Effectiveness of Recovery High Schools for Youth with Substance Use Disorders: Findings from a Quasi-Experimental Study

Introduction: Schools are influential environments in the lives of adolescents, particularly for students struggling with substance use disorders (SUDs). Peer pressure, association with substance-using peers, and (perceived) availability of substances are some of the strongest risk factors for adolescent substance use, all of which are deeply embedded within school contexts (Mason et al., 2014; Wambeam et al., 2014). Most high school settings may therefore be “recovery hostile” in that they fail to provide the social and therapeutic supports needed by students in recovery from SUDs. In response, recovery high schools have been developed as an alternative high school option for adolescents with SUDs (NIDA, 2014; ONDCP, 2014). These schools aim to foster recovery by providing a supportive learning environment that promotes sobriety along with academic success (Finch & Frieden, 2014). To date there has been limited research examining the effects of recovery high school attendance on students’ outcomes. The purpose of this study was therefore to investigate the effects of recovery high schools for reducing substance use among youth with SUDs.

Methods: This study used a longitudinal quasi-experimental design with propensity scores to examine the effects of recovery high schools. Participants were 260 adolescents with histories of SUDs who were enrolled in recovery high schools (n = 143) or high schools without a recovery focus (n = 117). Approximately 56% of the sample was male; with 83% White, 12% Hispanic, and 10% African American; and an average age of 16.28 years (SD = 1.09) at baseline. Dependent variables included measures of recent alcohol, marijuana, opiate, or other drug use. Three-level mixed-effects growth curve models (Rabe-Hesketh & Skrondal, 2008) were used to compare trajectories of substance use over the 12-month study period for students attending recovery high schools versus non-recovery high schools.

Results: Results from the multilevel growth curve models indicated that adolescents attending recovery high schools reported significantly greater reductions in alcohol use (b = -0.67, 95% CI [-1.22, -0.12], d = -0.33), marijuana use (b = -1.81, 95% CI [-2.79, -0.83], d = -0.64), and other drug use (b = -1.30, 95% CI [-2.03, -0.56], d = -0.47), relative to those in non-recovery high schools. There was no evidence that recovery high school attendance was associated with trajectories of opiate use (b = -0.17, 95% CI [-0.57, 0.23], OR = 0.84), however, opiate use was relatively rare in this sample of youth.

Conclusions: Recovery high school attendance may lead to significant reductions in substance use among youth with SUDs. Recovery high schools may thus offer a unique form of preventive continuing care for youth with SUDs by providing students with a safe and supportive learning environment.