Overdose continues to ravage US communities with deaths at an all-time high, and women are disproportionately affected. Overdose deaths among women rose nearly 500% in the past two decades, a rate considerably higher than men. Yet, overdose prevention approaches that target the unique risks of women, particularly those involved in the criminal legal system (CLS), are limited. Considering the complex histories of substance use and violence among justice-involved women, there is a need to adapt and implement innovative and targeted intervention strategies that address violent victimization and related problems as part of the substance use disorder (SUD) treatment continuum, including the need to target risks prior to prison release and during community re-entry. This application is submitted in response to RFA-DA-053 with the overall aim of accelerating the translation of research to practice addressing overdose risk for justice-involved women during community re-entry through the adaptation and testing of an innovative, trauma-informed, relational intervention approach, which also closely aligns with NIDA’s funding priority area NOT-DA-23-007 to improve substance use outcomes for individuals with a history of violence. Guided by the ADAPT-ITT framework and previous research, the R61 phase will focus on achieving 2 specific aims: 1) Adapt TBRI by focusing on two intervention components: prison group sessions and re-entry recovery support. A focus group process will be used that engages key stakeholders (N=30) including administrators, practitioners, and women with “lived experience,” target alignment with the unique treatment needs of the women, and establish intervention feasibility; 2) Pilot test the adapted TBRI-Women’s Reentry Approach (TBRI-WRA) intervention components in one group of women in KY (n=8). Final adaptations will be made to TBRI-WRA for the R33 implementation and testing across four sites. The R33 will use a Hybrid Type 1 effectiveness implementation design to achieve the following aims: Aim 3) Examine effectiveness of TBRI-WRA to reduce overdose risk among women (N=264) being released from four in-prison SUD treatment program sites, using random assignment of sites to start date. Comparisons will examine (1) Treatment as Usual (TAU, standard in-prison SUD treatment, n=88), (2) In-prison TBRI (TAU +TBRI prison-based sessions only; n=88), and (3) TBRI + Re-entry Recovery Support (TAU + prison-based TBRI sessions + Re-entry Recovery Support; n=88). The primary outcome is overdose risk, defined as any illicit substance use (self-reported and urine drug screen results; excluding alcohol and marijuana) during the 6 months after release from prison; secondary outcomes include trauma-related symptoms and connection (recovery supports, emotional regulation, and healthy coping) during the 6 months post-release. Aim 4) Examine implementation factors associated with study preparation, launch, and sustainability guided by the EPIS framework. This study and resulting adapted intervention have the potential for significant impact on overdose risk reduction among justice-involved women re-entering the community with a history of violence exposure. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.

PROJECT NARRATIVE This application is submitted in response to RFA-DA-053 with the overall aim of accelerating the translation of research to practice reduce overdose risk for women during community re-entry following release from prison through the adaptation and testing of an innovative, trauma-informed, relational intervention approach. The proposed study closely aligns with NIDA’s funding priority area NOT-DA-23-007 to improve substance use outcomes for individuals with a history of violence.