PROJECT ABSTRACT Inequity in addictions and their treatment are growing, ubiquitous threats to health and society. A global pandemic and large social movements, such as #BlackLivesMatter, have highlighted negative impacts of racism and discrimination for addictions and centered “structures as the root cause of inequities. Structural racism has fundamentally shaped responses to substance use in the U.S. Other structural factors, such as policies and systems like education, housing, criminal justice, and healthcare reinforce inequality and contribute to addictions disparities and inequities. However, structural factors in addictions, and how to increase equity in addictions care and outcomes, are grossly understudied. A new generation of addictions health services scholars is needed to address equity challenges rooted in structures. Consistent with the goals of NIDA’s Racial Equity Initiative, next generation scholars will need strong training in anti-racism and related research methods and fields that can alter structures that reinforce inequity (e.g., policy and implementation science) in addition to training in traditional health services and addictions-specific content and methodology. As the nation’s premier public university for research—home to a leading doctoral program in health services research, a top-ten medical school, nationally-recognized programs in implementation science and health policy, and one of only a handful of anti-racism centers in the nation—the University of Washington (UW) is well positioned to address these training needs. Thus, UW’s Department of Health Systems and Population and Division of General Internal Medicine seek NIDA funding to found the Training in Equity and Structural Solutions in Addictions (TESSA) Program to: 1) recruit 11 pre- and post-doctoral scholars with interest in addictions disparities, 2) deliver a specialized curriculum fostering a multidisciplinary understanding of addictions and their care, policy, implementation science, and anti-racism; 3) provide TESSA scholars mentored research opportunities focused on addictions equity in multidisciplinary research teams, 4) support TESSA scholars in developing research career training plans to enhance their skills and prepare them for research careers; and 5) evaluate the success of the program using explicit benchmarks and pre-defined outcomes. We have developed the TESSA program to train scholars in 17 core competencies addressing anti-racism, policy, and implementation science in addition to traditional health services and addictions content and methodology. If we continue to train addictions scholars without such a direct multidisciplinary approach, we are likely to see slow progress and missed opportunities to improve equity and reduce morbidity, mortality, and suffering associated with addictions. Investment in TESSA will result in a new generation of diverse, anti-racist and equity-focused addictions research scholars who are optimally prepared to develop and test novel strategies for prevention, treatment, and recovery, and implement effective strategies and policies into real-world settings through a lens of equity and anti-racism, advancing NIDA’s cross-cutting strategic goals and Racial Equity Initiative to reduce stigma and disparities in addictions.

PROJECT NARRATIVE Inequity in addictions and their treatment are ubiquitous threats to health and society; a global pandemic and large social movements (e.g., #BlackLivesMatter) have highlighted negative impacts of racism and discrimination for addictions and centered “structures” (e.g., policies and systems like education, housing, criminal justice, and healthcare which reinforce inequality) as the root cause of inequities, though these are grossly understudied. A new generation of addictions health services scholars trained in traditional health services and addictions content/methodology, as well as anti-racism and fields that can alter structures that reinforce inequity (e.g., policy and implementation science), is needed to address equity challenges rooted in structures. The University of Washington (UW) is a leader in addictions research, anti-racist pedagogy and research methods, policy, and implementation science and well-positioned to address the training needs of next- generation addictions scholars; thus, the UW’s Department of Health Systems and Population and Division of General Internal Medicine seek NIDA funding to found the Training in Equity and Structural Solutions in Addictions (TESSA) to prepare 11 pre- and post-doctoral scholars to be future leaders in structural solutions to inequity in addictions and their treatment via a specialized curriculum, mentored research opportunities, experience developing research career training plans, and iterative evaluation with support from both internal and external expert advisory committees.