Recovery High School Effects on Substance Use and Delinquency: The Moderating Role of Social Problem Solving Styles

Introduction: Schools are influential environments among adolescents, particularly those with substance use disorders (SUDs). Within school contexts, association with substance-using and delinquent peers and (perceived) availability of substances are significant risk factors for adolescent substance use. Most high school settings may fail to provide the supports needed by students in recovery from SUDs. In response, recovery high schools (RHSs) provide an alternative high school option for adolescents with SUDs; RHSs aim to foster recovery by providing a supportive environment that promotes sobriety and networks of sober, supportive, and prosocial peers. The effectiveness of RHSs for improving student outcomes may vary, however, for students with different problem solving styles whereby students who employ maladaptive (e.g., avoidant, impulsive) problem solving styles may be less responsive to interventions and treatments. There has been limited research examining the effects of RHS attendance on students’ outcomes and the impact of problem solving styles. The purpose of this study was therefore to investigate the effects of RHSs on substance use and delinquency outcomes among youth with SUDs, and to explore the potential moderating effects of social problem solving styles.

Methods: This study used a longitudinal quasi-experimental design with propensity scores to examine the effects of RHS attendance on student outcomes. Participants (N = 260) were adolescents with histories of SUDs who were enrolled in RHSs (n = 143) or non-recovery high schools (n = 117). Outcome variables included measures of recent substance use, illegal activity, and intoxicated illegal activity. Negative binomial regression models with clustered robust standard errors were used to compare 6- and 12-month outcomes for students attending RHSs versus non-recovery high schools; multiplicative interaction terms were used to test for moderator effects.

Results: Results indicated that at 6-month follow-up, on average, RHS students reported less substance use than non-RHS students. This effect was moderated by social problem solving styles, such that RHS attendance did not have a significant beneficial effect on substance use for students with maladaptive problem solving styles. The results also indicated that adolescents attending RHSs reported significantly lower levels of substance use (b = -0.50, 95% CI [-0.98, -0.02], IRR = .60) and intoxicated illegal activity (b = -0.87, 95% CI [-1.57, -0.18], IRR = .42) at the 12-month follow-up, compared to non- RHS students; however, there was no evidence that these associations were moderated by students’ social problem solving styles.

Conclusions: RHS attendance may be associated with significant reductions in substance use and delinquency among youth with SUDs, but the effects may vary depending on social problem solving styles. Prevention and treatment programs designed for youth with SUDs may need to consider social skills training components that promote more rationale and goal-driven problem solving styles.