An Innovative, Trauma-informed Approach for Reducing Overdose Risk Among Women Re-entering the Community From Prison

Substance use, including the misuse of opioids, continues to ravage US communities with overdose deaths at an all-time high. Women are disproportionately affected by the misuse of opioids and other substances; for example, overdose deaths among women rose 492% between 1999 - 2017, a 404% higher rate than men (VanHouten et al., 2019). Current overdose prevention interventions targeting the unique risks for women involved in the criminal legal system who have experienced trauma and have a history of experiencing violence are limited; there is a need to adapt innovative and targeted intervention strategies, particularly those that address violent victimization and associated trauma, and that aim to reduce overdose risks during community re-entry from prison. This application is submitted in response to RFA-DA-053 with the overall aim of accelerating the translation of research to practice addressing overdose risk for justice-involved women during community re-entry through the adaptation and testing of an innovative, trauma-informed, relational intervention approach, which closely aligns with NOT-DA-23-007 to improve substance use outcomes for individuals with a history of violence. The following specific aims will guide this phased project: R61 – Adaptation and Feasibility Testing (Years 01 - 02): Guided by the ADAPT-ITT framework, the R61 phase will build upon current and prior TBRI research and use a structured approach for intervention adaptation. Aim 1) Adapt TBRI for justice-involved women through engagement of relevant practitioners and stakeholders in focus groups to ensure the adapted intervention is feasible and addresses their unique treatment needs. Aim 2) Pilot test intervention components (assessment, prison group sessions, re-entry planning, and re-entry recovery support) for feasibility with one group of women. Final changes to the TBRI Women’s Re-entry Curriculum will be made in preparation for the R33 phase. R33 – Intervention Effectiveness and Implementation (Years 03 – 05): The R33 will incorporate a hybrid Type 1 effectiveness implementation design. Aim 3) Examine effectiveness of the adapted TBRI Women’s Re-entry Curriculum in reducing overdose risk among women (N=272) in four sites following release from prison-based SUD treatment using a stepped wedge design with random assignment to start date. Treatment as usual (TAU, n=136; standard prison SUD treatment) will be compared with TBRI Women’s Re-entry Curriculum (n=136). The primary outcome will be assessed as overdose risk defined as 1) relapse to any drug and 2) trauma related symptoms; secondary outcomes focus on assessing connection through recovery supports, emotional regulation, and healthy re-entry coping. Aim 4) Assess critical implementation factors associated with study preparation, trial launch, sustainability, and scalability of the adapted intervention. This study and resulting adapted intervention have the potential to have a significant impact on reducing overdose risk among justice-involved women re-entering the community with a history of violent victimization and trauma.