Early adulthood is a developmentally significant time of life when many people attend college or start their careers. But for those struggling with addiction it can be difficult to navigate.
Emerging adults, defined as those between 18 and 25 years old, have higher rates of substance use disorders than any other age group and have been particularly hard-hit by the ongoing opioid crisis.
Given this fact, it is concerning that this group has poorer adherence to and higher dropout rates from substance use services and lower utilization of these services than any other age group.
Emerging adults are 62% less likely to complete treatment than older adults. Failing to use these services can lead to continued substance use, incarceration, and overdose.
There is a pressing need for the development of cost-effective strategies to improve substance use treatment adherence that meet the specific developmental needs of emerging adults.
Kristyn Zajac, associate professor of medicine at UConn Health’s Calhoun Cardiology Center, received a grant for nearly $4 million from the National Institutes of Health to evaluate an innovative emerging adult-specific intervention to decrease treatment dropout. This intervention will be delivered by peer recovery supports in community-based substance use treatment clinics and can be incorporated into traditional treatment services.
Zajac is partnering with 10 substance use clinics in Connecticut that treat emerging adults with substance use problems.
Zajac will implement a strategy many substance use service systems already employ known as peer recovery supports. Peer recovery supports are other young people who have “lived experience” with substance use problems and work with emerging adult patients to help bolster treatment outcomes.
However, peer recovery supports have not been tailored specifically for emerging adults, and few have been tested in formal research studies at all.
In Zajac’s study, the peer recovery supports will deliver a brief motivational and skills-based approach specifically designed to help reduce risk for treatment dropout.
This intervention can easily be added to outpatient substance use services and capitalizes on the already-growing use of peer recovery supports. It may also be a cost-effective option that does not add to the workload of traditional substance use clinicians who often have high caseloads and competing demands on their time.
Additionally, Zajac will address the lack of understanding about risk factors that contribute to emerging adults dropping out of substance use treatment. Without this knowledge, it is difficult to develop effective interventions to reduce dropout among emerging adults.
Zajac will investigate which emerging adults are at particular risk for dropout and what factors might put them at risk, including executive functioning, identify formation, motivation, substance use severity, mental health conditions, social support, and perceptions about substance use treatment.
Significantly, this will be the first study to perform a comprehensive assessment of executive functioning, a measure of an individual’s ability plan, monitor, and execute goals, in this context. Executive functioning continues to develop well into early adulthood, meaning the cognitive processes that help people stay in treatment may not be fully mature in emerging adults.
Answering these key questions is a crucial next step in promoting positive outcomes for this high-risk group — Kristyn Zajac
Understanding how well these factors predict dropout will aid the development of improved dropout prevention efforts such as the intervention Zajac is studying. By better understanding which emerging adults are most likely to drop out of treatment and why, interventions can be designed to address this problem more effectively.
Zajac’s study will also determine the cost-effectiveness of this intervention and this information can aid substance use clinic’s decision about whether to adopt the intervention.
“This study will help us understand why emerging adults are at such high risk for dropping out of substance use treatment,” Zajac says. “It will also allow us to evaluate a very promising and innovative intervention to keep emerging adults engaged in treatment, which we hope will ultimately lead to better treatment outcomes and reduce the devastating consequences of untreated substance use disorders. Answering these key questions is a crucial next step in promoting positive outcomes for this high-risk group.”
Zajac holds a Ph.D. in clinical psychology from the University of Delaware. Her research focuses on developing and evaluating interventions for substance use disorders and mental health disorders among high-risk adolescents and young adults.
This award is NIH grant No.: 1R01DA051671-01A1