Enhancing Substance Use Treatment Services to Decrease Dropout and Improve Outpatient Treatment Utilization in Emerging Adults

摘要 新兴成年人（EAs;年龄18-25）的物质使用障碍率高于任何其他年龄 该组织受到阿片类药物危机的打击尤其严重。EA还显示对以下方面的依从性较差： 与药物使用服务相关的保健方案，辍学率较高，服务较少 比任何其他年龄段的人都多。这种不良的依从性导致毁灭性的结果，包括持续的 吸毒入狱和吸毒过量此外，高辍学率导致成本飙升， 由于更迫切的服务需求、昂贵的服务利用率和漫长的等待名单，治疗系统受到影响。费用- 有效的策略，旨在提高治疗坚持物质使用服务，并针对 满足电子艺界独特的发展需求是迫在眉睫的需要。此外，对风险因素知之甚少 这一年龄组特有的辍学问题，阻碍了系统对这一重大问题作出有效反应。 与此同时，药物使用服务系统越来越多地使用同伴康复支助（减贫战略; 也就是说，对药物使用问题有“生活经验”的辅助专业人员），以加强治疗效果 而不会产生相当大的额外成本。然而，减贫战略提供的服务没有针对具体情况加以调整 特别是为了减少EA辍学，很少有人经过严格的测试。目前的研究将评估一个 通过减贫战略， 社区药物使用治疗诊所（目标1）。我们将采用一个阶梯楔形集群随机 设计，导致每个诊所都有一个纵向的常规服务阶段和一个纵向的辍学预防阶段， 相位两个阶段将使用以下客观数据比较EA辍学率和服务利用率： 临床图表我们亦会评估成本效益，并采用质性的方法， 各种财务因素影响到这种加强预防辍学工作的潜在可持续性（目标2）。 此外，我们将利用阶梯楔形设计来研究预测EA脱落的因素 从物质使用服务，并初步调查是否因素中度辍学预防（目标3）。 这些关键变量包括执行功能，身份形成，动机，物质使用严重程度， 共病精神健康症状、社会支持和治疗相关认知。特别是，这项研究将 成为第一个全面评估执行功能的人，包括事件相关潜力， 在计算机化任务期间收集的行为数据，作为从物质使用服务中退出的预测因素。 结果将大大推进我们的知识EA辍学和一个潜在的增强，专门针对 减少EA辍学，这具有很高的潜力，是成本效益和易于传播。回答这些 关键问题是提高患者在物质使用服务中对EA的依从性的关键下一步， 最终，促进这一高风险群体的积极成果。

ABSTRACT Emerging adults (EAs; ages 18-25) have higher rates of substance use disorders than any other age group and have been hit particularly hard by the opioid crisis. EAs also demonstrate poor adherence to healthcare regimens associated with substance use services, with higher dropout rates and lower service utilization than any other age group. This poor adherence leads to devastating outcomes, including continued substance use, incarceration, and overdose. In addition, high dropout rates contribute to skyrocketing costs to treatment systems as a result of more acute service needs, expensive service utilization, and long waitlists. Cost- effective strategies that are aimed at improving treatment adherence to substance use services and tailored to meet the unique developmental needs of EAs are an imminent need. Further, little is known about risk factors for dropout specific to this age group, hindering effective system responses to this significant problem. At the same time, substance use service systems are increasingly using peer recovery supports (PRS; i.e., paraprofessionals who have “lived experience” with substance use problems) to bolster treatment outcomes without incurring considerable additional costs. However, services delivered by PRS have not been tailored specifically to reduce EA dropout, and few have been rigorously tested at all. The current study will evaluate an innovative EA-specific dropout prevention enhancement to usual treatment services, delivered by PRS in community-based substance use treatment clinics (Aim 1). We will employ a stepped-wedge cluster randomized design, resulting in each clinic having a longitudinal usual services phase and a longitudinal dropout prevention phase. The two phases will be compared on rates of EA dropout and service utilization using objective data from clinical charts. We will also evaluate cost-effectiveness and employ a qualitative approach to understanding the varied financial factors that influence potential sustainability of such a dropout prevention enhancement (Aim 2). In addition, we will leverage the stepped-wedge design to investigate factors purported to predict EA dropout from substance use services and preliminarily investigate whether factors moderate dropout prevention (Aim 3). These key variables include executive functioning, identity formation, motivation, substance use severity, comorbid mental health symptoms, social support, and treatment-related cognitions. In particular, this study will be the first to use a comprehensive assessment of executive functioning, including event-related potential and behavioral data collected during computerized tasks, as a predictor of dropout from substance use services. Results will greatly advance our knowledge of EA dropout and a potential enhancement specifically aimed at reducing EA dropout, which has high potential to be cost-effective and easily disseminated. Answering these key questions is a crucial next step in improving patient adherence for EAs in substance use services and, ultimately, promoting positive outcomes for this high-risk group.