NCAD: Opioid treatment initiative for youths combines three strategies

A four-year federal grant is allowing the state of Connecticut to test the blending of three evidence-based strategies to assist young people ages 16 to 21 with opioid use disorders, including by offering medication-assisted treatment (MAT) to those who need and want it.

In a breakout session at the National Conference on Alcohol & Addiction Disorders (NCAD) in Anaheim, Calif., leaders at the Connecticut Department of Children and Families and Chestnut Health Systems described a creative marriage of multidimensional family therapy, MAT and recovery management checkups. Funding for Project ASSERT under a youth treatment grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) is scheduled to end in 2021.

Mary Painter, director of the state Office of Intimate Partner Violence and Substance Use Treatment and Recovery, acknowledged that the initiative is moving into some uncharted territory in adolescent and young-adult treatment, including with long-term use of buprenorphine in cases where it appears warranted.

Buprenorphine, which has a strong research base for treatment of young people, is the only one of the three approved opioid dependence treatments being used in Project ASSERT, Painter said.

The multidimensional family therapy and recovery management checkup components of the initiative emphasize early and ongoing engagement of young people and their families. The family therapy piece, whch has been shown in research to decrease substance use and violence and improve school performance and family functioning, is designed to last for six months in Project ASSERT. It involves individual sessions with the youth and a family member and sessions conducted with both, with appointments occurring three times a week.

“The goal of the session is to have another session,” said Ines Eaton, program manager at the Department of Children and Families.

Recovery management checkups are designed to occur over the next 12 months, at a weekly frequency at the outset. The checkups may be done in person, by phone or by text, with a recovery support worker gathering information on subjects such as the young person's substance use and involvement in any recovery-affirming activities.

“The goal is rapid identification of youths with difficulties,” said Lora Passetti, research projects manager at Chestnut Health Systems. “It is up to the recovery support worker to make the connection,” as opposed to waiting for the client to come forward.

An affirmative answer to any of four questions, from whether the individual has used substances for 13 or more days in the past 90 to whether the youth thinks a return to treatment is necessary, will trigger a linkage to substance use services, though not necessarily a formal referral.