This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction. 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), 24 EAs with poly-substance use and their parents will be recruited. 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. Concurrently, EAs will be randomized to one of two conditions to work with a PRS. In the first condition, PRS will provide typical services, including recovery social networking. In the second, PRS will provide typical services but will also further build the EAs' recovery capital via vocational/educational/ financial skills. 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.

PROJECT NARRATIVE Emerging adults (EAs; aged 18-26) are the highest-risk population for poly-substance use, including opioid and stimulant poly-use, compared to all other age groups and are the least served population for substance use services. The overarching purpose of the proposed pilot study is to assess the feasibility and acceptability of an innovative substance use services package, Launch, that leverages supportive parents and peer recovery supports (PRS) to reduce poly-substance use and increase recovery capital in this critical developmental stage using quantitative, qualitative, and community-based participatory research procedures. The study will also lay the groundwork for a future large-scale adaptive trial of Launch services.