Pub Date : 2026-01-18DOI: 10.1016/j.josat.2026.209897
Leonard A. Jason , John M. Light , Robert Krause , Alexander Sikora
Introduction
Family members are often among the most important people in the social networks of those dealing with substance use disorders. The current study explored the effects of recovery-supportive family members on social network tie dynamics in recovery homes as well as recovery over time.
Methods
The sample included residents of 42 recovery homes in three states in the US. We collected data over a two-year period. We modeled the joint affiliation and recovery processes in Oxford House recovery houses over time using the Stochastic Actor-Oriented Model framework RSiena, in this observational study.
Results
We found that if a resident had a family member they listed as one of their most important people, had regular contact with that family member, and the family member was not using alcohol or an illegal substance, the resident's rate of recovery was significantly higher than if no such family relationship was reported. However, such family support lowered the likelihood of a resident being perceived as a strong relationship partner by other house members. However, residents without supportive family connections, who are able to form strong ties to better-recovered peers in the recovery homes, also have better outcomes over time.
Conclusions
Residents with strong ties to supportive non-substance-using family members exhibit better recovery than those without such family connections. For these residents who have supportive family members, peer ties within the recovery home appear less critical for their recovery progress. Those residents who do not have supportive family ties also have better recovery as long as they have one or more resident ties to more recovered peers within the home. We discussed the implications of these findings.
{"title":"The effect of supportive familial relationships on social networks and recovery","authors":"Leonard A. Jason , John M. Light , Robert Krause , Alexander Sikora","doi":"10.1016/j.josat.2026.209897","DOIUrl":"10.1016/j.josat.2026.209897","url":null,"abstract":"<div><h3>Introduction</h3><div>Family members are often among the most important people in the social networks of those dealing with substance use disorders. The current study explored the effects of recovery-supportive family members on social network tie dynamics in recovery homes as well as recovery over time.</div></div><div><h3>Methods</h3><div>The sample included residents of 42 recovery homes in three states in the US. We collected data over a two-year period. We modeled the joint affiliation and recovery processes in Oxford House recovery houses over time using the Stochastic Actor-Oriented Model framework RSiena, in this observational study.</div></div><div><h3>Results</h3><div>We found that if a resident had a family member they listed as one of their most important people, had regular contact with that family member, and the family member was not using alcohol or an illegal substance, the resident's rate of recovery was significantly higher than if no such family relationship was reported. However, such family support lowered the likelihood of a resident being perceived as a strong relationship partner by other house members. However, residents without supportive family connections, who are able to form strong ties to better-recovered peers in the recovery homes, also have better outcomes over time.</div></div><div><h3>Conclusions</h3><div>Residents with strong ties to supportive non-substance-using family members exhibit better recovery than those without such family connections. For these residents who have supportive family members, peer ties within the recovery home appear less critical for their recovery progress. Those residents who do not have supportive family ties also have better recovery as long as they have one or more resident ties to more recovered peers within the home. We discussed the implications of these findings.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209897"},"PeriodicalIF":1.9,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-18DOI: 10.1016/j.josat.2026.209904
Zachary C. Rich , Hilary A. Tindle , Debbie M. Cheng , Michael D. Stein , Natalia Gnatienko , Sally Bendiks , Leah Forman , Gregory J. Patts , Evgeny Krupitsky , Matthew S. Freiberg , Jeffrey H. Samet
Introduction
Cigarette and opioid use are two leading causes of preventable death and disability in the United States and are often comorbid. Nicotinic partial agonists, such as varenicline and cytisine, are considered highly effective for Nicotine Use Disorder in the general population. However, their efficacy and safety in smokers who use opioids remain unclear, with concerns about reduced efficacy or increased opioid use. We evaluated the impact of nicotinic agonists compared to nicotine replacement therapy (NRT) on opioid and cigarette use.
Methods
We conducted a secondary analysis of the St PETER HIV study, a randomized, double-blinded, placebo-controlled trial of 400 HIV-positive individuals recruited from July 2017 to December 2020 at HIV care sites in St. Petersburg, Russia. Participants (daily smokers with risky alcohol use) were randomized to varenicline, cytisine, or NRT. Our analysis focused on the 97 participants who reported opioid use at baseline. Logistic regression assessed the relationship between treatment arms and our primary outcome of self-reported opioid use. Hochberg-adjusted p-values accounted for multiple comparisons.
Results
The 97 St. PETER HIV participants with baseline opioid use exhibited significant differences from non-opioid users: higher rates of HCV infection; lower CD4 counts; and higher alcohol consumption and smoking rate. Among this opioid use subgroup, there was no significant difference in self-reported opioid use between participants randomized to nicotinic partial agonists and those randomized to NRT at 1, 3, 6 or 12 months.
Conclusions
Nicotinic partial agonists do not significantly impact opioid use outcomes compared to NRT in persons who use opioids. Clinicians should consider these options as part of a treatment approach to address nicotine use in this population.
{"title":"Assessing the impact of nicotinic partial agonists compared to NRT on opioid and cigarette use: A secondary analysis investigating treatment outcomes for co-occurring nicotine and opioid use","authors":"Zachary C. Rich , Hilary A. Tindle , Debbie M. Cheng , Michael D. Stein , Natalia Gnatienko , Sally Bendiks , Leah Forman , Gregory J. Patts , Evgeny Krupitsky , Matthew S. Freiberg , Jeffrey H. Samet","doi":"10.1016/j.josat.2026.209904","DOIUrl":"10.1016/j.josat.2026.209904","url":null,"abstract":"<div><h3>Introduction</h3><div>Cigarette and opioid use are two leading causes of preventable death and disability in the United States and are often comorbid. Nicotinic partial agonists, such as varenicline and cytisine, are considered highly effective for Nicotine Use Disorder in the general population. However, their efficacy and safety in smokers who use opioids remain unclear, with concerns about reduced efficacy or increased opioid use. We evaluated the impact of nicotinic agonists compared to nicotine replacement therapy (NRT) on opioid and cigarette use.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of the St PETER HIV study, a randomized, double-blinded, placebo-controlled trial of 400 HIV-positive individuals recruited from July 2017 to December 2020 at HIV care sites in St. Petersburg, Russia. Participants (daily smokers with risky alcohol use) were randomized to varenicline, cytisine, or NRT. Our analysis focused on the 97 participants who reported opioid use at baseline. Logistic regression assessed the relationship between treatment arms and our primary outcome of self-reported opioid use. Hochberg-adjusted <em>p</em>-values accounted for multiple comparisons.</div></div><div><h3>Results</h3><div>The 97 St. PETER HIV participants with baseline opioid use exhibited significant differences from non-opioid users: higher rates of HCV infection; lower CD4 counts; and higher alcohol consumption and smoking rate. Among this opioid use subgroup, there was no significant difference in self-reported opioid use between participants randomized to nicotinic partial agonists and those randomized to NRT at 1, 3, 6 or 12 months.</div></div><div><h3>Conclusions</h3><div>Nicotinic partial agonists do not significantly impact opioid use outcomes compared to NRT in persons who use opioids. Clinicians should consider these options as part of a treatment approach to address nicotine use in this population.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"184 ","pages":"Article 209904"},"PeriodicalIF":1.9,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.josat.2026.209905
Bryan Hartzler, Meg Brunner, J Konadu Fokuo, Michael J Ostacher, Anna Pagano, Beth A Rutkowski, Ryelee A Vest, Carmen L Masson
A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations-with its domain of adoption corresponding most directly to the CTN's mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup-currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library-promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN's 25th anniversary, we also reflect on the value of this multi institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.
{"title":"There and back again: Continuing efforts via regional partnership to promote workforce awareness of scientific advancements in addiction care.","authors":"Bryan Hartzler, Meg Brunner, J Konadu Fokuo, Michael J Ostacher, Anna Pagano, Beth A Rutkowski, Ryelee A Vest, Carmen L Masson","doi":"10.1016/j.josat.2026.209905","DOIUrl":"https://doi.org/10.1016/j.josat.2026.209905","url":null,"abstract":"<p><p>A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations-with its domain of adoption corresponding most directly to the CTN's mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup-currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library-promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN's 25th anniversary, we also reflect on the value of this multi institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209905"},"PeriodicalIF":1.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.josat.2026.209903
Adati Tarfa , Melissa Borker , Margaret Lancaster , Reuben Santiago , Angela Di Paola , Cynthia Frank , Sandra A. Springer
Background
For individuals with opioid use disorder (OUD) re-entering the community after incarceration, peer navigator (PN) support is increasingly implemented to support treatment initiation and continuity. However, little is known about the specific services PNs deliver in real-time encounters, contexts in which these services occur, and how they address barriers that affect access to medications for OUD (MOUD). This study presents the first empirically derived typology of PN support for criminal legal-involved (CLI) adults with OUD.
Methods
We applied qualitative content analysis (QCA) to PN encounters from the Connecticut (CT) site of a multi-site randomized controlled trial (RCT) evaluating extended-release buprenorphine (XR-B), extended-release naltrexone (XR-NTX), and enhanced treatment as usual (ETAU) among CLI adults with OUD. Of the 151 individuals enrolled in CT, this analysis focuses on the 108 participants who had at least one PN encounter. Two PNs with lived experience supported participants across all study arms and recorded 1316 real-time engagement notes in REDCap between January 2021 and January 2024. Descriptive quantitative data were triangulated with QCA findings, and Lincoln and Guba's criteria guided qualitative analytic rigor.
Results
Participants averaged 37.6 years (SD ± 7.7); 72% were men, 85% White, and 23% Hispanic. Three domains of support were identified: (1) Direct Services (41.9% of encounters), where PNs provided tangible resources, including transportation (29.3% of direct services) to pharmacies, court dates, and the provision of food and clothing. (2) Informational Services (40.6% of all encounters) involved educating peers about resources (29.1% of informational services), including employment for CLI individuals, as well as goal setting (12.0% of informational services) and MOUD visit reminders. (3) Facilitation Services (17.5% of all encounters) involved PNs helping participants navigate systems through advocacy (32.8% of facilitation services) with parole officers or housing managers, negotiating during evictions, and assistance with paperwork to receive social service benefits (14.5% of facilitation services). These service patterns reflected participants' high needs: 41.1% had unstable housing, only 4.4% were employed full-time, and 13.5% reported active substance use during PN encounters.
Conclusions
Peer Navigators provide direct, informational, and facilitation support during community re-entry that can help with MOUD access. Future research should examine how these service domains align with participant priorities and contribute to treatment outcomes.
{"title":"Real-time peer-navigation support during community re-entry for adults with opioid use disorder","authors":"Adati Tarfa , Melissa Borker , Margaret Lancaster , Reuben Santiago , Angela Di Paola , Cynthia Frank , Sandra A. Springer","doi":"10.1016/j.josat.2026.209903","DOIUrl":"10.1016/j.josat.2026.209903","url":null,"abstract":"<div><h3>Background</h3><div>For individuals with opioid use disorder (OUD) re-entering the community after incarceration, peer navigator (PN) support is increasingly implemented to support treatment initiation and continuity. However, little is known about the specific services PNs deliver in real-time encounters, contexts in which these services occur, and how they address barriers that affect access to medications for OUD (MOUD). This study presents the first empirically derived typology of PN support for criminal legal-involved (CLI) adults with OUD.</div></div><div><h3>Methods</h3><div>We applied qualitative content analysis (QCA) to PN encounters from the Connecticut (CT) site of a multi-site randomized controlled trial (RCT) evaluating extended-release buprenorphine (XR-B), extended-release naltrexone (XR-NTX), and enhanced treatment as usual (ETAU) among CLI adults with OUD. Of the 151 individuals enrolled in CT, this analysis focuses on the 108 participants who had at least one PN encounter. Two PNs with lived experience supported participants across all study arms and recorded 1316 real-time engagement notes in REDCap between January 2021 and January 2024. Descriptive quantitative data were triangulated with QCA findings, and Lincoln and Guba's criteria guided qualitative analytic rigor.</div></div><div><h3>Results</h3><div>Participants averaged 37.6 years (SD ± 7.7); 72% were men, 85% White, and 23% Hispanic. Three domains of support were identified: (1) Direct Services (41.9% of encounters), where PNs provided tangible resources, including transportation (29.3% of direct services) to pharmacies, court dates, and the provision of food and clothing. (2) Informational Services (40.6% of all encounters) involved educating peers about resources (29.1% of informational services), including employment for <!--> <!-->CLI<!--> <!--> individuals, as well as goal setting (12.0% of informational services) and MOUD visit reminders. (3) Facilitation Services (17.5% of all encounters) involved PNs helping participants navigate systems through advocacy (32.8% of facilitation services) with parole officers or housing managers, negotiating during evictions, and assistance with paperwork to receive social service benefits (14.5% of facilitation services). These service patterns reflected participants' high needs: 41.1% had unstable housing, only 4.4% were employed full-time, and 13.5% reported active substance use during PN encounters.</div></div><div><h3>Conclusions</h3><div>Peer Navigators provide direct, informational, and facilitation support during community re-entry that can help with MOUD access. Future research should examine how these service domains align with participant priorities and contribute to treatment outcomes.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209903"},"PeriodicalIF":1.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.josat.2026.209901
Thao D V Le, Thomas J Reese, Andrew D Wiese, Kristopher A Kast, Rachel P Craig, Mauli V Shah, Mariah Smith, David Marcovitz
Introduction: This study examines the impact of the State Opioid Response (SOR) grant on addiction care outcomes in uninsured patients at a longitudinal addiction and co-occurring disorder clinic (LACC).
Methods: In this retrospective cohort study, treatment engagement, substance use, and acute care utilization outcomes were compared between SOR grant-funded and traditionally insured patients receiving medications for opioid use disorder (MOUD).
Results: Data from 607 patients were analyzed, with 472 in the traditional insurance group and 134 in the SOR grant-funded group. The SOR grant-funded group had more male patients (70.4% vs 48%) and higher rates of cannabis use disorder (19.3% vs 12.1%), stimulant use disorder (51.9% vs 26.3%), and HCV infection (3.7% vs 0.8%). Unadjusted data showed higher rates of MOUD adherence, opioid use, and stimulant co-use in SOR grant-funded patients. After adjusting for demographic, social, and clinical differences, care outcomes were similar between the two groups, although SOR grant-funded patients had longer general hospital admissions compared to traditionally insured patients.
Conclusion: The comparable adjusted outcomes between the two groups suggest that uninsured individuals can achieve similar treatment success when access to care is provided, and after accounting for demographic, social, and clinical differences. However, the longer length of stay in hospitalized SOR grant-funded patients highlights more complex health and social challenges that require additional support beyond what the SOR grant covers. These findings underscore the need to sustain and expand funding mechanisms like the SOR grant while broadening insurance coverage to address disparities in addiction care, particularly in Medicaid non-expansion states.
{"title":"Addiction care outcomes between insured and state opioid response grant-funded patients in a medicaid non-expansion state.","authors":"Thao D V Le, Thomas J Reese, Andrew D Wiese, Kristopher A Kast, Rachel P Craig, Mauli V Shah, Mariah Smith, David Marcovitz","doi":"10.1016/j.josat.2026.209901","DOIUrl":"https://doi.org/10.1016/j.josat.2026.209901","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the impact of the State Opioid Response (SOR) grant on addiction care outcomes in uninsured patients at a longitudinal addiction and co-occurring disorder clinic (LACC).</p><p><strong>Methods: </strong>In this retrospective cohort study, treatment engagement, substance use, and acute care utilization outcomes were compared between SOR grant-funded and traditionally insured patients receiving medications for opioid use disorder (MOUD).</p><p><strong>Results: </strong>Data from 607 patients were analyzed, with 472 in the traditional insurance group and 134 in the SOR grant-funded group. The SOR grant-funded group had more male patients (70.4% vs 48%) and higher rates of cannabis use disorder (19.3% vs 12.1%), stimulant use disorder (51.9% vs 26.3%), and HCV infection (3.7% vs 0.8%). Unadjusted data showed higher rates of MOUD adherence, opioid use, and stimulant co-use in SOR grant-funded patients. After adjusting for demographic, social, and clinical differences, care outcomes were similar between the two groups, although SOR grant-funded patients had longer general hospital admissions compared to traditionally insured patients.</p><p><strong>Conclusion: </strong>The comparable adjusted outcomes between the two groups suggest that uninsured individuals can achieve similar treatment success when access to care is provided, and after accounting for demographic, social, and clinical differences. However, the longer length of stay in hospitalized SOR grant-funded patients highlights more complex health and social challenges that require additional support beyond what the SOR grant covers. These findings underscore the need to sustain and expand funding mechanisms like the SOR grant while broadening insurance coverage to address disparities in addiction care, particularly in Medicaid non-expansion states.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209901"},"PeriodicalIF":1.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209898
Li Li , Li-Jung Liang , Thang Hong Pham , Ha Thi Thanh Nguyen , Tuan Anh Nguyen
Background
Although trust in addiction treatment providers and trust in treatment services are related yet distinct constructs, the latter remains underexplored. In Vietnam, where addiction treatment is transitioning from punitive models to community-based harm reduction, research on trust in treatment systems is particularly limited.
Methods
Baseline data were drawn from an ongoing randomized controlled trial conducted across three provinces in Vietnam, involving 690 people who use drugs (PWUD). Data were collected through face-to-face, computer-assisted interviews using validated and adapted measures in addiction treatment services, depressive symptoms, perceived care support, and internalized stigma related to methadone maintenance treatment (MMT). A linear mixed-effects regression model with commune-level random-effects was used to assess associations between trust in addiction treatment services and the measures of interest, including demographic characteristics.
Results
Higher levels of internalized MMT stigma and depressive symptoms were both significantly associated with a decreased trust in addiction treatment services in the adjusted analysis. Demographic characteristics and current MMT status were not significantly associated with trust. Although trust in addition services was associated with perceived care support in bivariate analysis, this relationship was no longer significant after adjusting for other factors.
Conclusion
These findings suggest trust in addiction treatment could be understood not only as a function of provider-patient relationships but also in broader institutional and systemic contexts. Addressing treatment-related stigma and integrating mental health services in addiction services may be promising strategies to improve PWUD's trust in addiction services.
{"title":"Trust in addiction treatment services among people who use drugs in Vietnam","authors":"Li Li , Li-Jung Liang , Thang Hong Pham , Ha Thi Thanh Nguyen , Tuan Anh Nguyen","doi":"10.1016/j.josat.2026.209898","DOIUrl":"10.1016/j.josat.2026.209898","url":null,"abstract":"<div><h3>Background</h3><div>Although trust in addiction treatment providers and trust in treatment services are related yet distinct constructs, the latter remains underexplored. In Vietnam, where addiction treatment is transitioning from punitive models to community-based harm reduction, research on trust in treatment systems is particularly limited.</div></div><div><h3>Methods</h3><div>Baseline data were drawn from an ongoing randomized controlled trial conducted across three provinces in Vietnam, involving 690 people who use drugs (PWUD). Data were collected through face-to-face, computer-assisted interviews using validated and adapted measures in addiction treatment services, depressive symptoms, perceived care support, and internalized stigma related to methadone maintenance treatment (MMT). A linear mixed-effects regression model with commune-level random-effects was used to assess associations between trust in addiction treatment services and the measures of interest, including demographic characteristics.</div></div><div><h3>Results</h3><div>Higher levels of internalized MMT stigma and depressive symptoms were both significantly associated with a decreased trust in addiction treatment services in the adjusted analysis. Demographic characteristics and current MMT status were not significantly associated with trust. Although trust in addition services was associated with perceived care support in bivariate analysis, this relationship was no longer significant after adjusting for other factors.</div></div><div><h3>Conclusion</h3><div>These findings suggest trust in addiction treatment could be understood not only as a function of provider-patient relationships but also in broader institutional and systemic contexts. Addressing treatment-related stigma and integrating mental health services in addiction services may be promising strategies to improve PWUD's trust in addiction services.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209898"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209892
Alina I. Palimaru , Nipher Malika , Ryan A. Brown , Pierrce Holmes , Daniel L. Dickerson , Carrie L. Johnson , Virginia Arvizu Sanchez , Kurt Schweigman , Elizabeth J. D’Amico
Introduction
Substance use prevention programs tailored to American Indian and Alaska Native (AI/AN) populations in the U.S. have shown promise, particularly when they center on cultural relevance and community engagement. However, limited research has been conducted to understand program implementation and sustainability in AI/AN organizations and communities.
Methods
This study explores implementation and sustainability using 20 virtual in-depth interviews with AI/AN service providers and administrators across the U.S. following a randomized control trial of the virtual TACUNA (Traditions and Connections for Urban Native Americans) program for AI/AN emerging adults living outside Tribal lands.
Results
Participants highlighted the importance of a culturally grounded workforce, funding, and collaborative partnerships for the successful implementation and sustainability of prevention efforts. Initial funding is crucial for launching programs, and collaborative partnerships with federal and state agencies can improve funding opportunities and sustainability. Many also highlighted that integrated care models that combine medical, behavioral, and cultural health services effectively address complex needs, while hybrid delivery methods can balance accessibility and relational engagement. Participants also noted that tailored interventions require a deep understanding of community values and trust-building through local stakeholder engagement. In addition, many said culturally appropriate evaluation methods, combining quantitative and qualitative metrics, are essential for measuring success and ensuring continuous improvement. Finally, participants argued that systemic policy changes are needed to rectify funding inequities, reduce regulatory barriers, and support culturally relevant practices, thereby enhancing the effectiveness of health services for urban and non-urban Indian health organizations and communities.
Conclusion
These perspectives can help inform the implementation of TACUNA in communities across the U.S. Findings underscore the necessity of tailoring programs to cultural values and emphasize the need for systemic policy changes to address funding inequities and regulatory barriers. By addressing these gaps, stakeholders can consider how to enhance the effectiveness and sustainability of substance use prevention initiatives within AIAN communities.
{"title":"Bridging traditions and prevention: Insights into implementing and sustaining substance use programs for urban AI/AN communities","authors":"Alina I. Palimaru , Nipher Malika , Ryan A. Brown , Pierrce Holmes , Daniel L. Dickerson , Carrie L. Johnson , Virginia Arvizu Sanchez , Kurt Schweigman , Elizabeth J. D’Amico","doi":"10.1016/j.josat.2026.209892","DOIUrl":"10.1016/j.josat.2026.209892","url":null,"abstract":"<div><h3>Introduction</h3><div>Substance use prevention programs tailored to American Indian and Alaska Native (AI/AN) populations in the U.S. have shown promise, particularly when they center on cultural relevance and community engagement. However, limited research has been conducted to understand program implementation and sustainability in AI/AN organizations and communities.</div></div><div><h3>Methods</h3><div>This study explores implementation and sustainability using 20 virtual in-depth interviews with AI/AN service providers and administrators across the U.S. following a randomized control trial of the virtual TACUNA (Traditions and Connections for Urban Native Americans) program for AI/AN emerging adults living outside Tribal lands.</div></div><div><h3>Results</h3><div>Participants highlighted the importance of a culturally grounded workforce, funding, and collaborative partnerships for the successful implementation and sustainability of prevention efforts. Initial funding is crucial for launching programs, and collaborative partnerships with federal and state agencies can improve funding opportunities and sustainability. Many also highlighted that integrated care models that combine medical, behavioral, and cultural health services effectively address complex needs, while hybrid delivery methods can balance accessibility and relational engagement. Participants also noted that tailored interventions require a deep understanding of community values and trust-building through local stakeholder engagement. In addition, many said culturally appropriate evaluation methods, combining quantitative and qualitative metrics, are essential for measuring success and ensuring continuous improvement. Finally, participants argued that systemic policy changes are needed to rectify funding inequities, reduce regulatory barriers, and support culturally relevant practices, thereby enhancing the effectiveness of health services for urban and non-urban Indian health organizations and communities.</div></div><div><h3>Conclusion</h3><div>These perspectives can help inform the implementation of TACUNA in communities across the U.S. Findings underscore the necessity of tailoring programs to cultural values and emphasize the need for systemic policy changes to address funding inequities and regulatory barriers. By addressing these gaps, stakeholders can consider how to enhance the effectiveness and sustainability of substance use prevention initiatives within AIAN communities.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209892"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209895
Nicholas R. Livingston , Carol A. Malte , Madeline C. Frost , Andrew J. Saxon , Adam J. Gordon , Hildi J. Hagedorn , Amy J. Kennedy , Emily C. Williams , Eric J. Hawkins
Introduction
Buprenorphine, an evidenced-based medication for opioid use disorder (OUD), can be prescribed in any medical setting, including primary care (PC) and substance use disorder (SUD) specialty clinics. While research has identified patient characteristics associated with buprenorphine initiation and retention within both settings, between-settings evaluations have been limited. This evaluation examined differences in patient characteristics associated with buprenorphine initiation and retention between PC and SUD settings within the Veterans Health Administration.
Methods
Retrospective cohort quality improvement evaluation of veterans with OUD with ≥2 PC visits in a 1-year period who initiated buprenorphine within one-year of initial visit in either PC or SUD settings. Mixed-effects logistic regressions examined associations between patient characteristics and initiation setting and whether associations between patient characteristics and 180-day retention differed across setting.
Results
Of 372 patients who initiated buprenorphine in SUD clinics and 317 in PC, 47.6% and 44.3% had 180-day retention, respectively. Patients aged 35–65 (vs. < 35; adjusted odds ratio [AOR] = 3.17; 95% confidence interval [CI] = 1.56, 6.44) and 65+ (AOR = 5.37; CI = 2.32, 12.42), and married patients (AOR = 2.04; CI = 1.30, 3.19) were more likely to initiate in PC. Patients with unstable housing (AOR = 0.46; CI = 0.28, 0.76) and non-alcohol SUD (AOR = 0.42; CI = 0.27, 0.66) were less likely to initiate in PC compared to SUD clinics. Patients with PTSD were less likely to be retained in SUD clinics (AOR = 0.48; CI = 0.31, 0.75), with no significant association for PTSD in PC (AOR = 1.47; CI = 0.90, 2.38).
Conclusions
Findings suggest that patient characteristics associated with buprenorphine initiation may differ by health care setting. However, retention among subgroups of patients appears similar across settings.
{"title":"Differences in buprenorphine initiation and retention for opioid use disorder between primary care and substance use disorder specialty care settings","authors":"Nicholas R. Livingston , Carol A. Malte , Madeline C. Frost , Andrew J. Saxon , Adam J. Gordon , Hildi J. Hagedorn , Amy J. Kennedy , Emily C. Williams , Eric J. Hawkins","doi":"10.1016/j.josat.2026.209895","DOIUrl":"10.1016/j.josat.2026.209895","url":null,"abstract":"<div><h3>Introduction</h3><div>Buprenorphine, an evidenced-based medication for opioid use disorder (OUD), can be prescribed in any medical setting, including primary care (PC) and substance use disorder (SUD) specialty clinics. While research has identified patient characteristics associated with buprenorphine initiation and retention within both settings, between-settings evaluations have been limited. This evaluation examined differences in patient characteristics associated with buprenorphine initiation and retention between PC and SUD settings within the Veterans Health Administration.</div></div><div><h3>Methods</h3><div>Retrospective cohort quality improvement evaluation of veterans with OUD with ≥2 PC visits in a 1-year period who initiated buprenorphine within one-year of initial visit in either PC or SUD settings. Mixed-effects logistic regressions examined associations between patient characteristics and initiation setting and whether associations between patient characteristics and 180-day retention differed across setting.</div></div><div><h3>Results</h3><div>Of 372 patients who initiated buprenorphine in SUD clinics and 317 in PC, 47.6% and 44.3% had 180-day retention, respectively. Patients aged 35–65 (vs. < 35; adjusted odds ratio [AOR] = 3.17; 95% confidence interval [CI] = 1.56, 6.44) and 65+ (AOR = 5.37; CI = 2.32, 12.42), and married patients (AOR = 2.04; CI = 1.30, 3.19) were more likely to initiate in PC. Patients with unstable housing (AOR = 0.46; CI = 0.28, 0.76) and non-alcohol SUD (AOR = 0.42; CI = 0.27, 0.66) were less likely to initiate in PC compared to SUD clinics. Patients with PTSD were less likely to be retained in SUD clinics (AOR = 0.48; CI = 0.31, 0.75), with no significant association for PTSD in PC (AOR = 1.47; CI = 0.90, 2.38).</div></div><div><h3>Conclusions</h3><div>Findings suggest that patient characteristics associated with buprenorphine initiation may differ by health care setting. However, retention among subgroups of patients appears similar across settings.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209895"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209894
Mercy N. Mumba , Fatima Leghari , Olayemi Timothy Adekeye , Evans Kyei , Babatunde Owolabi , Donald Musonda , Moses Zulu , Angela Namukoko , Idah Nyati , Brenda Zulu , George Mugoya
Introduction
Substance use presents a growing public health concern in Zambia, affecting individuals, families, and communities across the country. Understanding the socio-economic, psychological, and environmental drivers is essential for developing effective interventions. This study aims to explore the underlying factors contributing to substance use in Zambian communities from the perspectives of key stakeholders.
Methods
A qualitative phenomenological approach was employed to gain in-depth insight into the factors influencing substance use. Twenty-seven participants from Chawama and Kabwata townships in Zambia were recruited through purposive and snowball sampling. Data were collected via semi-structured interviews and analyzed using Colaizzi's seven-step method. NVivo software supported thematic analysis.
Results
Three major themes emerged as key drivers of substance use: (1) Availability of Resources—highlighting a lack of funding, treatment facilities, and governmental support; (2) State of Social Network—encompassing peer and family influences that either exacerbate or protect against substance use; and (3) Escapism and Misconceptions of Benefits—where unemployment, idleness, and misbeliefs about performance enhancement and stress relief promote substance use. These factors interact within a socio-cultural environment marked by limited mental health infrastructure and weak social support systems.
Conclusion
Substance use in Zambia is driven by a complex interplay of resource scarcity, social influence, and misinformed beliefs. Addressing these drivers requires a multi-pronged approach, including strengthening social support networks, expanding access to treatment and prevention services, correcting substance-related misconceptions, and promoting community-based, culturally sensitive interventions. The findings offer actionable insights for policymakers, health professionals, and community stakeholders to collaboratively develop effective strategies to curb substance use in Zambia.
{"title":"Exploring the drivers of substance use in Zambia: A qualitative study of stakeholder perspectives","authors":"Mercy N. Mumba , Fatima Leghari , Olayemi Timothy Adekeye , Evans Kyei , Babatunde Owolabi , Donald Musonda , Moses Zulu , Angela Namukoko , Idah Nyati , Brenda Zulu , George Mugoya","doi":"10.1016/j.josat.2026.209894","DOIUrl":"10.1016/j.josat.2026.209894","url":null,"abstract":"<div><h3>Introduction</h3><div>Substance use presents a growing public health concern in Zambia, affecting individuals, families, and communities across the country. Understanding the socio-economic, psychological, and environmental drivers is essential for developing effective interventions. This study aims to explore the underlying factors contributing to substance use in Zambian communities from the perspectives of key stakeholders.</div></div><div><h3>Methods</h3><div>A qualitative phenomenological approach was employed to gain in-depth insight into the factors influencing substance use. Twenty-seven participants from Chawama and Kabwata townships in Zambia were recruited through purposive and snowball sampling. Data were collected via semi-structured interviews and analyzed using Colaizzi's seven-step method. NVivo software supported thematic analysis.</div></div><div><h3>Results</h3><div>Three major themes emerged as key drivers of substance use: (1) <em>Availability of Resources</em>—highlighting a lack of funding, treatment facilities, and governmental support; (2) <em>State of Social Network</em>—encompassing peer and family influences that either exacerbate or protect against substance use; and (3) <em>Escapism and Misconceptions of Benefits</em>—where unemployment, idleness, and misbeliefs about performance enhancement and stress relief promote substance use. These factors interact within a socio-cultural environment marked by limited mental health infrastructure and weak social support systems.</div></div><div><h3>Conclusion</h3><div>Substance use in Zambia is driven by a complex interplay of resource scarcity, social influence, and misinformed beliefs. Addressing these drivers requires a multi-pronged approach, including strengthening social support networks, expanding access to treatment and prevention services, correcting substance-related misconceptions, and promoting community-based, culturally sensitive interventions. The findings offer actionable insights for policymakers, health professionals, and community stakeholders to collaboratively develop effective strategies to curb substance use in Zambia.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"183 ","pages":"Article 209894"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.josat.2026.209896
Ingrid A Binswanger, Onchee Yu, Paige D Wartko, Megan Addis, Jennifer F Bobb, Amy K Lee, Bobbi Jo Yarborough, Julia Arnsten, Joseph E Glass, Thomas F Northrup, Mark Murphy, Jordan M Braciszewski, Viviana E Horigian, Jo Ann Shoup, Annie Potter, Katharine A Bradley
Introduction: Primary care patients with opioid use disorder (OUD) may receive treatment in primary care clinics or co-located specialty addiction treatment practices. To help guide operational leaders in organizing OUD care delivery systems, we described rates of OUD medication treatment among primary care patients in PRimary care Opioid Use Disorders treatment (PROUD) trial intervention clinics and four primary care clinics not in the trial because they already had OUD treatment programs in place (exemplar clinics).
Methods: Primary care patients seen at six PROUD trial intervention clinics that implemented the Massachusetts model of office-based addiction treatment (PROUD clinics) and four exemplar clinics (two co-located specialty models; two primary care models with universal prescribing, in which all primary care providers were expected to treat OUD) were compared. Primary outcomes were person-years (PY) of medication treatment for OUD with buprenorphine or extended-release naltrexone during follow up (3/2018-2/2020) and changes from baseline (3/2016-2/2018).
Results: Baseline primary care samples included 109,196 patients in PROUD clinics and 101,631 patients in exemplar clinics. Baseline OUD treatment rates varied across exemplar clinics (range: 10.9 to 328.7 PY per 10,000 primary care patients) but were higher than in PROUD clinics at baseline (3.9 PY per 10,000), with exemplar clinics with primary care models (established 2005 and 2017) providing the highest treatment rates to their primary care patients. During follow-up, PROUD clinics nearly tripled treatment, to 14.4 PY per 10,000, whereas most exemplar clinics increased treatment by less than 10% but still had higher treatment rates (range: 12.0 to 359.4 PY per 10,000).
Conclusions: Primary care OUD treatment rates varied markedly. Exemplar clinics in which all primary care providers were expected to treat OUD had the highest treatment rates at baseline and follow-up, suggesting that universal prescribing is a promising approach to increasing OUD treatment in primary care.
{"title":"Variability in medication treatment of opioid use disorder in primary care: Comparison of PROUD trial intervention clinics and other exemplar clinics.","authors":"Ingrid A Binswanger, Onchee Yu, Paige D Wartko, Megan Addis, Jennifer F Bobb, Amy K Lee, Bobbi Jo Yarborough, Julia Arnsten, Joseph E Glass, Thomas F Northrup, Mark Murphy, Jordan M Braciszewski, Viviana E Horigian, Jo Ann Shoup, Annie Potter, Katharine A Bradley","doi":"10.1016/j.josat.2026.209896","DOIUrl":"10.1016/j.josat.2026.209896","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care patients with opioid use disorder (OUD) may receive treatment in primary care clinics or co-located specialty addiction treatment practices. To help guide operational leaders in organizing OUD care delivery systems, we described rates of OUD medication treatment among primary care patients in PRimary care Opioid Use Disorders treatment (PROUD) trial intervention clinics and four primary care clinics not in the trial because they already had OUD treatment programs in place (exemplar clinics).</p><p><strong>Methods: </strong>Primary care patients seen at six PROUD trial intervention clinics that implemented the Massachusetts model of office-based addiction treatment (PROUD clinics) and four exemplar clinics (two co-located specialty models; two primary care models with universal prescribing, in which all primary care providers were expected to treat OUD) were compared. Primary outcomes were person-years (PY) of medication treatment for OUD with buprenorphine or extended-release naltrexone during follow up (3/2018-2/2020) and changes from baseline (3/2016-2/2018).</p><p><strong>Results: </strong>Baseline primary care samples included 109,196 patients in PROUD clinics and 101,631 patients in exemplar clinics. Baseline OUD treatment rates varied across exemplar clinics (range: 10.9 to 328.7 PY per 10,000 primary care patients) but were higher than in PROUD clinics at baseline (3.9 PY per 10,000), with exemplar clinics with primary care models (established 2005 and 2017) providing the highest treatment rates to their primary care patients. During follow-up, PROUD clinics nearly tripled treatment, to 14.4 PY per 10,000, whereas most exemplar clinics increased treatment by less than 10% but still had higher treatment rates (range: 12.0 to 359.4 PY per 10,000).</p><p><strong>Conclusions: </strong>Primary care OUD treatment rates varied markedly. Exemplar clinics in which all primary care providers were expected to treat OUD had the highest treatment rates at baseline and follow-up, suggesting that universal prescribing is a promising approach to increasing OUD treatment in primary care.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209896"},"PeriodicalIF":1.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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