1. PROJECT SUMMARY
Relapse rates among adolescents remain high despite advances in substance use disorder (SUD) treatment.
Chronic relapse cycles have high individual costs, such as higher risk of infectious disease transmission and
low life satisfaction, as well as downstream societal costs, including healthcare system burden and
inefficiencies. Limited adolescent-focused recovery supports represent a critical barrier to sustaining treatment
effects, highlighting the critical need to invest in research that contributes to the evidence base of adolescent-
focused continuing care and development of adolescent recovery supports. Recognizing the urgency of this
research and its potential contributions to the field, the National Institute on Drug Abuse’s (NIDA’s) 2022-2026
Strategic Framework identified developing and testing recovery support strategies as a priority scientific area,
with a goal of advancing the science of recovery support. Recovery supports affiliated with youth-serving
institutions offer a unique opportunity to provide adolescents with developmentally appropriate continuing care
following SUD treatment. Recovery high schools (RHSs) are one such approach, which are specialized
schools designed to provide students with therapeutic and peer recovery supports in a learning environment
where all students are committed to maintaining recovery from an SUD, cultivating a pro-recovery social
network for these adolescents. Using innovative approaches that align with NIDA key focus areas, this project
will draw upon data from the only controlled evaluation of RHSs to date to accomplish the following aims: (Aim
1) examine whether RHS attendance following SUD treatment has beneficial effects on long-term recovery
outcomes; (Aim 2) identify if and to what extent pro-recovery peer affiliation mediates the proposed
relationship between RHS attendance and recovery outcomes; and (Aim 3) assess whether and to what extent
the indirect effect of RHS attendance on substance use outcomes via pro-recovery peer affiliation is moderated
by perceived social benefits of substance use. Upon successful completion, this project will help NIDA
accomplish its goal of advancing the science of recovery support by delivering the expected outcomes: (1)
additional evidence supporting RHSs as a continuing care approach; and (2) greater insight into the underlying
mechanisms and conditional processes of RHS attendance. This critical knowledge is needed to support the
refinement and expansion of RHSs to provide greater and more equitable access as well as inform the
development of other continuing care approaches for this underserved population.