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. Author manuscript; available in PMC: 2026 Jun 4.
Published before final editing as: J Soc Work Pract Addict. 2025 Jun 4:10.1080/1533256X.2025.2514124. doi: 10.1080/1533256X.2025.2514124

Building an integrated care continuum for youth substance use treatment and recovery: A qualitative study

Kasey R Claborn 1,2,3, Katie A McCormick 1,3, Jake Samora 1,3, Julie McElrath 4, Lori K Holleran Steiker 1,3,5
PMCID: PMC12530147  NIHMSID: NIHMS2087302  PMID: 41112322

Abstract

The fragmented U.S. healthcare system impedes youth and young adults with substance use disorders (SUD) from accessing treatment and wrap-around services to support long-term recovery. This qualitative study aimed to inform the design of an integrated system of care for youth and young adults with a SUD and identify pain points and cost drivers across stakeholders. Researchers conducted listening sessions with community members (n=139) and individual interviews with SUD clinicians (n=17). Findings revealed pain points related to treatment initiation, issues during treatment, and concerns during the recovery process. System-level cost drivers included human capital, multiple treatment episodes, and inefficient workflow processes. Study findings highlight the need for a systems-level intervention focused on improving coordinated care across service providers, decreasing duplication of assessment protocols, and developing a client-centered care system. Data informed the development of a youth-oriented SUD system of care model.

Keywords: substance use disorder, youth, young adults, healthcare system, digital platform, continuum of care

Main text introduction

Substance use disorders (SUDs) are a major public health concern in the U.S. According to the National Survey on Drug Use and Health (NSDUH), 48.5 million Americans (aged 12 and older) battled a SUD in 2023 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024). Of those, 60% had alcohol use disorder, 56% had drug use disorder, and 16% struggled with both alcohol and drug use disorders simultaneously (SAMHSA, 2024). Youth and young adults (YYA) have the highest risk for substance misuse and SUDs (Chen et al., 2009; Dawson et al., 2008; Lopez-Quintero et al., 2011). In 2023, nearly 3 million adolescents (ages 12–17) reported needing SUD treatment, yet only 39% received it in the past year (SAMHSA, 2024). Among youth who receive treatment, approximately 60–80% relapse within the one year immediately following successful completion (Chung & Maisto, 2006; Ramo & Brown, 2008; Wagner, 2008).

It is widely known that many individuals with SUD require an array of services to support and sustain their recovery, including treating co-morbid conditions, access to peer support services, and recovery housing, among other wrap-around services. However, despite addiction being a bio-psycho-social-spiritual matter that requires a system of supports, time, and environmental change for effective recovery (Holleran Steiker, 2016), SUD interventions have historically existed in silos in which coordination across the care continuum is either informal or nonexistent (Kanary & Shepler 2014; Priester et al., 2016). There is not a “one-size-fits-all” prevention, treatment, or recovery intervention for youth and young adults with SUD—some may need in-patient care and abstinence-based models, some may be able to abstain with individual and/or family therapy, and still others may need non-abstinence-based models, such as medication assisted therapies, especially for opioid use disorders (Ashford et al., 2020; Peterson, et al., 2019). In addition to individuals needing different levels of care along the continuum, the continuum is not linear. Some youth need recovery residences, recovery schools, and/or recovery coaching before, during, and/or after their treatment, intervention, and recovery (Ashford et al., 2020; Best et al., 2021; Holleran Steiker, 2016). Though criteria for levels of SUD care have been developed, several interventions may be needed concurrently (Fadus et al., 2019). Relapse also complicates coordinated care, as it can be understood as “failure,” often leading to a repetition of the previous care mode, rather than a realization that another mode of intervention might be more advantageous for the client (Gonzales et al., 2012). As such, ongoing, developmentally appropriate recovery supports following treatment are necessary to augment treatment and support adolescents’ sustained recovery (National Institute on Drug Abuse, 2014).

However, the U.S. healthcare system infrastructure is designed to deliver acute episodic care and, thus, lacks the necessary resources to optimally manage complex, chronic conditions, such as SUDs, particularly among high-risk populations. Furthermore, many structural and systemic obstacles create barriers for youth and young adults to accessing treatment and recovery supports needed to maintain long-term recovery (Acevedo et al., 2020; Wisdom et al., 2011). For example, limited access and availability of resources have increasingly resulted in competition, rather than a coordinated or synergistic approach to inter-agency survival or success (Bunger et al., 2017; Bunger et al., 2021; Jang & Feiok, 2007). Additionally, the shift towards client-centered approaches in recent years highlights major barriers and gaps across the SUD care continuum, including a lack of age-appropriate services, a lack of provider training, poor interagency communication, and stigma (Ashford et al., 2018; Priester et al., 2016). This fragmented system impedes youth and young adults (YYAs) with SUD from accessing treatment and maintaining long-term recovery. In light of these challenges, there have been increasing calls for care coordination among providers involved in a patient’s care. Care coordination and collaborative care models have been demonstrated to improve patient tracking, provision of needed services, and coordination of comprehensive treatment plans (Kim et al., 2012). Such coordination prevents treatment dropout, decreases the lag-time between patient re-engagement in care, improves treatment outcomes, and decreases healthcare costs (Drainoni et al., 2014; Kim et al., 2012; Samet et al., 2001). Digital platforms can facilitate care coordination and treatment management by enabling rapid communication among providers and concerted tracking of patient service utilization and treatment approaches. Given the pressing need to support YYAs with SUD across the care continuum and the utility of digital platforms to improve care coordination, this study aimed to: (1) identify pain points and cost drivers across stakeholders providing services to YYA with SUDs, and (2) gather data to inform the creation of a digital platform for integrating addiction treatment and recovery supports for YYAs.

Materials and Methods

The University of Texas at Austin Institutional Review Board approved this study as exempt.

Design and Sample

We conducted a host of qualitative data collection activities to achieve the study aims. First, the research team facilitated three separate listening sessions with youth and young adults (YYAs) who had a SUD (n=42), parents/allies of YYAs with a SUD (n=42), and clinicians who serve YYAs with SUD (n=55) to understand facilitators and barriers to maintaining recovery and to identify potential solutions to addressing those barriers. Participants were recruited through flyers and word of mouth at various community-based organizations in Central Texas.

We then conducted in-depth qualitative interviews with substance use treatment providers and clinic directors (n=17). Participants were recruited via word of mouth and email through a local community network of SUD providers serving youth and young adults in Central Texas. Participants were selected based on the depth and diversity of their experience in the substance use field (i.e., inpatient and outpatient treatment, recovery high school, alternative peer group, sober living facility). We excluded potential participants who had been employed in their role for less than 12 months. Participation in study activities was voluntary, and no compensation was provided to participants.

Measures

The goal of the listening sessions was to engage the full spectrum of youth and young adults, their parents and allies, and providers to share their experiences with SUD treatment and recovery, to assess how the field of recovery is evolving, and to understand diverse perspectives about the directions that it could take in the future. Community-based listening sessions were conducted with each group: (1) Youth currently in recovery/treatment, older young adults, and at-risk youth; (2) Parents/allies of youth and young adults not engaged in treatment/recovery; and (3) Clinicians serving youth and young adults with substance use disorder. The listening sessions were conducted at a community-based location.

The listening sessions were led by an outside consulting firm and leadership from the Youth Recovery Network which included a doctoral-level research scientist. Dinner was provided to all participants. Following dinner, we employed a “conversation café” to assess participants’ experiences with substance use treatment and recovery, how youth and young adult recovery is evolving, and future directions. Following the conversation café, we summarized the data and presented to the participants for feedback and clarification prior to finalizing the report and debriefing summary.

Following analysis of the listening session data, we conducted in-depth individual interviews with providers and clinic directors to better elucidate findings from the listening session. For individual interviews, we developed and pre-tested a semi-structured interview guide with an eligible SUD counselor. Research questions included: (1) What are the perceived gaps in the system for youth and young adults, families, and clinicians? (2) What are the current interagency processes that facilitate or impede care coordination? and (3) What are stakeholders’ initial impressions of a digital platform? Topics in the interview guide regarding system gaps for youth and young adults and clinicians (RQ #1) included challenges navigating recovery support services and working with outside agencies, impression of a digital platform to improve assessment and care coordination, and key features recommended for the digital platform. Topics about existing organizational processes (RQ#2) included assessment procedures, current referral protocols, and what information is available to other providers. Topics specific to the digital platform (RQ #3) included design suggestions, training on platform utilization, and barriers and facilitators to implementation.

Data Collection

The listening sessions followed a semi-structured interview guide and were conducted by a trained facilitator and notetaker. Listening sessions lasted approximately 90–120 minutes. Individual interviews were conducted in-person at provider agencies or by phone by a trained research assistant. Interviews were approximately 45–90 minutes in length.

Data Analysis

Facilitators and notetakers from the listening sessions completed detailed debriefing summaries of each session. Individual interviews were audiotaped and transcribed verbatim. A codebook was developed based on a priori research goals. Debriefing summaries and interview transcripts were coded by two trained research assistants for a priori themes and entered into a framework matrix. All debriefing summaries and transcripts were double-coded, and discrepancies were reconciled with a third doctoral-level coder. Data were imported into NVivo 11 using the codebook and analyzed iteratively using applied thematic analysis (Guest et al., 2011).

Results

Qualitative data across listening sessions and individual interviews revealed critical information about gaps across the SUD continuum of care for youth and young adults (YYAs). (e.g., access to services, care transitions), and interagency care coordination, including system pain points and cost drivers (e.g., human capital, “frequent flyers”). Data highlighted critical areas for system intervention and outlined expected outcomes with the successful implementation of a robust youth-oriented system of care. Additionally, stakeholders shared initial reflections for a technology-driven solution to support a YYA-oriented substance use system of care. Findings are described in further detail below and outlined in Figure 1.

Figure 1. Youth-Oriented SUD System of Care Model.

Figure 1.

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Perceived SUD System Gaps for Youth Recovery

Youth and Young Adult Perspectives

YYAs described a lack of access as a significant barrier to obtaining and remaining engaged in services to support their recovery. Participants indicated that existing alternative peer groups and other supportive services are too far to get to regularly, and that transportation, more locations for meetings, a central source of information (e.g., website), and continuity between treatment centers and supportive services are needed to enhance the YYA SUD care continuum. Participants also described a lack of social support from friends and family as a barrier to maintaining recovery following treatment, specifically reconnecting with old friends who use drugs and home environments that do not support sobriety. Participants highlighted a need for sober social activities where they can connect with and learn from other YYAs in various stages of recovery and build a sober support system. Participants emphasized that these activities should be YYA-led and available across multiple regional locations.

Parents’ and Allies’ Perspectives

For parents and allies of YYAs, a lack of knowledge and resources about substance use and addiction was a central barrier to supporting YYAs in achieving and sustaining their recovery. Parents and allies highlighted the pressing need for families and physicians to receive training in substance use and addiction education, and for schools to educate YYAs about substance use and addiction. Similar to YYA participants, parents and allies reported a lack of access to services and resources as a major barrier. They noted that a lack of transportation and lengthy travel times to get to existing services prevent YYAs from engaging in available services altogether, especially for those living in rural areas. Relatedly, parents and allies highlighted the need for a resource center, satellite locations for alternative peer groups, and sober social programs in schools. Most salient for parents and allies was the lack of support for the whole family. While participants emphasized the need for family support and parental involvement in their child’s treatment and recovery, participants also noted the importance of peer support for parents and siblings who are navigating change.

Clinician Perspectives

Clinician participants primarily reported structural barriers to YYA treatment and recovery. Clinicians discussed a need for an overarching shift in theoretical approach to YYA substance use that prioritizes treatment before punishment. Clinicians also noted that the tension between abstinence-based and harm reduction approaches to YYA substance use limits what strategies and services are available to YYAs in some geographic locations. Despite philosophical differences in approaches to YYA substance use, clinicians described that both a common intake assessment across organizations and collaboration across the healthcare, criminal justice, and education systems are needed to streamline services and reduce the burden on YYAs and their caregivers in initiating treatment and recovery services.

Gaps in Interagency Care Coordination across the SUD Continuum

System Pain Points

Treatment initiation, retention, and recovery each emerged as pain points across the SUD continuum of care for YYAs. Regarding treatment initiation, participants noted that a lack of parent knowledge of existing resources and challenges navigating the system were persistent barriers to accessing care. Participants described a host of other barriers related to accessing treatment services, namely lack of transportation, limited availability of detoxification beds for YYAs, and an overall limited capacity of the treatment system in serving YYAs. Participants described challenges with care transitions within and across healthcare (e.g., unaffordable cost of care, lack of YYA-focused psychiatrists), education (e.g., lack of substance use education in schools, SUD screening), and criminal justice systems (e.g., lack of diversion programs, probation), as well as the foster care system and homeless shelters. Another treatment pain point highlighted by participants included issues related to real-time data sharing, specifically that there is a significant lag time (up to three months) in data sharing due to a lack of a centralized data repository. Participants reported recovery as the third care continuum pain point, describing that there is a general lack of knowledge about and linkage to wrap-around services for YYAs. This is compounded by systemic issues, including treating the chronic condition of addiction within an acute care model, SUD-related stigma, and YYAs and their families being unprepared for the long-term investment required to successfully complete treatment and maintain long-term recovery. Furthermore, these issues across the continuum are exacerbated by staff burnout and compassion fatigue, which contribute to high rates of turnover across the system.

System Cost Drivers

Participants described several cost drivers that underlie and contribute to systems-level issues. Some cost drivers result from inefficient workflow processes across the SUD system of care, such as staff time spent “playing phone tag” to track down client data, disjointed treatment admission and referral processes, repeat screenings and assessments across siloed organizations, and the lack of a streamlined resource database – all of which deplete staff capacity to better serve YYAs. Additional cost drivers include YYAs who have multiple treatment episodes or complex cases with comorbid conditions, as well as those who do not have payers.

Perceived Interventions to Inform a Youth-Oriented SUD System of Care

System Navigation Interventions.

Clinicians and parents noted a need for a common screening and assessment process. Parents indicated that completing intake forms and assessment measures across multiple service providers was burdensome. Clinicians validated this burden and also noted that this pain point contributes to the lag time in accessing data across systems. Both participant groups stressed support for a centralized, coordinated intake and assessment process to improve workflow, system navigation, and reduce burden. Further, both parents and clinicians noted a need for streamlining the referral process, particularly from treatment to recovery services. They agreed that developing an inventory of treatment and recovery services and resources was needed and that it should be housed on a publicly available website that is easy to access for parents and clinicians. Clinicians expressed a concern that the centralized resource would require frequent updating, as many programs frequently change their services offered or close operations entirely due to funding changes.

Improving Interagency Collaboration.

Clinician participants indicated value in developing a digital platform to enable data-sharing and client coordination across the treatment and recovery system of care. They also stated that interagency data sharing agreements would need to be executed by a centralized body that would host and maintain the digital platform.

Promoting Peer Connection.

Finally, all participant groups indicated the importance of peer-to-peer connection (e.g., youth to youth, parents to parents, and provider to provider). Increasing access to alternative peer groups and YYA recovery services was thought to improve peer support among YYAs. Parents and allies indicated that increasing family services, including family groups, would be beneficial. Clinicians indicated that developing easier communication methods, such as through a centralized digital platform, might facilitate better connection among providers. They also noted that the importance of convening providers in person at regularly scheduled intervals would facilitate relationships and awareness of services in their community.

Perceived Outcomes to Assess Effectiveness of the Youth-Oriented Model

Figure 1 outlines anticipated outcomes driven by the implementation of system-level interventions. Early post-implementation outcomes included improved navigation support to promote access to services, better alignment of YYA-serving systems, and improved connection across youth, families, and service providers. Intermediate outcomes were characterized by increased support from peers and allies, better access to recovery and harm reduction services, multiple entry points

Perspectives of a Digital Platform for Coordinated Treatment and Recovery

Across listening sessions and interviews, participants were clear that a data-sharing platform is necessary to strengthen the care continuum for YYAs with SUD. Participants emphasized that this platform would need to be secure and comply with the Health Insurance Portability and Accountability Act (HIPAA) and the Code of Federal Regulations regarding confidentiality of SUD patient records (42 CFR Part 2). Participants highlighted that a digital platform would need to have both a common consent and a common intake or assessment to generate comprehensive patient information. Participants agreed that a digital platform should have a resource bank, as well as a menu of culturally appropriate and evidence-based treatment modalities. Participants collectively underscored that this platform must be user-friendly and easy to navigate for them to regularly use it.

In addition to these features, participants described a host of additional features that would strengthen the digital platform and increase its utility. Participants offered several suggestions related to enhancing communication with clients, such as multilingual capabilities and SMS/text messaging capabilities for clinicians. Relatedly, participants hoped the platform would include an integrated clinical care directory with filtering algorithms, as well as client tracking and management features. Participants shared that they would like to see the digital platform be a centralized repository for SUD and recovery-oriented local event sharing and learning opportunities, and that users could be connected to a live person for technical assistance and support, which would facilitate SUD screening and linkage to appropriate care. Lastly, participants emphasized that the platform should use positive and supportive, person-first language throughout.

Discussion

These findings highlight systemic challenges encountered across the youth and young adult (YYA) system of care for SUDs. YYAs and their parents/allies attempting to navigate SUD treatment and recovery services encounter a number of barriers along the continuum. Our sample noted the lack of availability of evidence-based recovery services and the lack of social support structures for YYAs in recovery as the main challenges. Additionally, participant perspectives pointed to the needs of providers and parents for improved education on substance misuse and for increased collaboration between agencies to reduce pain points and streamline workflow across services. Lastly, participant perspectives were reflected in preferences for a digital platform to help enhance coordination and data-sharing across service providers along the continuum of SUD care and recovery for YYAs. Our findings are consistent with literature characterizing the difficult experiences of YYAs and their families attempting to access SUD care and underscore the importance of wrap-around services. Additionally, these findings illustrate how SUD care for YYAs typically does not apply harm reduction principles, which can lead to propagation of stigma and lower willingness to engage in treatment or recovery (Paquette et al., 2018; Lang et al., 2013). A digital platform that increases engagement along the SUD continuum and increases collaboration among providers should fill the necessary gaps in YYA SUD care.

Our findings are similar to adult samples of people who use drugs that also need specialized care (e.g., HIV care, reproductive healthcare), where much more of a focus is placed on educating providers to be client-centered and holistic (Browne et al., 2018). A necessary component of these efforts has been adopting a harm reduction and trauma-informed philosophy on the provider level to promote trust and understanding in order to reduce stigma and increase engagement with treatment services (Bartholow et. al., 2021). YYAs, parents/allies, and clinicians from our study called for the need to emphasize healing and treatment over punishment with YYAs who misuse substances. Interventions towards improving trauma-informed perspectives and flexible service provision have been effective in reconnecting clients to HIV care and substance use treatment (Powers et al., 2017). By increasing collaboration between providers via health information and technology, providers will understand factors contributing YYA’s experiences of trauma and how that may influence substance use concerns, ultimately improving the quality of care. Further, a centralized data repository may streamline intake processes across the system of care reducing burden on YYAs to repeat duplicative assessment processes.

Another core component for programs attempting to provide holistic, wrap-around care is that other members of the family and support structure need to be considered. Our parent and ally participants emphasized the need for parental and family support in successful engagement and retention of YYAs in SUD care. For instance, programs targeting mothers at risk for neonatal substance use exposure also have provided vouchers to local grocery stores so that their families could be supported. Additionally, these programs provided linkages to childcare support for mothers who had other children (Hubberstey et. al., 2021). Increasing collaboration between otherwise siloed care programs in the context of YYA SUD via a digital health solution will allow for the potential for programs to wrap support around the family collectively (Dixon et. al., 2018). As an example, a parent of a YYA with SUD may express to a substance use clinician that their child is having challenges that would best be solved through accessing parenting programming services. A digital platform would help the clinician and agency offering parenting programming to coordinate a streamlined linkage to support services for that parent.

Of note, providers in the system of SUD care providing acute services indicated that inefficient workflow practices and barriers to coordination with other services reduce time spent with clients providing direct services and contribute to burnout. For instance, providers shared that there were issues regarding inconsistency of health information sharing between agencies, resulting in lag time for data sharing and duplicate assessment and intake procedures which also burden the client. A digital platform that streamlines sharing of information across agencies that provide services along the YYA SUD care continuum may help to mitigate challenges that currently exist in the acute care model by providing a standardized assessment, reducing paperwork burden, and facilitating better communication between clients and providers (Dixon et. al., 2018; Norton et. al., 2022). Additionally, a digital platform may support a virtual learning collaborative for clinicians focused on evidence-based approaches to YYA SUD care, such as trauma-informed and non-pejorative philosophies for YYAs (Browne et. al., 2018). The platform may also support a virtual learning collaborative for parents and allies to learn from each other to better support their YYA along the SUD continuum.

Findings should be considered in light of study limitations. First, this was a qualitative study conducted in Central Texas, which may limit the generalizability of these findings to other regions. Additionally, we conducted community listening sessions instead of focus groups, which did not permit the collection of demographic data for listening session participants and thus did not allow for comparative analyses based on demographics. Future studies should further evaluate perceived system barriers for YYAs from minoritized backgrounds, including LGBTQIA+ youth, as they are at heightened risk for SUD and reduced family support.

Conclusions

Study findings underscore the difficulties encountered by youth and young adults (YYAs), their families, and clinicians in the current acute care model for SUD treatment. System-level interventions are needed to improve the care continuum including initiating treatment and wrap-around service support. Developing digital technologies that consider the preferences that these stakeholders have should (1) increase engagement of YYAs in long-term SUD care, (2) provide families and allies with solutions to gaps in the SUD care continuum, and (3) assuage pain points and reduce extra workload experienced by providers coordinating care across SUD treatment and recovery agencies and other services to support long-term recovery.

Funding:

This work was supported by the St. David’s Foundation and funding from The University of Texas at Austin Office of the Vice President of Research. Dr. Claborn’s work is supported in part by National Institute on Drug Abuse under Grant K23 DA039037.

Footnotes

Declaration of Interest Statement: KC and LHS have been retained by the plaintiff’s in the opioid litigation to serve as an expert advisor on matters pertaining to health information and technology, and improving the addiction system of care. All other authors declare that they have no conflicts of interest.

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