Functional outcomes of children after SARS-CoV-2 infection: An EHR-based cohort study.

Over 50% of adolescents use drugs or alcohol within 90 days of an acute residential or outpatient treatment episode (), underscoring the importance of access to effective continuing care. Although contemporary approaches to treating substance use disorders (SUDs) should ideally be developmentally appropriate and grounded in the unique biopsychosocial contexts in which adolescent substance use occurs, youth-focused recovery supports are limited (; ). Recovery high schools (RHSs) are one of the few options designed specifically for adolescents, providing therapeutic and peer-based support in a learning environment grounded in recovery principles (). By facilitating relationships with other youth in an environment steeped in recovery-oriented norms and values, RHSs establish the social conditions necessary to promote and sustain positive behavior changes (; ). There is a growing body of evidence supporting RHSs (), but knowledge gaps remain. This study sought to address these gaps by evaluating the long-term effects of RHS attendance and testing whether a peer-level social change mechanism drives them. Adolescents face the greatest risk of relapse immediately following treatment, with the sharpest decline in abstinence occurring between discharge and three months post-discharge in inpatient and outpatient samples (; ). Initial relapse among adolescents primarily occurs within a social context, placing those who return to pre-treatment social networks during this particularly vulnerable post-treatment window at elevated risk (; ; ). Conversely, adolescents who affiliate with recovery-positive peers—peers who are supportive of recovery and model low-risk social norms by discouraging or avoiding substance use—are less likely to relapse (; ; ; ; ). Thus, depending on the attitudes and behaviors of its members, a social group can serve as either a risk or protective factor during recovery. This pattern extends to broader social environments in which youth are embedded, where exposure to substance use, criminal activity, and violence increases relapse risk (; , ). Therefore, connecting youth to recovery-positive peers and alternative social environments is particularly beneficial as they transition out of treatment. Because recovery is non-linear and often marked by cycles of relapse and treatment re-entry (), it is critical youth in recovery are connected to post-treatment recovery supports to address their long-term needs and help maintain improvements. Continuing care, which includes recovery supports ranging from less intensive clinical services to community-based mutual help groups, aims to do so by increasing recovery capital and sustaining motivation (). Meta-analytic findings indicate that long-term treatment and recovery supports yield better outcomes than short-term treatment alone (), suggesting that suboptimal outcomes may reflect insufficient duration or lack of support rather than treatment ineffectiveness. A substantial barrier for recovering adolescents is the limited options for youth-focused, developmentally appropriate recovery supports. This gap is particularly important due to differences between recovering adolescents and adults (). For example, social situations are the most common antecedent of relapse among adolescents, whereas negative emotional states more often precipitate relapse in adults (; ). This along with the salience of peer affiliation suggests that adolescents would likely benefit from approaches designed to facilitate recovery-positive social networks and reduce exposure to social-environmental risk factors. Moreover, because recovering youth often struggle relating to experiences of their adult counterparts, they may be more reluctant to attend and derive fewer benefits from mixed-age recovery supports (; ). Thus, it is important to link adolescents to options tailored to their developmental stage and that connect them to other youth in recovery.