Pub Date : 2025-12-07DOI: 10.1016/j.josat.2025.209856
Michael Sobolev , Patrycja Sleboda , Beatriz Torre , Frederick Muench , Alexis Kuerbis
Introduction
There is a need for efficient and effective assessment, prevention, and intervention for alcohol use among older adults (ages ≥50) to reduce health risks and encourage healthy aging. However, most digital interventions for addiction are targeted to and evaluated among adults younger than 50. Given the growing digital literacy of older adults with mobile technologies, mobile messaging offers a promising, low-burden channel to deliver accessible behavioral interventions.
Methods
We designed a mobile text messaging program tailored to older adults that includes daily self-tracking and messages to encourage moderated drinking. We then conducted an exploratory, fully remote, single-blind randomized controlled study (NCT06126107) comparing three behaviorally designed messaging programs over a period of 8 weeks: gain-framed, loss-framed, and hybrid which alternated gain and loss messaging daily. Participants (N = 105, female = 44 %) were between the ages of 51 and 78 and were recruited through a variety of channels to capture a diverse sample of older adults. We evaluated the feasibility and preliminary effectiveness of these programs to optimize intervention design for future research trials and implementation in clinical practice.
Results
The mobile messaging programs were effective in reducing the number of heavy drinking days and in decreasing alcohol-related consequences and geriatric depression. Secondary measures, including intent-to-continue the program beyond the treatment period, favored the gain-frame program over the other two programs. Specifically, gain-framed messaging helped participants see both more benefits of drinking at safe levels and the consequences of excessive drinking more than the two other programs, even despite the focus of the loss-framed programs on consequences alone. Engagement with the program was high, with more than 70 % of daily self-tracking prompts completed during the 8 weeks intervention period.
Conclusion
The current trial shows promise for using mobile messaging to assist in moderating alcohol consumption in aging, with the gain-frame program as the most preferred by participants. Additional behavioral mechanisms should be optimized beyond the dimension of gain and loss framing to increase the effectiveness of mobile messaging and tailoring for older adults.
{"title":"Behavioral design for reducing alcohol consumption in aging: A mobile messaging randomized controlled trial","authors":"Michael Sobolev , Patrycja Sleboda , Beatriz Torre , Frederick Muench , Alexis Kuerbis","doi":"10.1016/j.josat.2025.209856","DOIUrl":"10.1016/j.josat.2025.209856","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a need for efficient and effective assessment, prevention, and intervention for alcohol use among older adults (ages ≥50) to reduce health risks and encourage healthy aging. However, most digital interventions for addiction are targeted to and evaluated among adults younger than 50. Given the growing digital literacy of older adults with mobile technologies, mobile messaging offers a promising, low-burden channel to deliver accessible behavioral interventions.</div></div><div><h3>Methods</h3><div>We designed a mobile text messaging program tailored to older adults that includes daily self-tracking and messages to encourage moderated drinking. We then conducted an exploratory, fully remote, single-blind randomized controlled study (<span><span>NCT06126107</span><svg><path></path></svg></span>) comparing three behaviorally designed messaging programs over a period of 8 weeks: gain-framed, loss-framed, and hybrid which alternated gain and loss messaging daily. Participants (N = 105, female = 44 %) were between the ages of 51 and 78 and were recruited through a variety of channels to capture a diverse sample of older adults. We evaluated the feasibility and preliminary effectiveness of these programs to optimize intervention design for future research trials and implementation in clinical practice.</div></div><div><h3>Results</h3><div>The mobile messaging programs were effective in reducing the number of heavy drinking days and in decreasing alcohol-related consequences and geriatric depression. Secondary measures, including intent-to-continue the program beyond the treatment period, favored the gain-frame program over the other two programs. Specifically, gain-framed messaging helped participants see both more benefits of drinking at safe levels and the consequences of excessive drinking more than the two other programs, even despite the focus of the loss-framed programs on consequences alone. Engagement with the program was high, with more than 70 % of daily self-tracking prompts completed during the 8 weeks intervention period.</div></div><div><h3>Conclusion</h3><div>The current trial shows promise for using mobile messaging to assist in moderating alcohol consumption in aging, with the gain-frame program as the most preferred by participants. Additional behavioral mechanisms should be optimized beyond the dimension of gain and loss framing to increase the effectiveness of mobile messaging and tailoring for older adults.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"182 ","pages":"Article 209856"},"PeriodicalIF":1.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717039","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 : 2025-12-06DOI: 10.1016/j.josat.2025.209853
Sabrina S. Rapisarda , Joseph Silcox , Katherine Nace , Shikhar Shrestha , Traci C. Green
Massachusetts law permits involuntary civil commitment (ICC) of people who use drugs (PWUD) into drug treatment. We sought to characterize experiences of PWUD with and without ICC histories by exploring the associations of one or more ICC experiences by sociodemographics, substance use, and subsequent health outcomes. We analyzed survey data of 714 PWUD, collected from multiple mixed-methods rapid assessments conducted between 2017 and 2022, with further examination of the 209 (29.3 %) participants who reported experiencing ICC and have since returned to use. We computed univariate and bivariate statistics by ICC experience—none versus at least one ICC experience and one versus multiple ICC experiences. Putative associations were also explored between recent ICC experience and subsequent overdose risk, response, and preventive behaviors. Among participants who reported ICC experience(s), most identified as men, White, housed, co-using opioids and stimulants, and having been civilly committed by a family member and most recently in 2015 or beyond. Overdose experiences, both personal (χ2 = 16.2, p < .001) and witnessed (χ2 = 6.7, p < .01), were more common among participants reporting one or more ICC experiences than those with no ICC. 35.1 % of participants with ICC experience(s) in the past year had subsequently experienced an overdose, while 20.3 % experienced incarceration following their ICC. Naloxone administration at last witnessed overdose was higher with versus without a history of ICC (χ2 = 6.45, p < .05). To mitigate future health and social harms among PWUD, the current study's findings underscore the need for consideration of the aforementioned risk factors when tailoring future ICC policy.
{"title":"Characteristics and experiences of people who use drugs with involuntary civil commitment (Section 35) histories in Massachusetts: 2017 to 2022","authors":"Sabrina S. Rapisarda , Joseph Silcox , Katherine Nace , Shikhar Shrestha , Traci C. Green","doi":"10.1016/j.josat.2025.209853","DOIUrl":"10.1016/j.josat.2025.209853","url":null,"abstract":"<div><div>Massachusetts law permits involuntary civil commitment (ICC) of people who use drugs (PWUD) into drug treatment. We sought to characterize experiences of PWUD with and without ICC histories by exploring the associations of one or more ICC experiences by sociodemographics, substance use, and subsequent health outcomes. We analyzed survey data of 714 PWUD, collected from multiple mixed-methods rapid assessments conducted between 2017 and 2022, with further examination of the 209 (29.3 %) participants who reported experiencing ICC and have since returned to use. We computed univariate and bivariate statistics by ICC experience—none versus at least one ICC experience and one versus multiple ICC experiences. Putative associations were also explored between recent ICC experience and subsequent overdose risk, response, and preventive behaviors. Among participants who reported ICC experience(s), most identified as men, White, housed, co-using opioids and stimulants, and having been civilly committed by a family member and most recently in 2015 or beyond. Overdose experiences, both personal (<em>χ</em><sup>2</sup> = 16.2, <em>p</em> < .001) and witnessed (<em>χ</em><sup>2</sup> = 6.7, <em>p</em> < .01), were more common among participants reporting one or more ICC experiences than those with no ICC. 35.1 % of participants with ICC experience(s) in the past year had subsequently experienced an overdose, while 20.3 % experienced incarceration following their ICC. Naloxone administration at last witnessed overdose was higher with versus without a history of ICC (<em>χ</em><sup>2</sup> = 6.45, <em>p</em> < .05). To mitigate future health and social harms among PWUD, the current study's findings underscore the need for consideration of the aforementioned risk factors when tailoring future ICC policy.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"182 ","pages":"Article 209853"},"PeriodicalIF":1.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710370","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 : 2025-12-05DOI: 10.1016/j.josat.2025.209847
Raymond R. Balise , Kyle Grealis , Laura Brandt , Sean X. Luo , Gabriel Odom , Guertson Jean-Baptiste , Daniel J. Feaster
Background
While medication for opioid use disorder (MOUD) is effective for a significant proportion of patients, many return to using opioids during treatment. Understanding which factors lead to successful treatment informs the development of implementation approaches that can improve outcomes. This manuscript and its accompanying website provide an applied introduction to interpretable machine learning for clinical investigators interested in predicting treatment response for people using MOUD.
Methods
This study applied machine learning (ML) algorithms (K-Nearest Neighbors (KNN), logistic regression with and without regularization, Multivariate Additive Regression Splines (MARS), Support Vector Machines, Classification and Regression Trees (CART), Random Forest, Bayesian Additive Regression Trees (BART), Boosted Trees, Neural Networks) to predict failure of treatment in a collection of 2478 individuals who had participated in the three largest pragmatic, clinical trials of MOUD.
Results
All models produced Receiver Operating Characteristic Area Under the Curve (ROC AUC) estimates in the range of 0.62 to 0.67 using cross-validation data and the optimal model, random forest, achieved 0.65 using testing data. The algorithms nearly universally identified predictive features such as age, intravenous drug use days, study medication, and study site. Most algorithms also identified various aspects of smoking. Only the algorithms that detect complex non-linear trends identified details from timeline follow-back. One algorithm, BART, performed well while devaluing all treatment-specific details.
Conclusion
After explaining how to apply, compare, and contrast various ML workflows, the results show that while overall modeling performance is similar across the models developed, the use of different algorithms identifies different sets of predictive features. Previous research has not recognized some features as important for predicting treatment outcomes. A companion website introduces clinical investigators to the concepts and implementations this study presents. That site also provides a detailed annotated blueprint to fully replicate, or even expand, this work.
{"title":"Applying machine learning in predicting medication treatment outcomes for opioid use disorder","authors":"Raymond R. Balise , Kyle Grealis , Laura Brandt , Sean X. Luo , Gabriel Odom , Guertson Jean-Baptiste , Daniel J. Feaster","doi":"10.1016/j.josat.2025.209847","DOIUrl":"10.1016/j.josat.2025.209847","url":null,"abstract":"<div><h3>Background</h3><div>While medication for opioid use disorder (MOUD) is effective for a significant proportion of patients, many return to using opioids during treatment. Understanding which factors lead to successful treatment informs the development of implementation approaches that can improve outcomes. This manuscript and its accompanying website provide an applied introduction to interpretable machine learning for clinical investigators interested in predicting treatment response for people using MOUD.</div></div><div><h3>Methods</h3><div>This study applied machine learning (ML) algorithms (K-Nearest Neighbors (KNN), logistic regression with and without regularization, Multivariate Additive Regression Splines (MARS), Support Vector Machines, Classification and Regression Trees (CART), Random Forest, Bayesian Additive Regression Trees (BART), Boosted Trees, Neural Networks) to predict failure of treatment in a collection of 2478 individuals who had participated in the three largest pragmatic, clinical trials of MOUD.</div></div><div><h3>Results</h3><div>All models produced Receiver Operating Characteristic Area Under the Curve (ROC AUC) estimates in the range of 0.62 to 0.67 using cross-validation data and the optimal model, random forest, achieved 0.65 using testing data. The algorithms nearly universally identified predictive features such as age, intravenous drug use days, study medication, and study site. Most algorithms also identified various aspects of smoking. Only the algorithms that detect complex non-linear trends identified details from timeline follow-back. One algorithm, BART, performed well while devaluing all treatment-specific details.</div></div><div><h3>Conclusion</h3><div>After explaining how to apply, compare, and contrast various ML workflows, the results show that while overall modeling performance is similar across the models developed, the use of different algorithms identifies different sets of predictive features. Previous research has not recognized some features as important for predicting treatment outcomes. A companion website introduces clinical investigators to the concepts and implementations this study presents. That site also provides a detailed annotated blueprint to fully replicate, or even expand, this work.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"182 ","pages":"Article 209847"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703401","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 : 2025-12-05DOI: 10.1016/j.josat.2025.209845
Tania Strout, James Dziura, Tyler W Barrett, Ethan Cowan, Kathryn F Hawk, Andrew A Herring, Jacob Manteuffel, Shara Martel, Patricia H Owens, Ryan P McCormack, Jeanmarie Perrone, David A Fiellin, Gail D'Onofrio, E Jennifer Edelman
Introduction: Treatment of opioid use disorder (OUD) with buprenorphine is safe and effective, but Emergency Department-initiated buprenorphine (ED BUP) uptake is suboptimal. As part of a randomized clinical trial (RCT), we evaluated Implementation Facilitation (IF)'s impact on EDs' readiness to provide ED BUP.
Methods: From February 2020 to May 2024, we surveyed 31 ED Medical Directors (MDs) and site-Principal Investigators (PIs) across 33 Emergency Department-INitiated bupreNOrphine VAlidaTION (ED-INNOVATION) sites (29 of which proceeded to RCT enrollment) at three time points: pre-IF (baseline), early-IF (pre-enrollment), and late-IF (post-enrollment). We collected 10-point Likert scale ratings and performed linear regression modeling and correlation analysis to evaluate relationships between readiness, barriers, facilitators, and readiness changes over time.
Results: Across 31 responses for the three time points, mean readiness increased pre-IF to early-IF (6.29 vs. 8.23, p < 0.0001) and pre-IF to late-IF (6.29 vs. 8.39, p < 0.0001). We observed decreases in 13/15 barriers and increases in 13/19 facilitators. When examining relationships between changes in readiness, barriers, and facilitators, the strongest relationships were follow-up treatment availability (r = 0.64, p = 0.0001), prescribing practices knowledge (r = -0.64, p = 0.001); insurance coverage (r = -0.52, p = 0.002); nursing support (r = -0.48, p = 0.01); and knowledge about addiction and its treatment (r = 0.47, p = 0.007); weak relationships were length of stay impact (r = 0.02, p = 0.92), trained clinicians (r = 0.02, p = 0.91), and social complexity (r = -0.10, p = 0.60).
Conclusions: IF was associated with improved readiness, decreases in barriers and an increase in facilitators of ED BUP. When faced with limited resources, these findings can help inform prioritization of addressable barriers and facilitators to improve readiness for ED BUP.
简介：丁丙诺啡治疗阿片类药物使用障碍（OUD）是安全有效的，但急诊科启动丁丙诺啡（ED BUP）摄取是次优的。作为随机临床试验（RCT）的一部分，我们评估了实施促进（IF）对ED提供ED BUP的准备程度的影响。方法：从2020年2月到2024年5月，我们在三个时间点调查了33个急诊科发起的丁丙诺啡验证（ED- innovation）站点（其中29个进行了随机对照试验入组）的31名ED医学主任（md）和站点首席研究员（pi）： if前（基线）、if早期（入组前）和if晚期（入组后）。我们收集了10分李克特量表评分，并进行了线性回归建模和相关分析，以评估准备、障碍、促进因素和准备变化之间的关系。结果：在三个时间点的31个应答中，平均准备度在IF前增加到IF早期（6.29 vs. 8.23, p ）。结论：IF与ED BUP的准备度提高、障碍减少和促进因素增加有关。在资源有限的情况下，这些发现有助于确定可解决的障碍和促进因素的优先次序，以提高对ED BUP的准备程度。
{"title":"Implementation facilitation improves readiness for emergency department-initiated buprenorphine to treat opioid use disorder.","authors":"Tania Strout, James Dziura, Tyler W Barrett, Ethan Cowan, Kathryn F Hawk, Andrew A Herring, Jacob Manteuffel, Shara Martel, Patricia H Owens, Ryan P McCormack, Jeanmarie Perrone, David A Fiellin, Gail D'Onofrio, E Jennifer Edelman","doi":"10.1016/j.josat.2025.209845","DOIUrl":"10.1016/j.josat.2025.209845","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of opioid use disorder (OUD) with buprenorphine is safe and effective, but Emergency Department-initiated buprenorphine (ED BUP) uptake is suboptimal. As part of a randomized clinical trial (RCT), we evaluated Implementation Facilitation (IF)'s impact on EDs' readiness to provide ED BUP.</p><p><strong>Methods: </strong>From February 2020 to May 2024, we surveyed 31 ED Medical Directors (MDs) and site-Principal Investigators (PIs) across 33 Emergency Department-INitiated bupreNOrphine VAlidaTION (ED-INNOVATION) sites (29 of which proceeded to RCT enrollment) at three time points: pre-IF (baseline), early-IF (pre-enrollment), and late-IF (post-enrollment). We collected 10-point Likert scale ratings and performed linear regression modeling and correlation analysis to evaluate relationships between readiness, barriers, facilitators, and readiness changes over time.</p><p><strong>Results: </strong>Across 31 responses for the three time points, mean readiness increased pre-IF to early-IF (6.29 vs. 8.23, p < 0.0001) and pre-IF to late-IF (6.29 vs. 8.39, p < 0.0001). We observed decreases in 13/15 barriers and increases in 13/19 facilitators. When examining relationships between changes in readiness, barriers, and facilitators, the strongest relationships were follow-up treatment availability (r = 0.64, p = 0.0001), prescribing practices knowledge (r = -0.64, p = 0.001); insurance coverage (r = -0.52, p = 0.002); nursing support (r = -0.48, p = 0.01); and knowledge about addiction and its treatment (r = 0.47, p = 0.007); weak relationships were length of stay impact (r = 0.02, p = 0.92), trained clinicians (r = 0.02, p = 0.91), and social complexity (r = -0.10, p = 0.60).</p><p><strong>Conclusions: </strong>IF was associated with improved readiness, decreases in barriers and an increase in facilitators of ED BUP. When faced with limited resources, these findings can help inform prioritization of addressable barriers and facilitators to improve readiness for ED BUP.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209845"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12826104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/S2949-8759(25)00218-8
{"title":"C2: editorial board","authors":"","doi":"10.1016/S2949-8759(25)00218-8","DOIUrl":"10.1016/S2949-8759(25)00218-8","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209839"},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681458","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 : 2025-12-02DOI: 10.1016/S2949-8759(25)00219-X
{"title":"TOC (update)","authors":"","doi":"10.1016/S2949-8759(25)00219-X","DOIUrl":"10.1016/S2949-8759(25)00219-X","url":null,"abstract":"","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"180 ","pages":"Article 209840"},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681459","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 : 2025-11-27DOI: 10.1016/j.josat.2025.209846
Devin E. Banks , Kaytryn D. Campbell , Maria E. Paschke , Rashmi Ghonasgi , Bridget Coffey , Jameala Jones , Brittany Blanchard , Ryan W. Carpenter , Daje Bradshaw , Rachel P. Winograd
Introduction
Black men in the United States have been disproportionately impacted by fatal drug overdose since the proliferation of synthetic opioids like fentanyl. This community based participatory research study examined determinants of overdose risk and substance use treatment disparities among Black men based on their lived experience.
Methods
Between February and December 2023, we enrolled 35 Black men reporting past-30-day opioid use to complete semi-structured qualitative interviews. Interviews were analyzed by a team of academic and community-based coders with lived experience using an inductive—deductive approach to thematic analysis.
Results
Six key themes were identified. Four themes described racism-related inequities posing overdose and comorbid risks to health and social wellness: (1) social stigma and isolation, (2) pervasive exposure to deadly drugs and overdose, (3) disproportionate exposure to trauma and societal consequences, and (4) gaps in health-related services and resources. Two themes addressed grassroots strategies Black men who use drugs employ to reduce harm and maintain wellness: (5) safe practices in drug purchasing, drug use, and overdose response, and (6) positive community and social supports.
Conclusions
Findings demonstrate how structural inequities like neighborhood segregation and economic deprivation interact with racial and substance use stigma, leading to daily experiences of social isolation, trauma, and fentanyl exposure for Black men. Findings extend previous research by illustrating how Black men work in and outside of systems to maintain wellness despite these vulnerabilities. Reducing the burden of overdose among Black men requires policy efforts that redress resource deprivation in Black neighborhoods and builds upon existing grassroots efforts and lived experience.
{"title":"“Another one bite the dust—It happens so much in Black neighborhoods”: Structural barriers and grassroots resources among Black men who use drugs facing fentanyl-era overdose and treatment disparities","authors":"Devin E. Banks , Kaytryn D. Campbell , Maria E. Paschke , Rashmi Ghonasgi , Bridget Coffey , Jameala Jones , Brittany Blanchard , Ryan W. Carpenter , Daje Bradshaw , Rachel P. Winograd","doi":"10.1016/j.josat.2025.209846","DOIUrl":"10.1016/j.josat.2025.209846","url":null,"abstract":"<div><h3>Introduction</h3><div>Black men in the United States have been disproportionately impacted by fatal drug overdose since the proliferation of synthetic opioids like fentanyl. This community based participatory research study examined determinants of overdose risk and substance use treatment disparities among Black men based on their lived experience.</div></div><div><h3>Methods</h3><div>Between February and December 2023, we enrolled 35 Black men reporting past-30-day opioid use to complete semi-structured qualitative interviews. Interviews were analyzed by a team of academic and community-based coders with lived experience using an inductive—deductive approach to thematic analysis.</div></div><div><h3>Results</h3><div>Six key themes were identified. Four themes described racism-related inequities posing overdose and comorbid risks to health and social wellness: (1) social stigma and isolation, (2) pervasive exposure to deadly drugs and overdose, (3) disproportionate exposure to trauma and societal consequences, and (4) gaps in health-related services and resources. Two themes addressed grassroots strategies Black men who use drugs employ to reduce harm and maintain wellness: (5) safe practices in drug purchasing, drug use, and overdose response, and (6) positive community and social supports.</div></div><div><h3>Conclusions</h3><div>Findings demonstrate how structural inequities like neighborhood segregation and economic deprivation interact with racial and substance use stigma, leading to daily experiences of social isolation, trauma, and fentanyl exposure for Black men. Findings extend previous research by illustrating how Black men work in and outside of systems to maintain wellness despite these vulnerabilities. Reducing the burden of overdose among Black men requires policy efforts that redress resource deprivation in Black neighborhoods and builds upon existing grassroots efforts and lived experience.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209846"},"PeriodicalIF":1.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624337","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 : 2025-11-27DOI: 10.1016/j.josat.2025.209849
Aimee N C Campbell, A Kathleen Burlew, Constance Guille, Mia A Haidamus, Denise A Hien, Therese Killeen, Michelle R Lofwall, Margaret M Paschen-Wolff, Christi A Patten, Dawn E Sugarman, T John Winhusen, Ludmila N Bakhireva, Amy M Loree, Shayna Mazel, Shelly F Greenfield
Despite rising rates of substance use disorders (SUD) in women and the narrowing of the SUD gender prevalence ratio in the U.S., large knowledge gaps in gender-specific treatment remain. The NIDA Clinical Trials Network (CTN) Gender Special Interest Group (GSIG) has provided opportunities to bring the gender lens to national multi-site clinical trials, ancillary studies, secondary data analyses, recommendations for data collection and demographic data, among other contributions to CTN and the SUD treatment field. This commentary provides background on gender differences and the knowledge gap, a history of the CTN GSIG, and its accomplishments via gender specific trials and key secondary analyses. The commentary will close with future directions and recommendations for research including improving the inclusion of intersectional identities in recruitment reach and analyses, reproductive health, pregnant and parenting people, and methodological considerations for clinical trials to enhance capacity to collect and understand data related to gender.
{"title":"Gender-specific addiction research needed now more than ever: Reflections from 25 years of the NIDA Clinical Trials Network Gender Special Interest Group.","authors":"Aimee N C Campbell, A Kathleen Burlew, Constance Guille, Mia A Haidamus, Denise A Hien, Therese Killeen, Michelle R Lofwall, Margaret M Paschen-Wolff, Christi A Patten, Dawn E Sugarman, T John Winhusen, Ludmila N Bakhireva, Amy M Loree, Shayna Mazel, Shelly F Greenfield","doi":"10.1016/j.josat.2025.209849","DOIUrl":"10.1016/j.josat.2025.209849","url":null,"abstract":"<p><p>Despite rising rates of substance use disorders (SUD) in women and the narrowing of the SUD gender prevalence ratio in the U.S., large knowledge gaps in gender-specific treatment remain. The NIDA Clinical Trials Network (CTN) Gender Special Interest Group (GSIG) has provided opportunities to bring the gender lens to national multi-site clinical trials, ancillary studies, secondary data analyses, recommendations for data collection and demographic data, among other contributions to CTN and the SUD treatment field. This commentary provides background on gender differences and the knowledge gap, a history of the CTN GSIG, and its accomplishments via gender specific trials and key secondary analyses. The commentary will close with future directions and recommendations for research including improving the inclusion of intersectional identities in recruitment reach and analyses, reproductive health, pregnant and parenting people, and methodological considerations for clinical trials to enhance capacity to collect and understand data related to gender.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209849"},"PeriodicalIF":1.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.josat.2025.209848
Olivia Lewis , Sumeeta Srinivasan , Ric Bayly , Jack Cordes , Shikhar Shrestha , Max R. O'Reilly , Simeon D. Kimmel , Alexander Y. Walley , Hermik Babakhanlou-Chase , Thomas J. Stopka
Introduction
Methadone treatment dispensed at opioid treatment programs (OTPs) reduces the risk of fatal opioid-related overdose. Access to OTPs is limited in many regions. We utilized location-allocation models to identify gaps in OTP services across Massachusetts and generated descriptive statistics to further prioritize areas for expansion of services for socially vulnerable communities.
Methods
We used a geographic information system to generate eight location-allocation models, tools to target the placement of new sites based on the distribution of existing sites and demand for services, with a goal of identifying gaps in geographic access to OTPs. We identified potential new OTP locations using 15- and 30-minute walk- and drive-times, considering the location of existing OTPs. We used opioid-related incident (ORI) locations and overdose decedent residences to measure methadone demand. We ranked suggested OTPs for each model by how many ORIs or decedent residences they could serve as the nearest OTP. We calculated mean Social Vulnerability Index scores, population density, fatal opioid-related overdose rates, and ORI rates for census tracts within a 30-minute walk of each suggested site. We also ran supplementary location-allocation analyses that ignored the locations of existing OTPs.
Results
Our models consistently recommended new OTP service locations to address unmet needs in the Roxbury and Dorchester neighborhoods of Boston, Lowell, Pittsfield, New Bedford, Gardner, Quincy, Malden, Peabody, Falmouth, Nantucket, and Martha's Vineyard, Massachusetts. Of all suggested new treatment centers, those in Boston, Gardner, Peabody, and Lowell could serve as the closest OTP for the most ORIs or decedent residences. Suggested new OTPs in Boston, Gardner, Springfield, Quincy, New Bedford, and Lowell were in areas with high social vulnerability. Our walk-time models suggested sites in areas with higher community-level social vulnerability than our drive-time models. Areas with existing OTPs had higher average social vulnerabilities than suggested new OTP locations. Location-allocation models that ignored existing OTPs still suggested OTP locations close to current methadone clinics.
Conclusions
Through our location-allocation models and vulnerability assessments, we recommended potential locations for new OTPs to provide increased methadone access within areas of high fatal overdose and ORI burden. Results can inform data-to-action expansion of OTP access.
{"title":"Filling in the gaps: A geospatial approach to optimizing placement of methadone clinics in Massachusetts","authors":"Olivia Lewis , Sumeeta Srinivasan , Ric Bayly , Jack Cordes , Shikhar Shrestha , Max R. O'Reilly , Simeon D. Kimmel , Alexander Y. Walley , Hermik Babakhanlou-Chase , Thomas J. Stopka","doi":"10.1016/j.josat.2025.209848","DOIUrl":"10.1016/j.josat.2025.209848","url":null,"abstract":"<div><h3>Introduction</h3><div>Methadone treatment dispensed at opioid treatment programs (OTPs) reduces the risk of fatal opioid-related overdose. Access to OTPs is limited in many regions. We utilized location-allocation models to identify gaps in OTP services across Massachusetts and generated descriptive statistics to further prioritize areas for expansion of services for socially vulnerable communities.</div></div><div><h3>Methods</h3><div>We used a geographic information system to generate eight location-allocation models, tools to target the placement of new sites based on the distribution of existing sites and demand for services, with a goal of identifying gaps in geographic access to OTPs. We identified potential new OTP locations using 15- and 30-minute walk- and drive-times, considering the location of existing OTPs. We used opioid-related incident (ORI) locations and overdose decedent residences to measure methadone demand. We ranked suggested OTPs for each model by how many ORIs or decedent residences they could serve as the nearest OTP. We calculated mean Social Vulnerability Index scores, population density, fatal opioid-related overdose rates, and ORI rates for census tracts within a 30-minute walk of each suggested site. We also ran supplementary location-allocation analyses that ignored the locations of existing OTPs.</div></div><div><h3>Results</h3><div>Our models consistently recommended new OTP service locations to address unmet needs in the Roxbury and Dorchester neighborhoods of Boston, Lowell, Pittsfield, New Bedford, Gardner, Quincy, Malden, Peabody, Falmouth, Nantucket, and Martha's Vineyard, Massachusetts. Of all suggested new treatment centers, those in Boston, Gardner, Peabody, and Lowell could serve as the closest OTP for the most ORIs or decedent residences. Suggested new OTPs in Boston, Gardner, Springfield, Quincy, New Bedford, and Lowell were in areas with high social vulnerability. Our walk-time models suggested sites in areas with higher community-level social vulnerability than our drive-time models. Areas with existing OTPs had higher average social vulnerabilities than suggested new OTP locations. Location-allocation models that ignored existing OTPs still suggested OTP locations close to current methadone clinics.</div></div><div><h3>Conclusions</h3><div>Through our location-allocation models and vulnerability assessments, we recommended potential locations for new OTPs to provide increased methadone access within areas of high fatal overdose and ORI burden. Results can inform data-to-action expansion of OTP access.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209848"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642900","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 : 2025-11-25DOI: 10.1016/j.josat.2025.209835
Carrie B. Oser , Joel G. Sprunger , Tim Hunt , JaNae Holloway , Redonna K. Chandler , Bridget Freisthler , Peter Balvanz , Brandy F. Henry , LaShawn Glasgow , Daniel R. Harris , Sharon L. Walsh , Arnie P. Aldridge , Kat Asman , Derek Blevins , Marisa D. Booty , Aaron D. Fox , Sandra A. Springer , Elizabeth N. Kinnard , Charles Knott , Patricia A. LeBaron , Peter D. Friedmann
Introduction
This article examines whether the Communities That HEAL (CTH) intervention implemented by the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS) expanded Medication for Opioid Use Disorder (MOUD) in jails and linkage to MOUD upon release.
Methods
Communities were randomized to the CTH intervention group (N = 34) to implement an integrated set of community coalition-selected evidence-based practices or to the wait-list control group (N = 33). A three-wave survey of jail administrators assessed changes in jails' provision of OUD-related services. Community-level generalized estimating equation (GEE)-based Poisson models regressed the effect of the CTH intervention on whether a community's jail (1) inducts clients onto MOUD and (2) links to MOUD on release.
Results
At baseline, more wait-list control communities' jails, compared to intervention communities' jails, inducted people on MOUD (75.9 % vs 63.3 %) and linked to MOUD upon release (79.3 % vs 66.7 %). During the evaluation period (July 2021 to June 2022), 71.0 % of CTH jails inducted people on MOUD (compared to 63.3 % at baseline), and 90.3 % of CTH jails linked persons to MOUD on release (compared to 66.7 % at baseline). Adjusted analyses detected no significant effect of the CTH intervention on MOUD induction or linkage.
Conclusions
Most CTH communities implemented linkage programs in jails. Compared to wait-list control communities, intervention communities' jails showed no difference in providing MOUD. Community coalitions can play an important role in facilitating MOUD linkage during reentry.
{"title":"The impact of the communities that HEAL intervention on the provision of jail-based medication for opioid use disorder & linkage programs at release: Results from a randomized, wait-list controlled trial","authors":"Carrie B. Oser , Joel G. Sprunger , Tim Hunt , JaNae Holloway , Redonna K. Chandler , Bridget Freisthler , Peter Balvanz , Brandy F. Henry , LaShawn Glasgow , Daniel R. Harris , Sharon L. Walsh , Arnie P. Aldridge , Kat Asman , Derek Blevins , Marisa D. Booty , Aaron D. Fox , Sandra A. Springer , Elizabeth N. Kinnard , Charles Knott , Patricia A. LeBaron , Peter D. Friedmann","doi":"10.1016/j.josat.2025.209835","DOIUrl":"10.1016/j.josat.2025.209835","url":null,"abstract":"<div><h3>Introduction</h3><div>This article examines whether the Communities That HEAL (CTH) intervention implemented by the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS) expanded Medication for Opioid Use Disorder (MOUD) in jails and linkage to MOUD upon release.</div></div><div><h3>Methods</h3><div>Communities were randomized to the CTH intervention group (N = 34) to implement an integrated set of community coalition-selected evidence-based practices or to the wait-list control group (N = 33). A three-wave survey of jail administrators assessed changes in jails' provision of OUD-related services. Community-level generalized estimating equation (GEE)-based Poisson models regressed the effect of the CTH intervention on whether a community's jail (1) inducts clients onto MOUD and (2) links to MOUD on release.</div></div><div><h3>Results</h3><div>At baseline, more wait-list control communities' jails, compared to intervention communities' jails, inducted people on MOUD (75.9 % vs 63.3 %) and linked to MOUD upon release (79.3 % vs 66.7 %). During the evaluation period (July 2021 to June 2022), 71.0 % of CTH jails inducted people on MOUD (compared to 63.3 % at baseline), and 90.3 % of CTH jails linked persons to MOUD on release (compared to 66.7 % at baseline). Adjusted analyses detected no significant effect of the CTH intervention on MOUD induction or linkage.</div></div><div><h3>Conclusions</h3><div>Most CTH communities implemented linkage programs in jails. Compared to wait-list control communities, intervention communities' jails showed no difference in providing MOUD. Community coalitions can play an important role in facilitating MOUD linkage during reentry.</div></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":"181 ","pages":"Article 209835"},"PeriodicalIF":1.9,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643051","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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