Peer Support for Polysubstance Abuse
(PRISM Trial)
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Maryland, College Park
Must be taking: Opioid use disorder medications
Disqualifiers: Unstable psychiatric symptoms, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The purpose of this study is to evaluate the feasibility and effectiveness of a peer-led, brief, behavioral intervention to improve adherence to medication for opioid use disorder (MOUD) and reduce polysubstance use among patients with OUD and polysubstance use in an underserved, rural area. The intervention is based on behavioral activation (BA) and is specifically designed to be implemented by a trained peer recovery specialist. In this hybrid, Type-1 effectiveness-implementation randomized controlled trial (RCT), the investigators will evaluate the effectiveness and implementation of Peer Activate vs. treatment as usual (TAU) over twelve months.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It focuses on improving adherence to medication for opioid use disorder and reducing polysubstance use.
What data supports the effectiveness of the treatment Peer-Delivered Behavioral Activation for polysubstance abuse?
Research suggests that peer recovery specialists, who have personal experience with substance use, can effectively deliver behavioral activation (a therapy that helps people engage in positive activities) to support individuals in methadone treatment and reduce problematic substance use. This approach has shown promise in improving treatment retention and is considered acceptable and appropriate in underserved communities.
12345Is peer-delivered behavioral activation safe for humans?
The studies suggest that peer-delivered behavioral activation is generally considered safe, as it involves trained peers supporting individuals with substance use issues. However, more research is needed to fully understand its safety and effectiveness.
12356How is Peer-Delivered Behavioral Activation different from other treatments for polysubstance abuse?
Peer-Delivered Behavioral Activation is unique because it involves trained peer recovery specialists, who have personal experience with substance use and recovery, delivering the treatment. This approach not only provides behavioral activation, which helps individuals engage in positive activities to improve their mood, but also leverages the shared experiences of peers to enhance support and retention in treatment.
12357Eligibility Criteria
This trial is for adults over 18 with opioid use disorder and polysubstance use in a rural area, who have struggled to stick to their medication plan or haven't refilled their pharmacy prescription recently. It's not for those with untreated severe mental health issues or pregnant individuals.Inclusion Criteria
I am getting treatment for opioid use disorder through a telemedicine program.
Exhibit polysubstance use within the past three months (i.e., use of one or more non-prescribed substances excluding opioids and/or tobacco by urine toxicology or self-report)
I am 18 years old or older.
Exclusion Criteria
Positive pregnancy status at enrollment
Inability to understand the study and provide informed consent in English
Demonstrating active, unstable or untreated psychiatric symptoms, including mania and/or psychosis that would interfere with study participation
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive a peer-delivered behavioral activation intervention to improve adherence to medication for opioid use disorder and reduce polysubstance use
12 months
Regular meetings with PRS and addiction medicine physician
Follow-up
Participants are monitored for safety and effectiveness after treatment
3 months
Participant Groups
The study tests 'Peer Activate,' a peer-led program aiming to improve adherence to opioid addiction medications and reduce the use of multiple substances. Participants will either receive this new intervention or the usual treatment, and they'll be followed for twelve months.
2Treatment groups
Experimental Treatment
Active Control
Group I: Peer-Delivered Behavioral Activation ("Peer Activate")Experimental Treatment1 Intervention
Participants in the Peer Activate intervention will receive a PRS-delivered behavioral activation intervention to address barriers to retention in methadone treatment and increase substance-free, positive reinforcement to support retention and reduce polysubstance use.
Group II: Treatment As UsualActive Control1 Intervention
Participants in the TAU group will receive enhanced treatment as usual, defined as MTU services as usual enhanced with additional community referrals and follow-ups on those referrals, in addition to regular meetings with an addiction medicine physician and PRS on the MTU. Standard PRS contact typically includes connection to local resources and general peer support as needed.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of Maryland Baltimore (UMD Drug Treatment Center)Baltimore, MD
University of Maryland, College ParkCollege Park, MD
Caroline County Behavioral HealthDenton, MD
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Who Is Running the Clinical Trial?
University of Maryland, College ParkLead Sponsor
University of Maryland, BaltimoreCollaborator
National Institute on Drug Abuse (NIDA)Collaborator
Weill Medical College of Cornell UniversityCollaborator
References
"You rise up and then you start pulling people up with you": Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment. [2023]Although medications for opioid use disorder (MOUD) are efficacious treatments for opioid use disorder, retention remains low. Peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, may be particularly well-suited to support patients receiving MOUD. While PRSs are rarely trained in evidence-based behavioral interventions other than motivational interviewing, preliminary evidence suggests that peers can deliver brief behavioral interventions, such as behavioral activation, with efficacy and fidelity. This qualitative study sought to explore patient perspectives on receiving an adapted PRS-delivered behavioral activation intervention (Peer Activate) to support patients receiving methadone treatment.
Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial. [2023]Despite the efficacy of methadone to treat opioid use disorder (OUD), retention is an urgent priority, particularly among low-income, minoritized populations. Peer recovery specialists are well-positioned to engage vulnerable patients, particularly when trained in an evidence-based intervention to promote retention. This hybrid effectiveness-implementation pilot trial aimed to demonstrate the proof of concept of a peer recovery specialist-delivered behavioral activation and problem solving-based approach (Peer Activate) to improve methadone retention.
Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City. [2023]Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.
Peer Support at the Intersection of Disability and Opioid (Mis)Use: Key Stakeholders Provide Essential Considerations. [2022]Individuals with disabilities may experience higher rates of opioid/substance use disorders (OUD/SUD) than other individuals and are likely vulnerable to unmet treatment needs. Peer support may be beneficial to these individuals, given the evidence of benefits in target populations with similar needs and the potential for overcoming barriers to treatment suggested in the available literature. The objective of this exploratory study was to specify essential considerations in adapting peer support for this population. Diverse key stakeholders (n = 16) were interviewed to explore the experiences, needs, and available supports for individuals with disabilities and OUD/SUD. A Peer Support Work Group including members with lived experience advised each component of the study. Semi-structured interview data were content analyzed and memos generated to summarize themes related to the research question. Participants reported extensive professional and personal experience in human services, disability, and recovery. Emergent themes included the importance of accessibility and model fit, the notion of "peerness" and peer match, and essential aspects of peer recruitment, training, and support. An accessible, acceptable, effective model of peer support requires particular attention to the needs of this diverse and varied population, and the contexts in which they are identified, referred, and engaged in services.
A Pilot Study of Training Peer Recovery Specialists in Behavioral Activation in the United States: Preliminary Outcomes and Predictors of Competence. [2023]The peer recovery specialist (PRS) workforce has rapidly expanded to increase access to substance-use disorder services for underserved communities. PRSs are not typically trained in evidence-based interventions (EBIs) outside of motivational interviewing, although evidence demonstrates the feasibility of PRS delivery of certain EBIs, such as a brief behavioral intervention, behavioral activation. However, characteristics that predict PRS competency in delivering EBIs such as behavioral activation remain unknown, and are critical for PRS selection, training, and supervision if the PRS role is expanded. This study aimed to explore the outcomes of a brief PRS training period in behavioral activation and identify predictors of competence.
Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. [2023]Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.
Peer recovery support for individuals with substance use disorders: assessing the evidence. [2015]In recent years, peer recovery support services have become an accepted part of the treatment of substance use disorders, providing a more extensive array of services than typically associated with mutual support groups. Peer providers may help consumers set recovery goals, develop a plan, and work toward and maintain recovery. In this literature review, the last in the Assessing the Evidence Base (AEB) Series, the authors review the evidence supporting peer recovery support services, noting that more research is needed to distinguish the effects of peer recovery support from other recovery support activities.