Substance use prevention for youth with parents in recovery: a pilot randomized controlled trial

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PROJECT SUMMARY Risk for substance use disorder (SUD) begins early in the life course. Although preventing and decreasing illicit and nonmedical drug use among youth is an urgent public health priority, there are currently few evidence- based prevention strategies feasible for delivery in the primary care setting. We propose a three-year plan to collect critical pilot data to pilot test and optimize a dyadic intervention that aims to increase family resilience, strengthen coping skills, help families plan for the future, and prevent youth SUD. Currently, over 12% of children in the US live in households with at least one parent who has SUD, including an estimated 3 million children between the ages of 12 and 17. Parental SUD is a known risk factor for the initiation and progression of substance use in adolescence and young adulthood. At the same time, parental recovery from SUD has been shown to be protective against youth substance use, particularly when there are supports in place to promote supportive parent-child relationships, problem solving skills, and effective family coping strategies. A key premise of our work is that an effective SUD prevention strategy for high-risk youth therefore needs to incorporate the family unit deliberately in the intervention process. The long-term objective of this proposed trajectory of work is to prevent substance use among a selective population of youth whose parents are in recovery from SUD. The ‘prototype’ for our intervention approach is Family Talk, an evidence-based parent-youth dyadic intervention that can be delivered within the existing infrastructure of the patient-centered medical home. We have made preliminary adaptations to the model in preparation for testing. To prepare for a subsequent efficacy study, we will conduct a two-arm pilot randomized controlled trial of the intervention with 40 parent- youth dyads to optimize the intervention model; evaluate feasibility; obtain empiric estimates of study parameters to inform the planning of a fully powered randomized controlled trial; and identify plausible intervention targets using semi-structured qualitative interviews. The product at the end of this R34 will be an optimized intervention model, ready for efficacy testing, adapted with parent and youth input. Our ultimate goal is to develop an effective approach to youth substance use prevention that can be delivered within the infrastructure of the patient-centered medical home. If successful, this trajectory of work has the potential to identify a novel, family-centered approach to SUD prevention for a high-risk population of youth whose parents are in recovery from SUD.