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

加强药物滥用治疗服务，以减少新生成年人的辍学率并提高门诊治疗利用率

• 批准号: 10372188
• 负责人: Kristyn Zajac
• 金额: $ 69.19万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10372188
• 关键词: Acute; Address; Adherence; Affect; Age; Ambulatory Care; Awareness; Behavioral; Brain region; Characteristics; Childhood; Clinic; Clinical Data; Cognition; Cognitive; Communities; Data; Development; Dropout; Drops; Elderly; Event-Related Potentials; Exhibits; Focus Groups; Health; Health Care Costs; Healthcare; Home; Impairment; Imprisonment; Income; Knowledge; Literature; Logistics; Mental Health; Motivation; Opiate Addiction; Outcome; Outpatients; Overdose; Phase; Predictive Factor; Prevention; Public Health; Quality of life; Randomized; Readiness; Recovery Support; Regimen; Research; Risk Factors; Schedule; Services; Severities; Short-Term Memory; Social Change; Social Network; Social support; Substance Use Disorder; Symptoms; System; Testing; Time; Treatment outcome; Waiting Lists; Work; Workload; age group; base; behavior measurement; cognitive process; combat; comorbidity; compliance behavior; computerized; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; design; economic impact; emerging adult; emerging adulthood; executive function; experience; flexibility; high risk; high risk population; improved; innovation; opioid epidemic; overdose death; peer; prevent; response; service utilization; skills; substance use; substance use treatment; symptomatic improvement; treatment adherence; treatment duration; treatment planning; treatment services

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.

抽象的 新兴成年人（EA；18-25 岁）物质使用障碍的发生率高于任何其他年龄段 群体，并受到阿片类药物危机的打击尤为严重。 EA 还表现出较差的遵守性 与物质使用服务相关的医疗保健方案，辍学率较高，服务水平较低 利用率高于任何其他年龄段。这种不良的依从性会导致灾难性的后果，包括持续 物质使用、监禁和服药过量。此外，高辍学率导致成本飙升。 由于更迫切的服务需求、昂贵的服务利用和漫长的等待名单，治疗系统的需求不断增加。成本- 旨在提高药物使用服务治疗依从性的有效策略，并针对 满足EA的独特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 对于这个年龄组特有的辍学者来说，阻碍了系统对这一重大问题的有效反应。 与此同时，物质使用服务系统越来越多地使用同伴恢复支持（PRS； 即具有药物使用问题“生活经验”的辅助专业人员）以增强治疗效果 且不会产生大量额外费用。然而，PRS 提供的服务并未量身定制 专门用于减少 EA 丢失，但很少经过严格测试。目前的研究将评估 PRS 提供的针对常规治疗服务的创新型 EA 特定辍学预防强化 基于社区的药物滥用治疗诊所（目标 1）。我们将采用随机的阶梯楔形簇 设计，使每个诊所都有一个纵向的常规服务阶段和纵向的辍学预防 阶段。将使用以下客观数据对这两个阶段的 EA 退出率和服务利用率进行比较 临床图表。我们还将评估成本效益并采用定性方法来了解 影响这种辍学预防强化措施的潜在可持续性的各种财务因素（目标 2）。 此外，我们将利用阶梯楔形设计来研究旨在预测 EA 丢失的因素 并初步调查因素是否会影响辍学预防（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 成为第一个对执行功能进行全面评估的人，包括与事件相关的潜力和 在计算机化任务期间收集的行为数据，作为从药物使用服务中退出的预测指标。 结果将极大地增进我们对 EA dropout 的了解以及专门针对 EA dropout 的潜在增强功能 减少 EA 辍学率，这具有很高的成本效益且易于传播的潜力。回答这些 关键问题是提高患者对物质使用服务中 EA 依从性的关键下一步， 最终，促进这一高风险群体取得积极成果。