PROJECT ABSTRACT The purpose of this timely and significant R34 proposal is to adapt an evidence-based posttraumatic stress disorder (PTSD) intervention for use among a polysubstance population receiving treatment for opioid use disorder in a methadone maintenance treatment (MMT) program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This innovative pilot will use three aims to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in illicit opioid-stimulant polysubstance use. The following aims are proposed: (1) to adapt the evidence-based intervention STAIR-NT for polysubstance use populations informed by the ADAPT-ITT framework, (2) to assess the feasibility and acceptability of the provisionally adapted STAIR-NT via an open pilot (n=10) to inform further adaptations, and (3) to conduct a small-scale randomized control pilot using the adapted intervention to examine implementation (i.e., feasibility and acceptability) and short-term polysubstance use and PTSD symptomology outcomes among MMT patients who are engaged in illicit opioid-stimulant polysubstance use. Completion of study aims will result in a fully adapted protocol for use in a multi-site randomized trial of the adapted STAIR-NT approach. The long-term goal of this research is to improve the health and treatment outcomes of populations who engage in high-risk polysubstance use through complementary layering of trauma-informed evidence-based interventions in opioid treatment programs.

PROJECT NARRATIVE This innovative pilot will adapt an existing evidence-based trauma intervention for posttraumatic stress disorder (PTSD), Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in a methadone maintenance treatment (MMT) program who are engaged in illicit opioid-stimulant polysubstance use. After a rigorous adaption process informed by the ADAPT-ITT framework, a pilot randomized control trial will examine implementation (i.e., feasibility, acceptability) and short-term polysubstance use and PTSD symptomology outcomes to inform a future multi-site trial. Addressing trauma among individuals engaged in MMT represents a critical opportunity to provide effective treatment that is responsive to the needs of individuals who engage in polysubstance use, thereby reducing the severity of polysubstance use and attendant risks of overdose.