identification Test

    1. Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) a self-assessment scale screening for hazardous drinking and alcohol abuse disorder.

    Measured: 0 weeks, 14 weeks and at follow up 6 months after treatment.

  14. Drug Use Disorders Identification Test

    1. Drug Use Disorders Identification Test (DUDIT; Berman, Bergman, Palmstierna, \& Schlyter, 2005) a self-assessment scale measuring the use and disorder of drugs.

    Measured: 0 weeks, 14 weeks and at follow up 6 months after treatment.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Oct 2021
  2. Study start16 Feb 2022
  3. Primary completion30 Sep 2023
  4. Study completion31 Dec 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
42 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05081934
Sponsor's protocol ID
2021-02258
Status last verified
Oct 2023
First submitted
14 Sep 2021
Last updated
19 Dec 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Malarstig I, Tyrberg M, Spannargard A, Garke MA, Lundgren T, Alfonsson S. Adolescent community reinforcement approach in secure care for adolescents with substance use and serious norm-violating behaviour: a randomised feasibility trial. BMJ Open. 2026 Feb 9;16(2):e111332. doi: 10.1136/bmjopen-2025-111332.

    PubMed 41663166

Questions about this trial

What is this clinical trial studying?

A study testing A-CRA and TAU in people with Substance Use Disorders and Criminal Behavior, run by Karolinska Institutet at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Attrition (time frame: During treatment and at follow up 6 months.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05081934, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Dec 2024.

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