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

这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear Initiative支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗。与所有其他年龄段相比，新兴成年人(18-26岁)使用多种物质的比率最高。他们受到阿片类药物危机的打击尤其严重，据估计，阿片类药物危机每年造成美国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。恢复资本，或 与老年人相比，可用于促进物质使用恢复的资源(例如，职业/教育技能、支持恢复的社区)也要少得多。考虑到目前处于不稳定和过渡的发展阶段，这并不令人惊讶。不幸的是，大多数使用多物质的EA没有得到服务， 这一问题在农村社区加剧，农村社区往往无法获得任何行为健康服务。此外，获得物质使用服务的EA不太可能得到循证护理，与老年人相比，他们更有可能辍学。显然，更适合发展和更具吸引力的服务 对于使用多物质的环境影响评估机构，无论其居住地如何，尤其是在农村社区，都需要。这个R34，从一个早期的研究人员，启动研究，通过对现有物质使用服务的创新调整来填补这一服务空白。它利用(1)EA的父母和(2)对等恢复支持(PR)，同时确保服务是公平和可扩展的。为EA提供的物质使用服务很少有父母参与，但他们的 参与可能是可持续复苏的关键因素。除了父母，缺乏注重康复的同伴社会支持是东亚地区持续复苏的主要障碍。幸运的是，经过认证的PR经过培训，以帮助EA找到恢复同行社区，并可能建立恢复资本。因此，这款R34为EA试行了一项可扩展的服务，名为Launch，涉及父母和PR，从而从两个关键角度瞄准多物质使用。在调整和评估培训方案和遵守工具(目标1)之后，将招募24名使用多种物质的EA及其父母。家长将参与基于网络的辅导，以使用应急措施 新兴成人管理(CM-EA)，建立在数十年的工作基础上，支持CM作为多物质使用的领先干预措施。同时，EA将被随机分成两种情况之一，以便与PRS一起工作。在第一种情况下，PRS将提供典型的服务，包括恢复社交网络。在第二个阶段，公共服务中心将提供典型的服务，但也将通过职业/教育/教育进一步建立环境援助机构的恢复资本。 财务技巧。将评估研究方案和发射服务的可行性和可接受性(目标2)。值得注意的是，该项目得到了基于社区的参与性研究(CBPR)实践的启发，这种做法在R34中继续存在，纳入了具有恢复生活经验的EA和家长教练、社区参与研究和家庭的反馈。此外，为了改进最终的使用情况，将与物质使用服务的付款人/提供者进行面谈。还将招募今后进行大规模适应性试验的地点(目标3)。如果启动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物质使用服务领域的一个重大空白，以降低风险并促进多种物质使用的东亚地区的适应性生活功能。

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.