Project Summary/Abstract Older adults with substance use disorders are at high risk for associated adverse outcomes due to co-existing chronic diseases and functional impairments. This is also a population that has experienced a profound loss of their social networks and is therefore also at risk for social isolation and loneliness. Additionally, older adults with substance use disorder also experience a high level of stigma related to drug use, drug use treatment, and ageism. Recently, there has been increasing interest in the relationship between lack of social connectedness and stigma with health outcomes. Yet, very little research in this area has focused on older adults with substance use disorders. To address this, the objective of this research is to use the national expertise of the Principal Investigators (Drs. Han and Inagaki) to measure social isolation, loneliness, and intersectional stigma longitudinally among older adults who receive care in opioid treatment programs and examine how this may influence health outcomes. Aim 1 of this study is to characterize trajectories of social isolation and loneliness longitudinally. 150 older adults (age ³55) living with opioid use disorder who receive treatment in San Diego County’s opioid treatment programs will be recruited to complete validated measures of social isolation and loneliness at three-time points (baseline, 6 months, and 12 months later). Aim 2 will examine whether trajectories of social isolation and loneliness predict 12-month opioid use disorder treatment outcomes, non-opioid psychoactive substance use, and acute healthcare utilization. Finally, Aim 3, through qualitative interviews with a subset of enrolled participants (n=40), will explore patient perspectives on how social isolation and loneliness influence substance use, recovery, and treatment and elicit perspectives on strategies to address social connectedness through opioid treatment programs. As an exploratory aim, this study will measure the experienced stigma of this population through validated scales. During qualitative interviews, perspectives regarding stigma related to opioid use disorder, ageism, and other potentially related factors will also be assessed. Results from this research will ultimately inform future interventions to address isolation and disconnection among older adults with opioid use disorder. This will have additional public health implications for the efficacy of improving addiction treatment and health outcomes.

Project Narrative Older adults with opioid use disorder who receive care in opioid treatment programs are at heightened risk of being socially isolated, reporting loneliness, and experiencing everyday stigma. Measuring the lack of social connectedness and its relationship to intersectional stigma is important given their possible influence on treatment and health outcomes. The information learned from this project will inform providers and policymakers across the spectrum of clinical care on improving social connectedness among a growing yet often overlooked population made vulnerable.