Todd Olmstead on team awarded $3.5M grant to study peer recovery support in substance use treatment | LBJ School of Public Affairs | The University of Texas at Austin

LBJ School Professor of Public Affairs Todd Olmstead is a co-investigator on a recently awarded National Institutes of Health grant to examine the effectiveness and cost-effectiveness of using peer recovery supports (paraprofessionals who have "lived experience" with substance use problems) to improve treatment adherence and reduce treatment dropout among emerging adults (ages 18-25) with substance use disorders.

Emerging adults (EA) are at higher risk for substance use disorders, including opiate addiction, than any other age group and are also more likely to drop out early from substance use treatment services. This project will evaluate an enhancement to usual services, delivered by peer recovery supports, specifically aimed at improving treatment adherence and reducing dropout in this age group. The study will also answer key questions about risk factors for dropout among emerging adults and the financial sustainability of enhancing services to reduce dropout.

"I'm very excited to be part of this study with my colleague Kristyn Zajac at UConn," Olmstead said. "Briefly, emerging adults — people between 18 and 25 years — suffer from the double whammy of having both higher rates of substance use disorders AND higher treatment dropout rates than any other age group in the U.S. And dropping out of treatment leads to recidivism and the cycle starts all over again. Our study focuses on adding peer recovery supports — people with 'lived experience' — to usual care to help keep emerging adults in treatment longer, with the goal of improving their substance misuse. And if it is successful, my job as the health economist on the study will be to answer the question: Is it worth it?"

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. Researchers 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. They 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. In addition, researchers 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. 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 from this project will greatly advance 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.