JMIR Publications

ABSTRACT

Background:

Emerging adults (EAs) are the most at-risk yet underserved age group among people with substance use disorder, especially rural EAs, and polysubstance use is common. Recovery capital is lower among EAs compared to older adults, and evidence-based treatments are typically not tailored to EA developmental needs, or simply not available, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support EAs with polysubstance use. Further, previous research has indicated that parents can be engaged to deliver contingency management, one of the most extensively researched evidence-based interventions for substance use.

Objective:

This protocol describes a funded pilot of Launch, a novel, scalable services package that pairs virtual coaching for parents to deliver contingency management for EAs (CM-EA) at home with their EA child and in-person PRSS with EA-appropriate educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing, as well as the steps taken to prepare for a future large-scale trial of Launch.

Methods:

Upon recruitment from primarily sites serving rural clients, participants will be randomized into one of three conditions: virtual parent coaching to deliver CM-EA, in-person PRSS for EAs, or both sets of services. EA eligibility will be determined by polysubstance use, a substance use disorder, and availability of a parent willing to participate. EAs will be interviewed at baseline and 6-month follow-up about substance use, quality of life, recovery capital, parental relationship, and will be asked about Launch feasibility, acceptability and appropriateness (implementation-related outcomes) at 6-month follow-up. Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will also be asked to complete checklists of specific services delivered after each session with the EA or parent. Finally, payors and providers will be interviewed for additional insight into Launch implementation and to identify key participant-level and economic outcomes of Launch.

Results:

Launch is currently ongoing, with funding received in August 2023 and is currently expected to end September 2025, with results anticipated in late 2026.

Conclusions:

While this pilot is limited by the small participant size and the restriction to only EAs with polysubstance use with an involved parent, it is appropriate for this pilot stage, and is mitigated by the study’s strengths. Launch uses an innovative combination of existing strategies to generate better outcomes for these EAs, while still being highly scalable, especially to rural communities. Clinical Trial: ClinicalTrials.gov ID NCT06414993