The crisis within the crisis

The health epidemic that now kills more people than car accidents has taken a disproportionate toll on our nation’s youth.

Young people between the ages of 16 and 26 are most likely to drink alcohol and use other drugs, most likely to engage in prescription opioid misuse and have the highest prevalence of heroin use.

For a variety of reasons, some systemic, they are also less likely to address their addiction or maintain their recovery. The treatment gaps that exist for young people with addiction exacerbate the problem, creating a scenario where the population at highest risk for addiction is also the hardest to reach and treat, even as their recovery holds the most promise.

Our response to these realities determines how well we protect and nurture some of our greatest assets and, in many ways, our most vulnerable citizens. There are hundreds of thousands of young people who, if properly treated and supported to recovery, will lead healthy, productive lives that include graduating from college and entering the work force.

Given what’s at stake, we need a national strategy for addressing the unique challenges of young adult substance use which will involve the participation and perspective of all stakeholders, from health care providers and policymakers to community partners and education leaders.

Neuroscientists have determined that young adult brains are particularly susceptible to addictive behaviors, making them prime targets for a confluence of factors, including the overprescribing that led to the opioid epidemic.
In 2018 alone, almost 400,000 young adults aged 18 to 25 were diagnosed with an opioid use disorder. Heroin and the emergence of inexpensive, highly potent synthetic drugs like fentanyl add a heartbreaking level of severity to the problem.

Even as we lose more young lives to drug overdose, our current treatment system is largely tailored to adults, and therefore is ill-equipped to address the unique aspects of the disease in younger people.

Unlike older people with addiction who often seek help because they have lost something to their disease – a relationship, employment or their physical health – young people may not have had as many consequences.

They see themselves as invincible with little reason to ask for support to overcome a problem they feel they can handle.

Connecting young people with substance use disorder (SUD) with treatment is an especially important challenge given that only a small portion of all people who need help for addiction get it.

According to a study by Scott Hadland, MD, MPH, MS, an Assistant Professor of Pediatrics and a physician at Boston Medical Center’s Grayken Center for Addiction, despite the fact that medication made individuals more likely to engage in treatment long term, only 1 in 4 young people received medication within three months of a diagnosis of opioid use disorder.

This underscores how critical it is that we find more effective ways to make these connections.

Young adults with significant addiction problems may not be ready to engage in traditionally structured models of care. They need practitioners who understand their unique issues.

Currently, there is a shortage of treatment options for young adults.

Identifying the barriers to treatment for young people helps us improve on and replicate the strategies that are working. Outpatient treatment models have proven to be extremely effective for young people with SUD, particularly those that are integrated with primary care and take into account the many determinants of a young person’s overall health.

There are some promising programs to learn from, including the Office-Based Addiction Treatment model at the Grayken Center at Boston Medical Center called CATALYST (Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances).

In addition to primary care, CATALYST offers recovery coaches and licensed social workers who provide helpful guidance and support, as well as nurses and other professionals who can administer life-saving medications like Buprenorphine.

Because the patient’s addiction treatment is part of the regular medical care they receive, CATALYST is able to build the kind of long-term relationships that foster retention in treatment. This is particularly important for young people, who have a harder time remaining in treatment than other age cohorts.

This past November, national experts on young adult addiction gathered at a full-day symposium hosted by the Grayken Center aimed at creating principles of care for young adults with SUD.

When finalized, these principles of care promise to serve as a much-needed roadmap to guide practitioners and policymakers working with young people.

One organization that participated in November’s symposium was the Association of Recovery in Higher Education, (ARHE), an advocacy organization that helps students with SUD stay in school.

ARHE is one of many groups that are working to help colleges and universities better identify and support students with SUD – those in recovery who are beginning or re-entering college and those who are struggling with their addiction on campus.

One certainty of the opioid epidemic is its extensive and indiscriminate reach.

In a 2015 survey by the Hazelden Betty Ford Institute for Recovery Advocacy and the Mary Christie Foundation, 16 percent of the college-aged youth surveyed reported having used painkillers not prescribed to them, and more than 34 percent said these medications were easy to acquire.

The rise in study drug misuse, the popularity of other drugs like “Molly,” and the dangerous mixture of these substances with alcohol have become major concerns for college health professionals and administrators alike.

From evidence-based prevention and education, to identification and referral, to active addiction response strategies, colleges and universities have a large role to play in fighting the addiction crisis in young people.

As we define, improve and scale strategies and practices for this population, higher education has an important seat at the table in forging pathways to health and long-term recovery.

Michael Botticelli is one of the nation’s leading addiction experts and served as the Director of National Drug Control Policy at the White House under President Obama. He is currently the Director of the Grayken Center for Addiction at Boston Medical Center in Boston.