Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults with Polysubstance Use: Feasibility, Acceptability, and Scaling Up of Launch

利用父母和同伴的康复支持来增加使用多物质的新兴成年人的康复资本：可行性、可接受性和扩大启动规模

• 批准号: 10590541
• 负责人: Tess K. Drazdowski
• 金额: $ 1.16万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10590541
• 关键词: Abbreviations; Abstinence; Address; Adherence; Adolescent; Adult; Affect; Back; Capital; Caring; Cessation of life; Clinic; Communities; County; Data; Development; Dropout; Drops; Educational process of instructing; Effectiveness; Elderly; Ensure; Family; Feedback; Felis catus; Funding; Future; Goals; Health Services; Helping to End Addiction Long-term; Injury; Intervention; Interview; Investigator-Initiated Research; Knowledge; Life; Medical; Mental Health Services; Methods; Modeling; Names; Online Systems; Opiate Addiction; Opioid; Outcomes Research; Outpatients; Parents; Performance at work; Pharmaceutical Preparations; Pilot Projects; Play; Population; Procedures; Protocols documentation; Provider; Public Health; Randomized; Recovery; Recovery Support; Reporting; Research; Resources; Risk; Role; Route; Rural Community; Rural Health; Schools; Service delivery model; Services; Site; Social Network; Social support; Specific qualifier value; Speed; Stimulant; Training; Training Support; Transportation; United States National Institutes of Health; Work; acceptability and feasibility; adverse outcome; age group; aged; behavioral health; community based participatory research; community engaged research; contingency management; cost; emerging adult; evidence base; experience; feasibility testing; future implementation; health equity; help-seeking behavior; heroin use; high risk population; improved; innovation; multiple drug use; opioid epidemic; opioid misuse; overdose death; peer; peer support; personalized approach; polysubstance use; prevent; programs; recruit; residence; rural area; scale up; service gap; skills; substance use; substance use treatment; tool; uptake; virtual; virtual coach

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. Emerging adults (EAs; aged 18-26) have the highest rates of poly-substance use compared to all other age groups. They have been hit particularly hard by the opioid crisis, estimated to cost the U.S. $1 trillion a year. In fact, nearly all EAs with a substance use problem report regular use of multiple drugs. Recovery capital, or the resources available to promote substance use recovery (e.g., vocational/educational skills, recovery-supportive community) is also much lower for EAs compared to older adults. This is not surprising given this developmental stage of instability and transition. Unfortunately, most EAs with poly-substance use are not receiving services, a problem that is exacerbated in rural communities, which often lack access to any behavioral health services. Further, EAs who do access substance use services are unlikely to receive evidence-based care and are more likely to drop out compared to older adults. Clearly, more developmentally appropriate and engaging services are needed for EAs with poly-substance use, regardless of residence, but particularly in rural communities. This R34, from an early stage investigator, initiates research to fill this service gap via an innovative adaptation of existing substance use services. It leverages (1) parents of EAs and (2) peer recovery supports (PRS), while ensuring services are equitable and scalable. Substance use services for EAs rarely involve parents, but their involvement could be the difference-maker for sustaining recovery. Beyond parents, the lack of recovery-focused peer social support is a major barrier to sustained recovery in EAs. Fortuitously, certified PRS are trained to help EAs find a recovery peer community and possibly build recovery capital. Thus, this R34 pilots a scalable service for EAs, named Launch, that involves both parents and PRS, thereby targeting poly-substance use from two crucial angles. After adapting and evaluating training protocols and adherence tools (Aim 1), 24 EAs with poly-substance use and their parents will be recruited. Parents will engage in web-based coaching to use Contingency Management for Emerging Adults (CM-EA), built on decades of work supporting CM as a leading intervention for poly-substance use. Concurrently, EAs will be randomized to one of two conditions to work with a PRS. In the first condition, PRS will provide typical services, including recovery social networking. In the second, PRS will provide typical services but will also further build the EAs' recovery capital via vocational/educational/ financial skills. The feasibility and acceptability of the study protocol and Launch services will be assessed (Aim 2). Notably, this project has been informed by Community-Based Participatory Research (CBPR) practices, which continue in the R34 by incorporating feedback from EAs with lived experience in recovery and the parent coach, PRS, and families. Further, to improve eventual uptake, payors/providers of substance use services will be interviewed. Sites for a future large-scale adaptive trial will also be recruited (Aim 3). If Launch is ultimately deemed effective, it would fill a major gap in the substance use services field by providing a highly specified and individualized service for reducing risk and promoting adaptive life functioning in EAs with poly-substance use.

这项研究是 NIH 帮助消除成瘾长期 (HEAL) 计划的一部分，该计划旨在加快国家阿片类药物公共卫生危机的科学解决方案。NIH HEAL 计划支持 NIH 的研究，以改善对阿片类药物滥用和成瘾的新兴成年人的治疗。与所有其他年龄组相比，EA（18-26 岁）的多种物质使用率最高，他们受到阿片类药物危机的打击尤为严重，估计每年给美国造成 1 万亿美元的损失。事实上，几乎所有有药物使用问题的 EA 都报告经常使用多种药物。 与老年人相比，可用于促进物质使用康复的资源（例如职业/教育技能、康复支持社区）也低得多，考虑到目前处于不稳定和过渡阶段，这并不奇怪。 - 物质使用未接受服务，a 这一问题在农村社区更为严重，因为农村社区往往无法获得任何行为健康服务。此外，获得药物使用服务的 EA 不太可能获得基于证据的护理，而且与老年人相比，辍学的可能性更大。适合发展且有吸引力的服务 具有多种物质使用的 EA 需要这些服务，无论其居住地如何，但特别是在农村社区，这项 R34 是一项早期调查人员发起的研究，旨在通过对现有物质使用服务进行创新调整来填补这一服务空白（1。 ) EA 的父母和 (2) 同伴康复支持 (PRS)，同时确保 EA 的药物使用服务很少涉及父母，但他们的参与。 除了父母之外，缺乏以恢复为重点的同伴社会支持是 EA 持续恢复的主要障碍。幸运的是，经过认证的 PRS 接受过培训，可以帮助 EA 找到恢复同伴社区并可能建立。因此，该 R34 为 EA 试点了一项名为 Launch 的可扩展服务，该服务涉及家长和 PRS，从而在调整和评估培训方案和遵守工具后，从两个关键角度瞄准多物质的使用。 1)，将招募 24 名使用多种物质的 EA 及其家长，进行使用应急措施的网络辅导。 新兴成人管理（CM-EA）建立在几十年来支持 CM 作为导致多种物质使用的干预措施的基础上。同时，EA 将被随机分配到两种情况之一，以与 PRS 一起使用。第一种情况是 PRS。将提供典型服务，包括恢复社交网络。第二，PRS 将提供典型服务，但还将通过职业/教育/进一步建立 EA 的恢复资本。 将评估研究方案和启动服务的可行性和可接受性（目标 2）。值得注意的是，该项目以社区参与性研究 (CBPR) 实践为基础，该实践在 R34 中继续纳入 EA 的反馈。此外，为了提高最终的接受度，还将采访药物使用服务的付款人/提供者，以进行未来的大规模适应性试验。 （目标 3）。如果 Launch 最终被认为是有效的，它将通过提供高度具体和个性化的服务来填补药物使用服务领域的一个重大空白，以降低风险并促进多物质使用的 EA 的适应性生活功能。