Substance Use Disorder Treatments

Today’s emerging adults belong to one of the most diverse generations in the United States and show the highest rates of alcohol and illicit drug misuse, facing significant health risks. Thus it is critical to develop effective interventions to reduce alcohol and illicit substance misuse and its related harms among this diverse group. This chapter examines the current literature on the development and effectiveness of existing culturally relevant substance use disorder treatments and makes recommendations for future research and best practices. We argue that given their unique needs, the severity of their substance use, and the low rates of treatment engagement among this population, it is critical that treatment efforts focus on increasing effective treatment access to all emerging adults. We further encourage substance use disorder treatment researchers and practitioners to move beyond addressing culture-bound intervention targets focused on specific cultural groups. The chapter advocates for the development, testing, and adoption of interventions that are responsive to cultural contexts and that (1) target social determinants of health, (2) are equally effective with privileged and marginalized emerging adults, and (3) prepare therapists to effectively deliver interventions to diverse groups and demonstrate cultural competence.

What Is the State of the Art in Preventing and Treating Substance Use Disorders among Emerging Adults?

This chapter reviews state-of-the-art substance use prevention and treatment models available for college-attending and non-college-attending emerging adults. Findings on the widely researched Brief Alcohol Screening and Intervention for College Students (BASICS) model are summarized, as well as those for community-level prevention efforts for college students. For non-college attending emerging adults, motivational interviewing, twelve step facilitation treatment, and cognitive-behavioral therapies have the most empirical support. Few studies are available on the use of primary care–based interventions for emerging adults, which are needed if integrated care is to be realized. There is also new evidence suggesting personalized feedback is less effective than other treatments for emerging adults in non-college settings. Finally, the chapter discusses the mixed findings on electronic interventions and provides recommendations for future research.

Screening, Assessment, and Diagnosis of Substance Use Disorders among Emerging Adults

Several challenges may hinder accurate screening for and assessment of substance use disorders among emerging adults ages 18–29. This chapter discusses emerging adult–specific research on diagnosing substance use disorders and several empirically supported screeners and assessments that may be useful to those working with emerging adults. First, emerging adult–specific research supporting changes to the most recent version of the Diagnostic and Statistical Manual for Mental Disorders, the DSM-5, is reviewed, and nuances in using the DSM-5 with emerging adults are discussed. The chapter highlights idiosyncrasies in emerging adult symptom patterns using data from large national surveys. Finally, a practice-friendly review of screening and assessment instruments commonly used with emerging adults is provided. For screening instruments, administration time, the instrument’s ability to discern which emerging adults exhibit substance use problems, and emerging adult–specific cutoff points in the literature are addressed. For assessment tools, comprehensiveness of the instrument, administration time, and contexts in which the instrument has been used with emerging adults are discussed.

Why Should We Focus on Emerging Adults with Substance Use Disorders?

Emerging adulthood (roughly ages 18–29) is the lifespan period when the peak prevalence of substance use disorders (SUD) and substance use occurs. Opportunities for prevention and intervention abound during these years. This chapter provides a brief introduction to the concept of emerging adulthood, as well as a laundry list of terms used to describe problematic substance use. The chapter argues that we must be mindful of using person-first language and, based on available stigma research, advocates for use of the term substance use disorder. The chapter then presents a strong rationale for creating more developmentally appropriate treatments for emerging adults. This rationale is based on three pillars: (1) emerging adults’ current underrepresentation in large outcome studies, (2) existing disparities in treatment outcomes between emerging adults and individuals in other age groups, and (3) the possibility of expanded substance use treatment access under healthcare reform.

Emerging Issues in the Emerging Adult Substance Use Field

Nearly two decades of research exist that use emerging adulthood as an organizing developmental construct to describe individuals ages 18–29. Yet, much remains to be learned regarding how to best provide effective substance use disorder prevention and treatment services to this population. This chapter argues that emerging adults should be considered a special population worthy of additional research and clinical program development efforts. Additionally, it provides one clinical scientist’s views on priority research and clinical practice areas that may improve substance use disorder treatment and prevention services to emerging adults. These priority research areas include increasing access and retention of emerging adults in substance use treatment, improving the diagnostic classification of substance use problems with emerging adults, monitoring macro-level trends with marijuana and opiate use among emerging adults, and gaining a better understanding of whether developmental constructs thought to be unique to emerging adults predict the onset, course, or treatment response of substance use disorders.

The Potential for Delivering Substance Use Disorder Treatments to Emerging Adults in Child Welfare Settings

Foster youth exiting child welfare systems through emancipation or aging out are at elevated risk for substance use disorders. Many may experience challenges to accessing substance use disorder treatment after foster care. This chapter explores the potential for delivering substance use disorder treatments to emerging adults in the context of federal policy, which has expanded over the past three decades to better support the transition that foster youth make to adulthood. First, background information on aging-out foster youth is provided, and what is known about alcohol and substance use disorders and associated treatment is reviewed. The chapter also discusses potential barriers to treatment engagement and offers considerations for developing programs that address population-specific needs. This review of substance use and aging-out foster youth comes at a time when the transition to adulthood is increasingly considered an important developmental period to target interventions aimed at promoting positive health behaviors.

Collegiate Recovery Programs for Emerging Adults

Collegiate recovery programs (CRPs) offer support to college students in recovery from substance use disorders. That support is centered around a community of students in recovery, recovery-supportive programming, and a space on campus where recovery is actively celebrated and normalized. While the first CRP was established 40 years ago, recent proliferation of these programs across the United States has led to a diversity of models and practices that is not yet well catalogued. National surveys of CRPs are helpful in demonstrating the range of variation among CRPs and the positive effects these programs have on the students they serve, although there are methodological limitations. A case study of the CRP at the University of Texas at Austin provides an example of a CRP model at one end of the spectrum of variation. These programs provide a unique opportunity for institutions of higher education and the communities in which they are embedded to support college students in recovery from substance use disorders.

Emerging Adult Development and Substance Use Disorders

Developmental processes influence emerging adults’ substance use. Such processes may occur both before and during the period of emerging adulthood, which lasts roughly from ages 18 to 29. This chapter begins by reviewing the prevalence of risky substance use and substance use disorders among emerging adults as well as the sequelae of such use. After a brief review of Arnett’s theory of emerging adulthood, the chapter provides an updated review of how the dimensions of emerging adulthood (i.e., identity exploration, feeling in between, self-focus, instability, optimism) are associated with substance use. Also reviewed are the additional risk factors for substance use that likely interact with these dimensions.

The Impact of the Affordable Care Act on Substance Use Disorder Treatment for Emerging Adults

Emerging adults have the highest prevalence of substance use disorders (SUD) of any age group, and only a fraction of those emerging adults in need of SUD treatment ever receive it. However, the Affordable Care Act (ACA) has dramatically increased the number of emerging adults with health insurance coverage for SUD in the United States. In this chapter, we examine how several provisions of the ACA, including Medicaid expansion, the dependent coverage mandate, and the establishment of healthcare marketplaces, have increased emerging adults’ access to quality SUD treatment. On the whole, the ACA has significantly increased access to SUD treatment among emerging adults. However, addressing existing barriers to effective implementation, including issues related to the capacity of our current SUD treatment system, socioeconomic barriers, public outreach and awareness, and variation in treatment access and quality, will prove vital in securing long-term success of the ACA.

An International Perspective

Brazilian emerging adults are treated for alcohol and other drugs problems in psychosocial care centers for alcohol and other drugs (CAPSad). The treatment for these individuals changed drastically over the past 40 years in Brazil, resulting in numerous positive changes involving deinstitutionalization, harm reduction, and comprehensive care. Against this backdrop, the goal of this chapter is to review the prevalence and etiology of substance use in this population in Brazil, discuss the Brazilian treatment system and which services are offered to this population, and present findings from a study comparing emerging and older adults, assessing the care they received in CAPSad in two states of Brazil. Data were collected from 2013 to 2014 in 15 CAPSad in the State of São Paulo and 14 CAPSad in the State of Minas Gerais. The results show emerging adults were less satisfied with treatment and more likely to be using illicit drugs than older adults. These results show the necessity of implementing treatment strategies focused on these population needs, to increase their treatment satisfaction and prevent the use of illegal drugs.