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Adaptive Interventions for Co-Occurring OUD and PTSD

Award Number: R61DA061327
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2025
PERIOD OF PERFORMANCE END DATE: 08/31/2027

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Adaptive Interventions for Co-Occurring OUD and PTSD - PROJECT ABSTRACT Nearly half of those with opioid use disorder (OUD) experience co-occurring PTSD (co-OUD/PTSD). Among people with OUD, untreated PTSD is associated with more severe clinical profiles and higher rates of suicide attempts and drug overdoses. Exposure therapy for PTSD, delivered alongside medication for OUD improves both OUD and PTSD outcomes, but low uptake and high levels of dropout are common, resulting in sub-optimal outcomes. Reasons for poor uptake and retention include the scarcity of mental health providers resulting in long wait lists, patient avoidance, and uncertainty about the optimal timing of PTSD treatment. Interventions to increase access to and retention in trauma therapy are essential and must include primary care. Responding to both NOT-DA-23-007 and NOT-DA-23-008, this study aims to develop a scalable and optimal adaptive treatment strategy for PTSD in patients with OUD by answering three questions: 1) Is Written Exposure Therapy (WET), an evidence-based therapy for PTSD, feasible and appropriate for delivery by community health workers? 2) What is the optimal timing of therapy for PTSD in patients with OUD? and 3) Are PTSD treatment interventions provided entirely by a collaborative care team more effective than interventions that include a referral to a licensed mental health provider? We will answer the first question by assessing the “fit” of WET for delivery by community health workers and the feasibility of different adaptive treatment strategies (R61 phase—preparation), and the latter two questions using a two-stage, Sequential Multiple Assignment Randomized Trial (SMART) design that allows us to vary the timing of when therapy is offered and by whom (R33 phase—optimization). Our study is a collaboration among RAND, the University of New Mexico, Stanford University, Boston University and the New Mexico Office of Community Health Workers. Our long-term goal is to increase access to a scalable and optimized adaptive treatment strategy for PTSD in people with OUD that improves PTSD and OUD outcomes and reduces morbidity and mortality. We also seek to shift clinical practice paradigms about what appropriate care for PTSD requires. The end-users of our research are clinicians faced with decisions about how to treat co-OUD/PTSD and decisionmakers searching for ways to solve the mental health workforce shortage. Our study is significant because it will equip providers with evidence-based guidance about how to address PTSD in patients with OUD at critical decision points: initial treatment and the point of non-response or symptom worsening for two synergistic and co-occurring disorders with high lethality. By testing a scalable and sustainable solution to the mental health workforce shortage—using a community health worker to deliver WET as part of a collaborative care team—it will equip decisionmakers with data about ways to effective treatment for PTSD into routine use, increasing access to an effective and life-saving treatment for individuals with co-OUD/PTSD.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $410,221 )
2026	2026	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	2	9/3/2026	NON-COMPETING CONTINUATION	$410,221
														Subtotal = $410,221

Issue Date FY: 2025 ( Subtotal = $408,679 )
2025	2025	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	000	1	8/27/2025	NEW	$408,679
2025	2025	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Drug Use and Addiction Research Programs	001	1	9/8/2025	NEW	$0
														Subtotal = $408,679

Grand Total All Awards = $818,900

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Adaptive Interventions for Co-Occurring OUD and PTSD

Award Number: R61DA061327

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2025

PERIOD OF PERFORMANCE END DATE: 08/31/2027

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