Project Summary Despite the high prevalence of substance use disorders (SUDs), including opioid use disorder (OUD), among people incarcerated in the US, only a small portion receive SUD treatment while incarcerated. One barrier is limited evidence-based treatment availability in correctional facilities. Concerning OUD, though a growing number of facilities are screening for OUD and providing medication for OUD (MOUD), supporting these services across correctional facilities has been limited; adjunctive behavioral counseling to support MOUD adherence and outcomes is recommended in clinical practice guidelines, but availability may be limited in correctional facilities. Furthermore, correctional mental health staff report high burnout, which affects the quality of care delivered. Digital therapeutics for SUDs—which may offer an accessible, low-cost, and low- burden option for providing treatment—would be helpful in closing the gap between incarcerated individuals with OUD and other SUD(s) who need treatment and services available in correctional facilities. The proposed training plan and research project of this K23 application will provide mentored training to support Dr. Jennifer Loya's pursuit of an independent research career conducting patient-oriented research with dual expertise in substance use treatment and implementation science. The training goals focus on gaining knowledge in implementation science methods, learning specific qualitative methods and respective data analysis, and gaining experiencing in conducting a pilot clinical trial, as well as advancing career development. Complementing these goals, Dr. Loya will receive mentorship from experts in these areas and participate in structured didactic and experiential training through formal coursework and trainings/workshops, attendance at seminars and annual conferences, and direct research activities. The research plan aims to gain a comprehensive understanding of how an evidence-based digital therapeutic of cognitive and behavioral skills for substance use—Computer Based Training for Cognitive Behavioral Therapy (CBT4CBT)—could be effectively implemented as a treatment for incarcerated people with current OUD/SUD. In Aim 1, attitudes and perceptions of using a digital therapeutic for SUDs and input regarding barriers to and facilitators for implementing CBT4CBT will be assessed with qualitative individual interviews among addiction treatment providers in two Connecticut correctional facilities. In Aim 2, with implementation recommendations from providers incorporated, CBT4CBT will be implemented through a pilot clinical trial among 50 incarcerated individuals with current OUD (primary), as well as other SUD(s), to examine its feasibility and acceptability, as well as preliminary efficacy. Results of this project will inform future efforts to modify and adapt CBT4CBT to enhance implementation and examine its efficacy as a pre-release intervention to improve substance use outcomes post-release. Completion of the proposed training plan and research project will optimally position Dr. Loya to pursue a career as an independent patient-oriented researcher.

Project Narrative Although there is a high prevalence of substance use disorders (SUDs), including opioid use disorder (OUD), among people incarcerated in the US, only a small portion receive evidence-based treatment for SUDs, as well as screening and medication for OUD. This proposed K23 application involves career development training and a complementary research project incorporating implementation science methods to gain a comprehensive understanding of how an evidence-based digital therapeutic for substance use—Computer Based Training for Cognitive Behavioral Therapy (CBT4CBT)—could be effectively implemented as a treatment for incarcerated people with current OUD (primary), as well as other SUD(s).