PROJECT SUMMARY
Over a third of American adults engage in unhealthy substance use (USU), which includes a spectrum
ranging from any illicit drug use or alcohol consumption above guideline-recommended levels through more
severe substance use disorder. USU results in increased mortality through overdose and substantial morbidity
including reduced functioning, poorer chronic disease outcomes and increased health care utilization. A broad
range of biological, psychological and social factors contribute to USU. However, while primary care clinicians
frequently encounter patients with USU, they rarely screen for, diagnose, or treat USU using a comprehensive
approach that would account for all these factors. Furthermore, existing strategies and models to improve USU
care frequently fail to consider practice and community context, and thus have not been widely disseminated.
In our study, Supporting Unhealthy Substance use care Through a whole person Approach and user
centered INtegration into primary care (SUSTAIN), we propose to engage primary care practices and
individuals with lived USU experience in codesigning a whole person USU intervention and collaboratively test
the implementation of the SUSTAIN intervention in primary care practices. In phase 1 of our study, we will
convene a series of stakeholder groups with practice representatives and individuals with USU who will
codesign a change package that includes a menu of interventions that considers the psychological, social, and
biological factors that contribute to USU. In phase 2, we will conduct a cluster randomized controlled trial with
waitlist control in 24 practices with 50 patients each from 2 practice-based research networks, the WWAMI
(Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network and the Virginia
Ambulatory Care Outcomes Research Network. Participating practices will join a learning collaborative where
they will be supported in implementing their customized approach to identifying and treating USU by selecting
from the menu of interventions developed in Phase 1. The primary outcome will be patient functioning
(measured by the PROMIS-29-v2) and secondary outcomes will include unhealthy substance use (TAPS-1),
recovery (RAS), health care utilization and process outcomes. Guided by the Consolidated Framework for
Implementation Research (CFIR), we will evaluate implementation outcomes and conduct qualitative
interviews with a subset of patients and clinicians. Our proposed intervention will enhance equity since the
intervention is adaptable to the needs and preferences of each practice and individuals served by the practice.
It is innovative in that it transcends the current focus on implementing a specific model and recognizes and
adapts to the diversity of primary care practices in communities served, organizational structures and payment
models. If successful, the SUSTAIN model can transform how primary care practices care for individuals with
USU in a sustainable and whole person approach, improving patient outcomes and enhancing communities.
