Testing a Matching Hypothesis for Emerging Adults in Project MATCH: During-Treatment and One-Year Outcomes

Abstract

ABSTRACT. Objective: Compared with older adults, emerging adults (18-29 years old) entering treatment typically have less severe alcohol use consequences. Also, their unique clinical presentations (e.g., modest initial abstinence motivation) and developmental contexts (e.g., drinkingrich social networks) may make a straightforward implementation of treatments developed for adults less effective. Yet, this has seldom been examined empirically. This study was a secondary analysis of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) data examining (a) overall differences between emerging adults and older adults ( 30 years old) on outcomes during treatment and at 1-year follow-up, and (b) whether emerging adults had poorer outcomes on any of the three Project MATCH treatments in particular. Method: Participants were 267 emerging adults and 1,459 older adults randomly assigned to individually delivered cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), or 12-step facilitation (TSF).Multilevel growth curve models tested differences on percentage of days abstinent (PDA) and drinks per drinking day (DDD) by age group and treatment assignment. Results: During treatment, compared with older adults, emerging adults reported more DDD but similar PDA. Further, emerging adults assigned to TSF had less PDA and more DDD than emerging adults and older adults assigned to CBT or MET during treatment (i.e., emerging adults in TSF has poorer outcomes initially), but this matching effect was not evident at 1-year follow-up. Conclusions: This study is among the first to test age group differences across three psychosocial interventions shown to be efficacious treatments for alcohol use disorder. Although emerging adults generally did as well as their older counterparts, they may require a more developmentally sensitive approach to bolster TSF effects during treatment. (J.

Substance use prevention and treatment outcomes for emerging adults in non-college settings: A meta-analysis.

“…These counterintuitive differences with prior literature could reflect differences in coding of comparison conditions, or that MI may be more efficacious than some other treatments. For example, Davis and colleagues (2017) found that EAs randomized to Twelve Step Facilitation treatment in Project MATCH had poorer initial outcomes compared with those receiving MI. Thus, although direct comparisons here yielded no differences between MI and CBT, or MI and PTs coded as Miscellaneous, our sample size may have precluded finding significant differences.…”

“…EAs represent one-quarter of all heroin users in the U.S. and 34% of treatment admissions (SAMHSA, 2014). Further, EAs’ treatment outcomes are worse than those for adolescents (Smith, Godley, Godley, & Dennis, 2011) or older adults (Davis, Bergman, Smith, & Kelly, 2017) necessitating additional research focus.…”

Addressing the opioid epidemic with behavioral interventions for adolescents and young adults: A quasi-experimental design.

“…For young adult males, either TAU or MET/CBT or CBT alone may be preferred treatment approaches. Yet, recent work using Project MATCH data has shown that young adults assigned to 12-step treatments have significantly worse outcomes compared with their young adult and older adult counterparts receiving MET/CBT or CBT alone (Davis, Bergman, Smith, & Kelly, 2017). Several studies have provided evidence suggesting that men and women vary in their patterns of treatment utilization (see Greenfield et al, 2007 for a review), with men having more negative attitudes toward seeking help, and being less likely to seek formal help (Oliver, Pearson, Coe, & Gunnell, 2005) or initiate treatment (Pederson & Vogel, 2007; J.…”

Substance Use and Mental Health in Emerging Adult Vs Older Adult Men and Women With Opioid Use Disorder

“…Despite previous research examining age differences on sociodemographic and drug‐related variables among opioid users, several important gaps remain. First, some studies only examined age differences among women 8‐10 . Second, those studies that included both men and women did not examine gender differences 3‐7 .…”

“…These characteristics may contribute to continued illicit opioid use during treatment and lower levels of buprenorphine treatment retention; however, not all studies have found buprenorphine treatment outcomes differ between emerging and older adults 7 . Large studies have demonstrated that emerging adults have inferior treatment retention and outcomes when compared with other age groups in multiple contexts, for example, with treatment outcomes for alcohol in comparison to older adults 8 and adolescents, 9 as well as higher rates of drug dependence and higher psychiatric symptoms compared with older adults 10 . Related to opioid use disorder (OUD), emerging adults enter treatment with more severe employment, legal, and psychiatric problems compared with older adults 7 …”