Harm Reduction Behavior Therapy for Post-Incarceration Drug Use in Enhanced Reentry Primary Care - ABSTRACT People who use drugs (PWUD) often experience adverse health outcomes in the year following release from incarceration, including overdose, suicide, and infectious disease. Psychological distress and illicit drug use are key mediators of these adverse outcomes, and risk is compounded by low health service engagement. Yet effective interventions targeting these mechanisms in previously incarcerated PWUD are lacking. This application proposes integrating a harm reduction-focused behavioral intervention into the Formerly Incarcerated Transition (FIT) program, a reentry primary care program enhanced with peer support. This will target multiple mechanisms of post-release adverse outcomes, including psychological symptoms, drug use, and health service disengagement. Specific aims are: (1) Identify barriers and facilitators to implementing harm reduction therapy for drug use in a primary care setting via qualitative interviews with previously incarcerated PWUD and community stakeholders (n=15 each); (2) Develop a protocol for integrating Harm Reduction Behavioral Activation (HR-BA) therapy with the FIT program based on Aim 1 findings, with guidance from expert mentors and input from a community advisory board; and (3) Test the feasibility, acceptability, and initial efficacy of HR-BA as an adjunct to FIT’s enhanced reentry primary care program using a randomized controlled trial (RCT). As a part of this aim, adults with current illicit drug use disorders who have been incarcerated in the past year (N=80) will be recruited from community-based settings and randomly assigned to HR-BA + FIT, or FIT treatment as usual (FIT TAU; n=40 each arm). Assessment of feasibility and acceptability will then be conducted posttreatment. Treatment outcomes will be measured from pre- to 6 months post-treatment. It is hypothesized that (1) HR-BA will be feasible and acceptable; (2) compared to FIT TAU, HR-BA + FIT will be associated with greater improvements in drug use, depressive symptoms, and healthcare engagement at posttreatment; and (2b) these effects will be sustained 6 months posttreatment. This proposal fills an important gap in research testing harm reduction psychosocial treatment for the PWUD at greatest risk of adverse outcomes, including overdose. The training plan will allow the applicant to develop new skills in three areas critical to her long-term career goals and the successful completion of the proposed project: (1) community engaged research in criminal legal and health service contexts, (2) implementation science, and (3) RCTs with longitudinal follow-up. The applicant’s career development and training goals will be accomplished through regular meetings with expert mentors, directed readings, didactic courses, and academic conferences. After study completion, the applicant will be well positioned to apply for a future hybrid type I effectiveness-implementation trial (R01) testing the intervention on a larger scale. The award will support the applicant’s goal of becoming an independent scientist contributing to the development, testing, and empirically guided implementation of interventions for illicit drug use and related health risk behaviors.
