Effectiveness, Implementation, and Cost of Cognitive Processing Therapy in Prisons - Project Summary Addiction and trauma exposure are ubiquitous among the 5.5 million people (1 in 47 adults) who are either incarcerated or under correctional supervision in the US. Approximately 85% of people in prison have an active substance use disorder or are incarcerated for a drug-related crime, and pre-incarceration exposure to chronic and severe trauma is the norm rather than the exception. Posttraumatic stress symptoms (PTSS), a common outcome of trauma exposure, are linked to greater drug use severity and increased rates of relapse and crime among people who use drugs. PTSS and substance use disorder (SUD) each increased risk for new arrests and new felony arrests among people who are justice-involved, indicating that reducing trauma sequelae such as drug use and PTSS may also reduce recidivism and the community burden associated with incarceration. Yet, evidence-based interventions for PTSS have poor reach in prisons and, to our knowledge, there have been no tests of whether providing therapy for PTSS in prisons reduces post-release drug use, PTSS, or crime. This 5-year R01 proposal will test group-delivered Cognitive Processing Therapy that has been adapted for implementation in criminal justice settings (CPT-CJ) as an intervention for reducing post-incarceration drug use, mental health symptoms, and drug-related crime. We will use a patient-randomized Hybrid type II implementation-effectiveness design in which CPT-CJ is compared to individual self-help via workbook (i.e., bibliotherapy, an enhanced treatment-as-usual comparison condition) and concurrently evaluate implementation facilitation as a strategy to support CPT-CJ uptake in prisons. We will also collect data on the costs and cost offsets of both the CPT-CJ and facilitation. Participants in the effectiveness portion of the trial (N = 640; 50% female) will be enrolled from 10 prisons in 5 states, ensuring variability in population and setting characteristics. The study builds on a NIDA K23 to the PI, which found strong preliminary evidence that CPT was acceptable, feasible, and effective when delivered in prison by bachelor’s-level addiction counselors who were supported by an external facilitator. Importantly, our study vision aligns with NIDA’s Strategic Plan, as we aim to both “develop and test novel strategies for preventing drug use, SUDS, and their consequences” (Goal 2.1) and “support research to scale up the application of evidence-based interventions for SUDs, including in justice settings” (Goal 4.3). Indeed, this study will be the first fully powered randomized trial of treatment for PTSS in prisons as a method for reducing drug addiction. Together, our work will provide foundational information on PTSS as a novel intervention target for reducing post-incarceration drug use and will gather the implementation and cost data needed to inform rapid scale-up if effective.
