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), 48 EAs with poly-
substance use and their parents will be recruited. Families will be randomized to one of three conditions. In the
first condition, 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. In the second
condition, PRS will provide typical services, including recovery social networking and will also further build the
EAs’ recovery capital via vocational/educational/ financial skills. In the third condition, families will get both a CM-
EA coach and a PRS. 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.
