Development and Pilot Testing of a Novel Treatment Intervention for Dual Substance Use Disorder (DUD) in Heterosexual Couples - PROJECT SUMMARY Drug use disorders (DUDs), a subclassification of substance use disorders (SUDs) involving the misuse of non-alcohol illicit drugs, remain a major public health crisis in the U.S., affecting 27 million persons and contributing to over 100,000 overdose deaths annually. Among those with DUDs, 30% to 50% have a primary sexual partner who also has a DUD—dual-DUD couples. These couples experience significantly poorer treatment outcomes, including higher relapse rates and lower treatment engagement, compared to individuals without a drug-using partner. Despite the well-documented reciprocal influence of partners on each other’s substance use, current treatment paradigms remain predominantly individual-focused, overlooking the relational context in which substance use and recovery occur. The absence of couples-based treatment models designed specifically for dual-DUD couples represents a critical gap in the addiction treatment landscape. This study aims to address this gap by developing and piloting a novel couples-based intervention tailored to the needs of dual-DUD couples who use opioids and/or stimulants. Grounded in the Recovery Capital framework and the SUD Couple System model, this study will incorporate a Co-Creation approach to intervention development, ensuring meaningful engagement from stakeholders, including affected couples, treatment providers, and administrators. The research design follows an R61/R33 phased structure, integrating the Intervention Mapping + Adapt (IMA) framework for intervention development with the Consolidated Framework for Implementation Research (CFIR) to guide and evaluate implementation strategies. In the R61 phase, formative mixed-methods research will be conducted to identify key determinants and recovery assets influencing drug use behavior and treatment outcomes among dual-DUD couples (Aim 1). These findings will inform the development and adaptation of a couples-based treatment program using an intervention mapping approach (Aim 2). The R33 phase will involve finalizing intervention materials and implementation strategies (Aim 3), conducting a dual-site pilot randomized controlled trial (RCT) at SUD treatment centers in Rochester, NY, and Newark, NJ (Aim 4), and evaluating post-pilot data to refine the intervention and assess readiness for a confirmatory Hybrid Type 2 effectiveness trial (Aim 5). This project aligns with the objectives of RFA DA-26-024 (R61/R33 Exploratory/Developmental Phased Award), which seeks to engage loved ones in the recovery process and enhance access to evidence-based care for those affected by DUDs. develop and test dyadic approaches to support engagement in evidence-based care for individuals in DUD-affected relationships. By addressing a longstanding treatment gap, this study aims to contribute to the broader goal of reducing substance use-related harm and improving public health through innovative, relationship-centered care models.
