Partnerships to improve translation between clinical practice and community-engaged research for substance use disorder treatment

Abstract: The number of those afflicted by substance use disorders continues to rise. Rhode Island is disproportionately affected by substance use disorder, and death rates in the state are consistently higher than those in the rest of the country. Despite an increase in prevalence, treatment for persons diagnosed with substance use disorder remains static. This suggests a need for greater treatment access and modifications to current treatment practices. Partnerships between clinical practice and community-engaged research are necessary for finding best treatment outcomes and improving the continuum of care. Our project aims to improve this translation through a partnership between research staff, faculty, and students at the Center for Alcohol and Addiction Studies at Brown University and health care professionals at Ocean State Recovery Center. This project will utilize patient electronic medical records of various survey responses and longitudinal data to understand patterns and predictors of treatment response for substance use disorders. We will use mixed-effects modeling and generalized estimating equations, along with methods to account for non-response and missing data, such as inverse probability weighting and multiple imputation to examine how duration of treatment impacts recovery. The long-term goals of this project are to: 1) Provide patients and providers with information that can improve clinical decision-making and patient outcomes and 2) Inform best data collection and analysis practices for future studies investigating substance use treatment. Through this research, we aim to mend the gap and create an effective partnership that benefits all stakeholders at the university, clinical, and patient level.

Narrative: Corresponding Authors: Zoe’ Brown, Alexis Friedman, Brian Gully, Hannah Ziobrowski, Maryna Rasputna, Christopher Dorval, and Carolina Haass-Koffler

Statement/ goals of the project: This project will establish partnerships between academic researchers at Brown University and a substance use treatment center in the local community. The long-term goals of this project are to: 1) Provide patients and providers with information that can improve clinical decision-making and patient outcomes and 2) Inform best data collection and analysis practices for future studies investigating real-world substance use treatment.

Brief Summary: More than 46 million people in the United States are estimated to have a substance use disorder (SUD) (SAMHSA, 2022). SUDs are associated with myriad adverse physical and mental health consequences, and they negatively impact individuals’ ability to function in social, academic, and professional settings (McLellan, 2017). In addition, studies have found that the presence of substance use disorder doubles the odds of subsequent chronic disorders including heart disease, stroke, diabetes, and hypertension (Scott et al., 2016). Despite the increase in those afflicted by substance use disorders, the number of those receiving treatment has been relatively static, suggesting that there is an unmet need for treatment (Bouchery, 2021). In the year 2021, there were 106,699 drug-involved overdose deaths reported in the U.S., with synthetic opioids (predominately fentanyl) as the primary driver for these outcomes (NIDA, 2023). Roughly 140,000 individuals died in the United States per year due to excessive alcohol consumption during 2015-2019, or more than 380 deaths per day (CDC, 2023). Rhode Island is disproportionately affected by substance use. The age adjusted death rate due to opioid overdose increased from 13.3 per 100,000 people in 2011 to 35.9 per 100,000 people in the state of Rhode Island in 2021 compared to an increase from 7.3 to 24.7 per 100,000 people in the US (KFF, 2023). Providing effective treatment for SUDs in Rhode Island is thus critically important to lowering prevalence and mortality rates.

In this project, researchers at the Brown University School of Public Health will collaborate with a local SUD treatment center, the Ocean State Recovery Center, to examine treatment effectiveness. The Ocean State Recovery Center provides medication-assisted treatment, group therapy, clinician support, counseling, and peer-based recovery methods to adults diagnosed with substance use disorders including alcohol use disorder, cocaine use disorder, marijuana use disorder, and opioid use disorder. They provide partial, full, and outpatient programs for individuals in recovery. The faculty involved in this project will include those affiliated with the Center for Alcohol and Addiction Studies, who have clinical research expertise, and the Department of Epidemiology, who have expertise in analyzing real-world observational data. Community-engaged research can help to draw public attention to emergent trends, enhance dissemination of scientific findings, and increase participation in clinical research (McLellan, 2017). The National Institutes of Health (NIH) has made community-engaged research a priority by expanding grant funding to promote collaboration between local organizations and academic institutions (Eder et al., 2018). However, there are some potential difficulties that can arise when community organizations partner with academic research (Vaughn et al., 2018). For instance, academic institutions may have different underlying goals than the community’s needs. Moreover, power dynamics can complicate the quality and applicability of the research being conducted, which can impact the benefit received by the community (Andress et al., 2020). Therefore, when conducting community-engaged research, it is extremely important to engender research hypotheses and proposed outcomes based directly upon the community’s needs and perspectives. In addition, open communication and frequent check-ins should occur as the project progresses.

The proposed project presents a unique opportunity for faculty, staff, and students across disciplines at the Brown University School of Public Health to partner with a local substance use treatment center. This partnership will not only be beneficial for the treatment center and patients, but it will also be an excellent learning and research opportunity for students.

Description of the research design and methods: Brown University School of Public Health faculty, staff, and Master of Public Health (MPH) students recently partnered with Ocean State Recovery Center to analyze real-world patient electronic medical record (EMR) data. Throughout their treatment, patients completed several self-report surveys including the Brief Addiction Monitor Scale (BAM), Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Patient Health Questionnaire 9-item (PHQ-9). Data from these surveys, along with information on socio-demographics, medications, and treatment characteristics will be abstracted from EMRs, which the research team will use to understand patterns and predictors of treatment response. The research team has met with the director of Ocean State Recovery Center to determine outcomes of interest that are of high priority so that efforts could be directed towards the needs of the treatment center. The first project will examine how the duration of treatment impacts recovery. We will use longitudinal data analysis methods, such as mixed-effects modeling and generalized estimating equations, along with methods to account for non-response and missing data, such as inverse probability weighting and multiple imputation.

The project findings: The project is currently underway, and the team is working to compile a comprehensive dataset of the EMR data for data analysis.

Theoretical and or practical significance or implications of the research: The proposed research would provide much needed information for the recovery center on treatment outcomes that can ultimately help providers tailor treatments for future patients. Eligible and interested patients at OSRC will also be provided an opportunity to participate in the currently ongoing research studies investigating potential treatments for substance use disorders at Brown University. Students at the Brown University School of Public Health will have the opportunity to analyze real-world data and publish their findings. Long-term plans include expanding collaborative partnerships between research faculty/staff at Brown and local treatment centers/patients in the Providence, RI area.

3-4 keywords: substance use disorders, substance use treatment, community partnerships, community-engaged research