Age Group Comparison for Treatment Initiation, Engagement, and Effect of a Culturally Grounded Substance Use Treatment Intervention

Background: The age-effect in substance use delineated by Gottfredson and Hirschi (1983) along with a new concept of emerging adulthood, asserted by Arnett (2000) indicates the transitional period to adult is associated with higher propensity of risky substance use. Yet, only a disproportionately small portion of young adults who need treatment for problematic substance use receive it. Hence, it is imperative to make sure evidence-based interventions developed for adults equally reach young adults. Through analysis using secondary data from the Community Wise Optimization study, this presentation will explore differences in treatment engagement and substance use outcome between young adults (aged 18-29) and those who are older (age 30 and older). Community Wise is a 15-week manualized multi-level behavioral group intervention. A research team recently completed an optimization study funded by the National Institutes of Minority Health and Health Inequalities (R01MD010629) using the multiphase optimization strategy (MOST) to engineer the most efficient, effective, and scalable version of Community Wise.

Methods: Grounded in community-based participatory research (CBPR) principles, a community collaborative board operated the optimization project under the advisement of principal investigators utilizing strategies such as including indigenous field worker sampling, community organization-based sampling, community advertisement, and street outreach. Participants were randomized into 16 experimental conditions in a factorial experiment. Eligibility criteria included: over 18 years of age; reside in Essex County, NJ; history of SUD; released from incarceration in the past 4 years; English-speaker; and able and willing to provide informed consent. Exclusion criteria included: women; gross cognitive impairment; and severe, unstable mental illness such as untreated psychotic disorders and suicidality.

Results: Among total sample of 602, 13% were young adults (M = 25.47, SD = 3.07) and 87% were older adults (M = 47.96, SD = 8.98). Both treatment initiation and treatment engagement rates were lower among young adults. A McNemar’s test (McNemar, 1947) with continuity correction (Edwards, 1948) determined that the difference in the proportion of abstinent participants pre- and post- intervention was not statistically significant for both older adults (X²(1) = .878, p = .349) and young adults (X²(1) = .571, p = .453). However, observed differences in treatment outcome were profound as directionality of treatment effect is inversed. For older adults, five months post-intervention, the number of abstinent participants had increased 30.44%. On the contrary, the number of abstinent participants had decreased 5.77%.

Implications: Results reveal that Community Wise is less likely to be initiated and engaged by young adults compared to the older adults who are 30 years old or older. In addition, the treatment effect was undesirable for young adults. Findings highlight the importance of developing and testing interventions that respond to the unique needs of young adults. Future Community Wise studies should exclude young adults and further research is needed to examine why these differences occurred and whether adapting the intervention to this population is warranted.