This application is being submitted in response to NOT-DA-19-003. Young adults are the age group at highest risk for substance use, and young adults in the justice system are at particularly high risk. This use places them at very high risk for opioid misuse and development of opioid use disorder (OUD). At the same time, justice- involved young adults who have substance use problems usually lack access to evidence-based practices (EBPs) that could reduce risk for converting from substance use to OUD. This is particularly true in rural areas, where the opioid epidemic has had a disproportionate impact. Preliminary evidence suggests that probation/parole officers may be uniquely positioned to prevent the future development of OUD via a task-shifting approach; that is, probation/parole officers may be able to deliver an EBP, like Contingency Management (CM), to young adults in the justice system who use substances but have yet to develop OUD. Given that probation/parole officers operate in every jurisdiction in the nation, including rural areas, this would have immense future potential for national scalability of a substance use risk reduction EBP, especially for such a highly under-served population at risk for developing OUD. This study leverages and extends the investigative team?s work in CM efficacy, delivery, technology transfer in justice settings, as well as their experience with developmentally-appropriate substance use EBPs for young adults. In particular, CM is one of the most extensively validated substance use risk reduction EBPs and has demonstrated success in large randomized trials for opioid and other substance use, including polysubstance use. Further, CM is ideal for probation/parole officers to learn and implement because it is highly specified and low in complexity relative to other substance use EBPs for young adults. Additionally, probation/parole officers regularly monitor their probationers? substance use via frequent biological screens and implement consequences based on results, making CM consistent with officers? current work. The proposed 12-month pilot research will train 10 probation/parole officers to deliver CM to three young adult clients who currently use substances but have not yet developed OUD and track CM delivery and young adult outcomes over time. Additionally, to fully understand and implement the next stage of research, focus groups with probation/parole officers and stakeholders from entirely rural communities in states highly affected by the opioid epidemic will occur. This project would provide the preliminary data for a future large-scale trial by providing (1) initial evidence for the feasibility of probation/parole officers to deliver a substance use EBP for reducing risk of developing OUD in a high-risk population of young adults, (2) initial evidence of clinical efficacy for officers as service delivery providers for young adults prior to OUD development, and (3) identify ways to ensure scalability and transfer to entirely rural communities. The primary motivation for this pilot is the clear public health need for improving and expanding delivery of substance use risk reduction interventions for young adults in the justice system. The ultimate outcome would be prevention of OUD in this high-risk population.
Justice-involved young adults are one of the highest-risk populations for the development of opioid use disorder (OUD) and other significant public health problems, but they lack access to evidence-based practices that could potentially prevent this trajectory. The risk of unintentional death and other deleterious outcomes and long-term costs for opioid misuse for young adults, their communities, and society (costs estimated at over $115 billion annually) make this a priority, with rural areas in need of the most attention and assistance. The overriding purpose of the proposed pilot study is to prevent the onset of OUD by improving young adult offenders? access to evidence-based risk reduction interventions by testing whether officers in the adult probation and parole setting can deliver such an intervention to their young adult substance using probationers who have not yet developed OUD.
