Like many other chronic medical conditions, substance use disorder (SUD) requires comprehensive support services to help people achieve and sustain lasting recoveries. However, treatment and recovery support for addiction are often siloed either in the clinic or in the community, leaving many gaps in services that can imperil recovery. Young adults with SUD, in particular, face complex challenges when they are working to change or stop their substance use.
In a new article published in January’s Pediatrics supplement, experts argue the critical need to integrate recovery support services into existing treatment and community settings for this age group.
“Creating a comprehensive network of services that address the health-related social needs of young adults can be quite challenging. The scope needs to be comprehensive, encompassing a variety of settings, including education, employment, skills training, criminal justice, even housing, in addition to typical medical treatment. There is a huge heterogeneity of resources that are needed,” argues social epidemiologist Ziming Xuan, ScD, a professor at Boston University School of Public Health and lead author of the article "Youth Addiction and Recovery: The Role of Young Adult Support Services."
SAMHSA's working definition of recovery is "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." SUD’s chronic nature means there is no cure, and recovery can be marked by periods of relapse and repeated treatment.
Health-related social services within the community are integral to supporting sustained recovery — especially during the nascent time of emerging adulthood. Mutual help groups, including 12-step programs like Alcoholics Anonymous, and peer support services, including sober-living housing, are proven examples of effective support.
But the authors note more can be done to connect and streamline health-related social services for patients. It’s an effort that will require input from policymakers, community leaders, hospital administrators, and clinicians. The authors outline three principles of care for working with young adults recovering from SUD.
1. Given their developmental needs, young adults should have access to a wide variety of recovery support services regardless of their treatment level of care.
Whether after early intervention for alcohol use or intensive, inpatient care for opioid addiction, for example, recovery from SUD is often marked by periods of relapse. The support gap between acute treatment and re-entry into the community can threaten recovery. A 2009 study of individuals who left publicly funded addiction treatment programs found that 54% expressed unmet needs for social services, particularly in job training and housing. Experts believe that a multidimensional approach that provides support outside acute treatment — whether it's educational recovery support, sober-living environs, or employee assistance programs — is beneficial for young adults re-entering society.
“A lot of this work and change is happening in the community — in schools, in the workplace, at home — so we really have to think more broadly outside of the treatment system as we think about providing young people with support,” says article coauthor Amy Yule, MD, a psychiatrist specializing in the treatment of young adults with SUD at Boston Medical Center.
Practitioners can support their patients in recovery by adopting a patient-centered approach that considers the many social and community factors that can affect relapse.
2. The workforce for addiction services for young adults may benefit from the inclusion of individuals with lived experience in addiction.
Peer mentors with lived experience are particularly successful in helping young adults navigate sustained recovery. Whether in sober living houses, 12-step programs, or community-based treatment settings, active engagement with these mentors has been shown to reduce relapse rates.
“Youth in their specific developmental stage tend to perceive mentors among their peers to be more similar to them, and that encourages them. They see less of a gap,” explains Xuan.
Peer mentorship can be provided in a variety of modalities, including internet-based approaches that improve access for patients.
The authors underline that these mentors are an enhancement to formal treatment, and clinicians can help patients identify peer mentor opportunities to support recovery. Practitioners who recognize the value of peer services can also advocate for certifications, inclusion of services in Medicaid reimbursement, and other support to strengthen this critical workforce.
3. Recovery support services should be integrated to effectively promote recovery and provide strong social support.
Care gaps for addiction are common between traditional treatment settings and community support programs. Case managers and patient navigators can better integrate care, helping patients alternate between care and support services in their communities. Studies have indicated that patients who received integrated care used more social services and demonstrated greater abstinence rates than those who received standard care.
A goal would be to build community coalitions, streamline social services, and coordinate efforts among stakeholders to make it easier for young adults who have SUD to seek help and to receive recovery support services. And clinicians who treat with this population are in a unique position to advocate for needed services and push for more integrated partnerships between community entities and health centers.
“I think physicians, especially addiction specialists, are tremendous stakeholders. They understand the pulse of what’s going on in the community by speaking to patients in the clinic,” explains Xuan. “I think they can be tremendously insightful because they understand their patients’ needs. They can be opinion leaders and strong advocates of what more is needed.”