Description of problem: Opioid use disorders (OUDs) have reached an all-time high and have devastating effects on individuals, families, and communities. While medication treatment for OUD saves lives, rates of treatment dropout are very high. In addition, existing OUD treatments neglect the impact of untreated OUD on the family, and ignore the potential role family members and significant others (SOs) could have on encouraging long-term recovery.
Incorporating the patient’s support system may be an important way to improve treatment retention. This study will evaluate a counseling program for concerned family members, spouses, and friends called Community Reinforcement and Family Training (CRAFT), which is successful at engaging and retaining patients in substance use treatment. While promising, no studies have evaluated whether CRAFT can help patients remain on medication treatment for OUD, provided by community health clinics. If effective, this could save lives and help both patient and family member health outcomes.
Methods: This study will recruit 500 patient and SO pairs in 12 community health clinics throughout northern and southern California. We will recruit patients who are starting OUD medication treatment and randomly assign half of the SOs to receive CRAFT; the other half would receive treatment-as-usual. We will then interview patients and SOs three and twelve months later to evaluate whether patients with CRAFT SOs stay in OUD treatment longer, and whether patient and SO health outcomes improve.
Outcomes: We will follow patient and SOs for a year and assess patient retention in OUD treatment. We will also assess patient opioid use, SO health, relationship, and quality of life. We will assess for which patient subgroups CRAFT is most helpful, and we will survey staff to understand the best ways to make CRAFT available to other clinics in the future.
Importance to Patients: This study is important to patients with OUD because treatment dropout is linked to a substantially greater risk of opioid relapse and overdose. Thus, finding ways to keep patients in treatment is essential.
Stakeholder Engagement: Our team consists of patients, SOs, clinic staff, psychologists, psychiatrists, statisticians, payers, and other qualified individuals who have dedicated their lives and careers to improving the well-being of those affected by opioid and other substance use. We have assembled clinic and patient stakeholder advisory panels who will guide us in planning and conducting the study, and disseminating study results. We will meet with each panel monthly, using a community engagement process that emphasizes joint leadership, open communication, and two-way knowledge exchange. In doing so, we want to create a project that is relevant and meaningful to the community that can be successfully completed. The proposed study not only fills critical gaps in what we know about CRAFT and OUD treatment, but also provides data to inform a much-needed new way to address the opioid epidemic.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.