Cooperative Extension: Substance Abuse Prevention and Recovery 2nd Version

The state of substance use disorders (SUDs) has become a public health crisis in the United States. Rates of hospitalizations and overdoses have increased so drastically that they have led to an unprecedented increase in mortality among middle-aged White Americans (Kochanek, Arias, & Bastian, 2016). Despite growing efforts to combat the opioid epidemic, people with SUDs continue to demonstrate notoriously high rates of relapse (roughly 40-60%) that are comparable to other chronic diseases such as diabetes, hypertension, and asthma (NIDA, 2014). The Stress-Vulnerability Model of Addiction posits that psychosocial stressors are predictors of relapse (Brown et al., 1995). Moreover, research shows that individuals with SUDs are especially vulnerable to relapse during early stages of recovery (Dennis, Foss, & Scott, 2001). This increased risk of relapse is due, in part, to financial stress (i.e., debt, poor credit, limited employment opportunities, etc.) that people in recovery from SUDs often encounter (Granfield & Cloud, 2001; Siahpush & Carlin, 2006; Siahpush et al., 2009). To our knowledge, no research has examined the potential for financial programming aimed at mediating the impact of financial stress on people in early recovery from SUDs. Given the well documented adverse effects of SUDs and the relatively high likelihood for post-treatment relapse, there is a critical need to examine the potential impact of financial programming to reduce financial stress for people in recovery. In the absence of development of such a program, financial stressors will continue to create barriers between people with SUDs and long term, sustained recovery. Our long-term goal is to develop and implement an effective educational intervention that will improve the financial efficacy of individuals in SUD recovery, especially those individuals in early recovery. Financial burden and stress can create a formidable barrier to long-term recovery. The objective of this application is to identify the key financial burdens and risk factors that contribute to substance use relapse, and based on this information, develop a financial education intervention program that will increase financial capability and literacy of those individuals in inpatient treatment centers. Our central hypothesis, based on the Stress Vulnerability Model of Addiction, as well as preliminary qualitative data, is that individuals with SUDs lacking financial capital and financial self-efficacy are more likely to relapse. For this study, the target audience will be individuals residing in substance use disorder inpatient treatment facilities. Our rationale for this project is that its successful completion would provide critical financial life skill development ultimately reducing financial stress; thereby, increasing the likelihood of sustained recovery. We propose the following specific aims: Specific aim #1: Identify key financial stress factors and barriers that contribute to SUD relapse. Our working hypothesis is that individuals in early SUD recovery experience a unique set of financial burdens (legal fees, debt collections, jail costs, child support arrears, poor credit, etc.) that ultimately increase stress and inhibit long-term recovery success rates. Specific aim #2: Develop a financial education intervention based on the needs and risk factors of the target audience. Informed by the needs based assessment, we will develop and pilot test a research-based financial education intervention at inpatient SUD treatment centers. Furthermore, we will develop an implementation plan and train-the-trainer program to disseminate the research-based financial education intervention. At the completion of this project, it is our expectation that we will have identified those financial risk factors that increase the likelihood of SUD relapse. We also expect to have utilized this information to develop a financial education intervention that will be delivered at inpatient SUD recovery centers. Finally, we expect the financial education intervention will be disseminated widely to SUD recovery centers. The successful completion of this project would be expected to have a positive impact on those in recovery from SUDs.