No abstract

BACKGROUND: While substance use disorder remains a leading cause of morbidity and mortality for young adults, low rates of treatment engagement and retention persist. One explanation is that substance use disorder treatment approaches do not match young adults' expectations for recovery. While the concept of recovery has been explored among adult populations, less is known about how young adults think about recovery. OBJECTIVE: To describe perspectives of recovery among young adults with substance use disorder. DESIGN: Qualitative, in-depth interviews exploring young adults' definitions of recovery. PARTICIPANTS: Twenty English-speaking young adults (7 women; 21-29 years old) diagnosed with substance use disorder recruited from an urban safety net hospital in Massachusetts. APPROACH: Interviews were recorded and transcribed verbatim. An iterative categorization analytic approach was used to identify and interpret themes. KEY RESULTS: Four themes related to recovery were identified. First, young adults described recovery as a way to grow up and live a normal life not defined by the substance use. A second theme was recovery had to include multiple components, such as mental health treatment, to be successful. Third, young adults described recovery as a self-motivated process, and it was important that young adults had agency in recovery decision-making. Fourth, recovery was described as a lifelong pursuit that required vigilance and commitment. CONCLUSIONS: In this qualitative study of young adults with substance use disorder, participants identified themes that have implications for treatment models. Participants recognized recovery as a complex and individually motivated process that includes multiple components such as mental health treatment and re-engagement in regular daily activities. Models of care for young adults should consider incorporating these treatment elements to improve engagement and retention.

Aims To explore how people who use fentanyl and health‐care providers engaged in and responded to overdose risk communication interactions, and how these engagements and responses might vary by age. Design A single‐site qualitative in‐depth interview study. Setting Boston, MA, United States. Participants The sample included 21 people (10 women, 11 men) who were either 18–25 or 35+, English‐speaking, and reported illicit fentanyl use in the last year and 10 health‐care providers who worked directly with people who use fentanyl (PWUF) in clinical and community settings. Measurements Open‐ended, flexible interview questions guided by a risk communication framework were used in all interviews. Codes used for thematic analysis included deductive codes related to the risk communication framework and inductive, emergent codes from interview content. Findings We identified potential age‐based differences in perceptions of fentanyl overdose, including that younger participants appeared to display more perceptions of an immunity to fentanyl's lethality, while older people seemed to express a stronger aversion to fentanyl due to its heightened risk of fatal overdose, shorter effects and potential for long‐term health consequences. Providers perceived greater challenges relaying risk information to young PWUF and believed them to be less open to risk communication. Compassionate harm reduction communication was preferred by all participants and perceived to be delivered most effectively by community health workers and peers. PWUF and providers identified structural barriers that limited compassionate harm reduction, including misalignment of available treatment with preferred options and clinical structures that impeded the delivery of risk communication messages. Conclusions Among people who engage in illicit fentanyl use, fentanyl‐related risk communication experiences and preferences may vary by age, but some foundational elements including compassionate, trust‐building approaches seem to be preferred across the age spectrum. Structural barriers in the clinical setting such as provider‐prescribing power and infrequent encounters may impede the providers’ ability to provide compassionate harm reduction communication.