Funded Projects

Central Appalachia has been devastated by opioid use disorder and overdose deaths for decades. Treatment access is improving across that region, yet few individuals successfully remain on treatment with medications for opioid use disorder (MOUD). Peer recovery support services can be highly effective in improving treatment outcomes and recovery, but there is limited evidence of how they can be implemented and used most effectively, particularly for individuals receiving MOUD. This project will create the Studies To Advance Recovery Supports (STARS) Network that aims to expand the infrastructure necessary to implement and evaluate peer recovery support services for these individuals. It will build research capacities at universities and health partners, enroll MOUD clinics and peer recovery support professionals, and promote data harmonization across network partners.

Little is known about what motivates people to use multiple drugs. Understanding these factors is important for tailoring treatment services. Behavioral economic theory, which determines how much value individuals assign to drugs and potential negative consequences, provides a framework to understand the choices people make. This project will identify patterns, motivating factors, and long-term trajectories of opioid-involved polysubstance use behaviors and treatment. This research will use a range of methods to analyze substance use episodes as well as examine motives and preferences associated with polysubstance use behaviors and how they change over time. The findings will be combined into a toolkit to inform timing, type, and tailoring of interventions and policies to guide implementation of effective clinical strategies and policies for managing polysubstance use in healthcare systems.

Compared to people with stable housing, individuals experiencing homelessness are more likely to use both fentanyl and stimulants and experience drug-related harms. This project will examine fentanyl-stimulant polysubstance use patterns and how they evolve over time in response to changes to housing status. It will also assess use of overdose prevention and substance use disorder treatment interventions in homeless individuals who use both fentanyl and stimulants, including how polysubstance use patterns shape their risk of overdose over time. This research will also interact with community stakeholders toward translating the findings into future research, policy, and program recommendations.

Use of both opioids and stimulants is increasing, but little is known about how polysubstance use evolves over time and how it influences overdose risk. This project will use data from two groups at high risk for overdose: i) participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study who inject drugs and ii)  participants in the new Stimulant Opioid Non-Injection Cohort (SONIC) study. This research will identify drug use patterns and their association with treatment and overdose over time – toward informing overdose prevention efforts and interventions to improve the U.S. opioid crisis.

Although methadone is an effective treatment for opioid use disorder, many individuals drop out of treatment, putting them at risk of relapse and overdose. One of the factors associated with poor retention in methadone treatment is concurrent cocaine use. There is currently no effective medical treatment for cocaine use disorder. However, contingency management, in which individuals receive tangible rewards for desired behaviors such as abstinence, has been shown to be effective for cocaine use. This project will test the value of a digital therapy app, DynamiCare Health Contingency Management, in methadone treatment programs to promote treatment for polysubstance use.

Polysubstance use, especially use of both opioids and stimulants, is compounding the already devastating effects of the opioid crisis in underserved rural areas. This project builds on a previously established treatment model for opioid use disorder that uses telehealth and mobile treatment units, which seeks to engage people in activities they enjoy, to help them avoid negative behaviors such as drug use. This research will evaluate the effectiveness of a behavioral treatment approach delivered by peer recovery support specialists in rural areas and using mobile treatment units. The project will measure the intervention’s effect on treatment retention and polysubstance use – as well as evaluate the intervention’s feasibility, acceptability, adoption, and economic value.

Although approximately 80% of people with opioid use disorder smoke cigarettes, tobacco use is rarely addressed in treatment of opioid use disorder. Moreover, smoking cessation interventions that are effective in the general population have been minimally effective among people with opioid use disorder. This project will integrate into methadone treatment programs the Mindfulness-Oriented Recovery Enhancement intervention and motivational interviewing to address use of tobacco and other drugs. This research will determine the value of this intervention compared to attending a support group or receiving motivational interviewing. The project will also examine use of tobacco, opioids, and other drugs, and whether people begin treatment. The research will also study implementation barriers and facilitators to the mindfulness-based approach as well as strategies to enhance its adoption into clinical practice.

Compared to people who use only one type of drug, people who use combinations of drugs, such as opioids and stimulants, are more likely to have histories of childhood trauma, including post-traumatic stress disorder (PTSD). This project will adapt an existing PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy, to treat individuals with polysubstance use. This research will be piloted in a methadone maintenance treatment program to assess feasibility and acceptability. If successful, the findings will lay the groundwork for a large-scale clinical trial.

Young adults (18 to 26) with a substance use problem have the highest rates of polysubstance use among all age groups. At the same time, individuals in this age group (especially in rural areas) are generally lacking in recovery capital: resources to help them recover from substance use, such as vocational or educational skills. This project will assess the feasibility and acceptability of “Launch,” which uses parental and peer recovery support to increase recovery capital for young adults with polysubstance use. The intervention will use coaching as well as contingency management, a treatment approach in which individuals receive tangible rewards as incentives for desired behaviors such as abstinence. If successful, the findings will inform a future large-scale trial assessing the effectiveness of this approach.

Patients who use both opioids and methamphetamine often experience serious medical complications requiring hospitalization. While hospitalization provides an opportunity to start addiction treatment, linking patients to outpatient treatment after discharge is hard. This project will develop and conduct a pilot trial of an intervention that combines patient navigation with a mobile app offering financial incentives for outpatient treatment. This research will also develop outcome measures to describe participants’ use of healthcare and how it is influenced by baseline methamphetamine use. If effective, this patient-navigator-plus-mHealth approach could help reduce substantial gaps in treatment and retention for people who use opioids and methamphetamines simultaneously.

The opioid crisis has been particularly devastating to adolescents and young adults between 16 and 25 years old. Recovery support services in community settings can help these individuals who take medications for opioid use disorder find a path to recovery. This project will develop a network of advanced researchers, recovery support specialists, adolescents and young adults in recovery, and other key community stakeholders to help rapidly advance the science of recovery support services. This research will focus in particular on continuing care services specialized for adolescents and young adults who currently take or who have taken medications for opioid use disorder.

About 23 million Americans identify as being in recovery from opioid and other substance use disorders. While recovery support services are an established best practice to support people in recovery, there is little scientific evidence to support the efficacy and implementation of peer recovery support services, training approaches, and delivery models. Recovery support services are particularly lacking in the U.S. Southwest and for individuals who choose to take medications for opioid use disorder as part of their recovery pathway. This project will establish the Peer Recovery Innovation Network to address research gaps. This research will incorporate input from people with lived experience in all stages of the recovery process – toward helping to set the research agenda and conducting the research, as well as enhancing infrastructure for peer recovery support services research.