Testing a social mechanism of recovery high schools: Peer affiliation as a mediator of substance use outcomes.

Abstract

Limited options for developmentally appropriate continuing care represent a critical barrier for youth in recovery. As one of the few options designed specifically for adolescents, recovery high schools (RHSs) warrant investigation to better understand their effects and the mechanisms through which they operate. This study examined the long-term effects of RHS attendance and tested whether peer-level social change operates as a mechanism. Data were drawn from a longitudinal, group-design study of RHS effectiveness. Twelve-month follow-up substance use outcomes were compared between 146 adolescents who enrolled in RHSs after treatment and a propensity score-balanced comparison group of 117 adolescents who enrolled in traditional schools. Time-lagged mediation models tested whether recovery-positive peer affiliation at the 6-month follow-up mediated these effects. Relative to the comparison group at the 12-month follow-up, adolescents who attended an RHS were less likely to have alcohol use disorder (OR = 0.31) or a drug use disorder (OR = 0.42), reported fewer cannabis use days (IRR = 0.62), and had higher odds of abstinence (OR = 2.53) after adjusting for baseline levels. Recovery-positive peer affiliation mediated the beneficial effects of RHS attendance on meeting criteria for a drug use disorder, cannabis use frequency, and abstinence. These findings provide robust evidence of the long-term beneficial effects of RHS attendance and indicate that some benefits result from improvements in recovery-positive peer affiliation. Improving access to youth-focused recovery supports that facilitate positive social network changes could help reduce relapse risk and sustain treatment effects.