Emerging adults (EAs; 18-25) have the highest rates of substance use disorders and are particularly affected by the opioid crisis. They also tend to drop out of treatment more frequently and use services less than other age groups, leading to worse outcomes like continued substance use, incarceration, and overdose. High dropout rates also drive up treatment costs due to more severe service needs and long waitlists. Cost-effective strategies to improve treatment adherence for EAs are urgently needed, but little is known about the specific reasons for dropout in this group. Peer recovery supports (PRS), who have personal experience with substance use, are increasingly used to improve outcomes without significant additional costs, but they have not been tailored to prevent EA dropout. This study will evaluate an EA-specific dropout prevention program delivered by PRS in community treatment clinics (Aim 1) using a stepped-wedge randomized design to compare dropout rates and service use. The study will also assess cost-effectiveness and factors influencing sustainability (Aim 2). Additionally, it will explore risk factors for dropout, such as executive functioning and social support, to better understand what drives dropout and how to prevent it (Aim 3). Results will greatly advance our 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. Answering these key questions is a crucial next step in improving patient adherence for EAs in substance use services and, ultimately, promoting positive outcomes for this high-risk group.
