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

摘要 新兴成年人(18-25岁)的物质使用障碍的发生率比其他任何年龄段都要高。 该集团受到阿片类药物危机的打击尤其严重。EAS还显示出对 与药物使用服务相关的医疗保健方案，辍学率较高，服务较低 使用率高于任何其他年龄段。这种糟糕的坚持导致了毁灭性的后果，包括继续 吸毒、监禁和服药过量。此外，高辍学率导致成本飙升， 由于服务需求更加急迫、服务利用率昂贵和等待名单较长而导致的治疗系统。成本- 旨在提高治疗对物质使用服务的依从性并量身定做的有效战略 满足东亚地区独特的发展需求是迫在眉睫的需要。此外，人们对风险因素知之甚少。 对于这一年龄段特有的辍学，阻碍了系统对这一重大问题的有效反应。 与此同时，药物使用服务系统越来越多地使用同伴恢复支持(PRS； 即有药物使用问题的“生活经验”的辅助专业人员)，以支持治疗结果 而不会招致相当大的额外成本。然而，PrS提供的服务并没有量身定做 特别是为了减少EA的辍学，而且几乎没有人经过了严格的测试。目前的研究将评估一个 创新的针对EA的辍学预防增强了常规治疗服务，由PrS在 社区物质使用治疗诊所(目标1)。我们将使用随机的阶梯形楔形集群 设计，使每个诊所都有纵向的正常服务阶段和纵向的辍学预防 相位。将使用以下目标数据比较这两个阶段的EA辍学率和服务利用率 临床病历。我们还将评估成本效益，并采用定性的方法来了解 影响这种防止辍学的潜在可持续性的各种财务因素(目标2)。 此外，我们将利用阶梯式楔形设计来调查据称可以预测EA辍学的因素 从物质使用服务和初步调查因素是否适度防止辍学(目标3)。 这些关键变量包括执行功能、身份形成、动机、药物使用严重程度、 共病心理健康症状、社会支持和治疗相关认知。特别是，这项研究将 第一个使用全面的执行功能评估，包括事件相关电位和 在计算机化任务期间收集的行为数据，作为退出药物使用服务的预测指标。 结果将极大地提高我们对EA辍学的了解，以及专门针对以下目标的潜在增强 减少EA辍学，这具有很高的成本效益和易于传播的潜力。回答这些问题 关键问题是提高EAS患者对物质使用服务的依从性的关键下一步， 最终，促进这一高风险群体的积极结果。

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.