Journal of substance use and addiction treatment最新文献

{"title":"Facilitators and barriers to lethal means counseling in veterans with substance use disorder: A qualitative analysis of veteran and clinician perspectives.","authors":"Lauren R DiPaolo, Gillian Geffen, Joseph Simonetti, Deirdra Kelly, Gabriela Khazanov","doi":"10.1016/j.josat.2026.210145","DOIUrl":"https://doi.org/10.1016/j.josat.2026.210145","url":null,"abstract":"<p><strong>Introduction: </strong>U.S. Veterans with substance use disorders are at disproportionately high risk for suicide. Lethal Means Counseling is a collaborative approach where clinicians and Veterans discuss strategies to reduce access to lethal means. While evidence is strong for lethal means counseling reducing suicide risk broadly, the unique needs and experiences of this population are not well understood. This qualitative study sought to elicit perspectives from U.S. Veterans and Veterans Health Administration clinicians about barriers and facilitators to the delivery of and participation in Lethal Means Counseling for Veterans with substance use disorders.</p><p><strong>Methods: </strong>In this pragmatic and postpositivist study, semi-structured qualitative interviews were conducted with 15 U.S. Veterans with substance use disorders identified through electronic health record review and recent completion of lethal means counseling and with 10 Veterans Health Administration clinicians who administered lethal means counseling. Interviews explored experiences with lethal means counseling and substance use in relation to suicide risk. Inductive and iterative thematic analyses were used to code transcripts of interviews for barriers and facilitators at the Individual, Inner Setting, Outer Setting, and Innovation levels of the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>Six themes were identified for barriers, including substance use as a coping strategy, lack of assessment and access to care, nondisclosure and autonomy, ease of access, military culture, and substances increase risk. Three themes were identified for facilitators, including recognition of use as problematic, sharing resources, and providing a rationale for lethal means counseling.</p><p><strong>Conclusion: </strong>Veterans with substance use disorders experience unique challenges that interfere with efforts to reduce suicide risk. The findings of this study highlight current gaps and opportunities for improving conversations during Lethal Means Counseling and may help enhance implementation among those with Substance Use Disorders. Substance use magnifies suicide risk and it will be important for future research to develop strategies to help mitigate this risk.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210145"},"PeriodicalIF":2.8,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient versus inpatient detoxification of alcohol use disorder: an observational cohort study.","authors":"Sicco Kieviet, Ruud Zuidmeer, Niki Lijftogt, Marissa de Vries, Edwin de Beurs","doi":"10.1016/j.josat.2026.210144","DOIUrl":"https://doi.org/10.1016/j.josat.2026.210144","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol detoxification can take place in outpatient or inpatient settings, however, clear criteria for allocation are lacking. This study compared patient characteristics between settings, identified predictors of treatment allocation, and compared treatment completion, relapse, adverse events, and costs.</p><p><strong>Methods: </strong>This prospective cohort study included 75 patients with severe alcohol use disorder (AUD) between December 2022 and January 2024 (41 inpatient, 34 outpatient). Data collection covered demographic and medical characteristics. Multivariable logistic regression with forward stepwise selection (p < 0.1) identified predictors of treatment allocation. Secondary outcomes were treatment completion, relapse, adverse events, a composite 'any adverse outcome', and treatment costs.</p><p><strong>Results: </strong>Gender, marital status, psychiatric comorbidity, and a history of seizures or delirium differed significantly between the groups. A predictive model based solely on demographic characteristics (gender, marital status, and country of origin) achieved an area under the curve (AUC) of 0.789, outperforming a model based on medical characteristics (AUC 0.724) and a mixed model (AUC 0.766). Non-completion did not differ significantly between outpatient and inpatient detoxification (17.6% vs 14.6%; adjusted OR 0.591, p = 0.446), nor did the composite outcome (17.6% vs 24.4%; adjusted OR 1.06, p = 0.94). Relapse occurred only in the outpatient group (n = 6) and adverse events only in the inpatient group (n = 4). The average total cost of outpatient treatment was €3123 (SD ± €1621), compared with €6681 (SD ± €2200) for inpatient treatment.</p><p><strong>Conclusions: </strong>Demographic factors appear to influence the allocation of detoxification setting more than medical factors, even though the Dutch national protocol lists predominantly medical criteria. While treatment completion did not differ significantly between settings, outpatient detoxification cost about half as much as inpatient detoxification. Relapses and adverse events did not occur frequently enough to draw conclusions about safety. Larger studies in more diverse populations should confirm these findings.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210144"},"PeriodicalIF":2.8,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multilevel predictors of stable treatment for opioid use disorder in pregnant individuals enrolled in Medicaid.","authors":"M Luke Smith, Yi Wang, Russell S Kirby, Deborah B Ehrenthal","doi":"10.1016/j.josat.2026.210142","DOIUrl":"10.1016/j.josat.2026.210142","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid use disorder (OUD) during pregnancy poses significant risks for maternal and infant health. Medications for opioid use disorder (MOUD) are recommended as first-line treatment, yet uptake remains limited among Medicaid-covered populations, and evidence delineating individual- and contextual-level correlates of stable MOUD treatment is limited.</p><p><strong>Methods: </strong>We analyzed 3420 Wisconsin Medicaid-covered live births (2013-2019) with OUD diagnoses using linked birth and claims data. Trajectories of MOUD treatment were identified via repeated-measures latent class analysis and modeled using logistic regression within the Andersen-Aday framework, incorporating individual and contextual predictors.</p><p><strong>Results: </strong>Stable MOUD treatment (consistent receipt of MOUD treatment for full pregnancy) was achieved by 31.5% of the identified births. County-level access to facilities offering MOUD plus pregnancy services and residence outside large metropolitan areas were associated with higher odds of stability, while cumulative contextual vulnerability factors (primary care shortage, unemployment, housing cost, less than high school education, child population, and crowding) reduced odds by 10% per factor.</p><p><strong>Conclusion: </strong>Access to specialized treatment and combined social vulnerability measures significantly influence MOUD stability, underscoring the need for targeted interventions.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210142"},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-five years of the NIDA clinical trials network and the future of addiction research.","authors":"Adam J Gordon, Mary A Hatch, Frankie B Kropp, Jane M Liebschutz, Larissa J Mooney, Gerald Cochran","doi":"10.1016/j.josat.2026.210140","DOIUrl":"10.1016/j.josat.2026.210140","url":null,"abstract":"<p><p>The National Institute on Drug Abuse Clinical Trials Network (CTN) was established in 1999 to bridge the persistent divide between addiction research and clinical practice through partnerships between researchers and community treatment providers. This editorial examines the evolution of the CTN over its first 25 years and considers priorities for its future. Drawing on the historical development of the Network and articles in this 25-year special collection, we examine changes in the populations and settings represented in CTN research, the incorporation of implementation science, the evolution of community partnerships, the scientific value of accumulated CTN data and experience, and emerging clinical and methodological priorities. Over 25 years, the CTN has developed from a network focused principally on clinically relevant effectiveness trials into a broader national infrastructure for clinical trials and translational addiction research. Its research has expanded beyond specialty addiction treatment programs into primary care, emergency departments, hospitals, community health centers, pharmacies, and other settings in which people with substance use disorders receive care. The Network has also increasingly addressed populations historically underrepresented in addiction research, incorporated implementation questions into clinical research, strengthened community engagement, and used accumulated trial data and emerging analytic methods to generate new scientific knowledge. These developments demonstrate that the value of a clinical research network extends beyond individual trial outcomes. Clinical trials should remain at the core of the CTN's scientific mission. However, trial designs and complementary research methods should be determined by the scientific questions being addressed. The CTN's future impact will depend on its ability to conduct rigorous multisite trials while incorporating implementation, representation, community partnership, and accumulated data and responding rapidly to changes in the drug supply and addiction care environment. These capabilities can help the Network generate evidence that is rigorous, relevant, timely, and more likely to improve addiction care.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210140"},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance use disorder treatment research in the National Drug Abuse Treatment Clinical Trials Network: Portfolio analysis of approved studies, 2000-2024.","authors":"Sabeeh A Baig, Landhing M Moran, Jeremiah W Bertz, Hoa Vo, Quandra D Blackeney, Udi E Ghitza, August F Holtyn, David S Liu, Geetha A Subramaniam","doi":"10.1016/j.josat.2026.210143","DOIUrl":"10.1016/j.josat.2026.210143","url":null,"abstract":"<p><strong>Introduction: </strong>The National Drug Abuse Treatment Clinical Trials Network (CTN) is a program of clinical research funded by the National Institute on Drug Abuse that brings together academic scientists and community-based treatment providers to conduct research to improve care for substance use disorders (SUDs). This program-level analysis of the CTN portfolio's scientific composition and scientific influence characterizes all CTN studies approved from 2000, the year that the first CTN study was approved for implementation, through 2024.</p><p><strong>Methods: </strong>We integrated multiple administrative and scientific data sources to conduct a portfolio analysis of all CTN studies with funded and approved protocols through December 31, 2024. We used structured deductive content analysis to characterize scientific areas represented in the CTN portfolio, descriptive analyses to summarize portfolio growth, and bibliometric analyses to describe the scientific influence of CTN publications.</p><p><strong>Results: </strong>Through the end of 2024, the CTN portfolio included 200 studies. CTN studies have predominantly focused on SUD treatment, particularly opioid use disorder, in specialized substance use treatment programs. The portfolio expanded over time to include a broader range of treatment settings, such as primary care; and research methods, including hybrid effectiveness-implementation designs and data science techniques. The CTN has supported the publication of 1296 peer-reviewed manuscripts, with the subset of primary outcome manuscripts demonstrating strong scientific influence relative to other publications supported by the National Institutes of Health.</p><p><strong>Conclusions: </strong>Over 25 years, the CTN scientific portfolio has evolved to address changing priorities in SUD treatment research. This portfolio analysis provides a program-level characterization of the CTN and establishes a foundation for future metascience to further enhance its research and operations.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210143"},"PeriodicalIF":2.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in trajectories of fatal and nonfatal opioid overdose by race and ethnicity in the HEALing Communities Study from 2018 to 2023.","authors":"Dawn Goddard-Eckrich, Rouba A Chahine, Redonna Chandler, Jennifer Villani, Louisa Gilbert, Pamela Salsberry, Nishita Dsouza, Sugy Choi, Sharon L Walsh, Kathryn E Lancaster, Emmanuel Oga, Nicole Mack, Lauren D'Costa, Avik Chatterjee, Alexander Y Walley, Charles H Lea, Erin Kim, Katherine Calver, Terry T-K Huang, Timothy Hunt, Stephanie Mack, Jennifer L Brown, James L David, Jerel Ezell, Bridget Freisthler, Marc LaRochelle, Michael S Lyons, Aimee Mack, Svetla Slavova, Stephanie R Mack, Nabila El-Bassel, Anindita Dasgupta, ClaraGrace Pavelka, Daniel J Feaster","doi":"10.1016/j.josat.2026.210127","DOIUrl":"10.1016/j.josat.2026.210127","url":null,"abstract":"<p><strong>Introduction: </strong>Racial and ethnic differences in opioid overdose outcomes are a significant public health challenge in the United States.</p><p><strong>Methods: </strong>We examined differences in trajectories of fatal opioid overdose deaths (OOD) and nonfatal opioid overdoses (NFO) across different racial and ethnic groups and treatment assignment using data from the HEALing Communities Study, a cluster-randomized trial in 67 highly impacted communities in Kentucky, Massachusetts, New York, and Ohio from 2020 to 2023. Rates were calculated as events per 100,000 adults, with trends visualized by treatment assignment. Absolute risk differences and mixed models were used to examine the differences in OOD and NFO trajectories.</p><p><strong>Results: </strong>Non-Hispanic Black individuals had greater increases in OOD rates than Hispanic and Non-Hispanic White individuals (F(3,1507) = 3.26, p < 0.021), while NFO rates were higher across time for non-Hispanic Black individuals than for Hispanic and Non-Hispanic White individuals (F(3,195) = 3.12, p < 0.027). Non-significant reductions in both OOD and NFO rates were observed in the intervention group for non-Hispanic Black individuals compared with controls, with relative risk reductions of 24-30% for OOD and 21-27% for NFO in the period of 2021-2022. In stratified analyses, non-Hispanic Black individuals were observed to have 31% and 55% higher rates of OODs than non-Hispanic White individuals in 2021 and 2022, respectively, in intervention communities. This difference, though not statistically significant, was more pronounced in control communities, where non-Hispanic Black individuals experienced 91% and 104% higher rates of OOD than non-Hispanic White individuals.</p><p><strong>Conclusions and relevance: </strong>The study intervention reduced, but did not eliminate, Black-White differences in OOD rates. Expansion of culturally tailored interventions, strategies, and policies that address contributors to differences in health care access may help to reduce them further.</p><p><strong>Trial registration: </strong>(ClinicalTrials.gov Identifier: NCT04111939).</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210127"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalization and acute care utilization after substance use disorder-related emergency department visits among deaf or hard of hearing youth.","authors":"Rie Sakai-Bizmark, Carren Stika, Frank Wu, Emily H Marr, Miho Sodeno, Dennys Estevez, Debra Guthmann-Ternus","doi":"10.1016/j.josat.2026.210126","DOIUrl":"https://doi.org/10.1016/j.josat.2026.210126","url":null,"abstract":"<p><strong>Introduction: </strong>Youth with hearing loss face challenges such as communication barriers in acute care settings and increased risk for substance use. Yet the association between hearing loss and healthcare utilization following substance use disorder (SUD)-related emergency department (ED) visits has not been examined.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using 2016-2019 State Emergency Department and State Inpatient Databases from New York and Maryland. Youth aged 15-24 with documented hearing loss and SUD-related ED visits were identified. A 1:5 propensity score-matched cohort was constructed using nearest-neighbor matching with a caliper of 0.2 standard deviations of the logit of the propensity score. Mixed-effects regression models with a hospital-level random intercept estimated associations between hearing loss and hospitalization following an ED visit, ED revisit within 30 days of discharge, inpatient length of stay, hospitalization costs, and hospitalization cost per day.</p><p><strong>Results: </strong>The cohort included 287 youths with documented hearing loss and 1435 matched peers without documented hearing loss. Hearing loss was associated with higher odds of hospitalization (adjusted odds ratio [aOR] 4.12; 95% CI, 2.78-6.10). Among hospitalized youth, hearing loss was associated with higher total hospitalization costs (adjusted mean ratio [aMR] 1.18; 95% CI, 1.04-1.34), but not length of stay (aMR 1.11; 95% CI, 0.98-1.25) or 30-day ED revisits (aOR 0.92; 95% CI, 0.63-1.33). No significant association between hearing loss and cost per day was observed in the primary analysis (aMR 1.08; 95% CI, 0.99-1.17), but several sensitivity analyses suggested higher cost per inpatient day among youth with hearing loss.</p><p><strong>Conclusion: </strong>Among youth with SUD-related ED visits in New York and Maryland during 2016-2019, documented hearing loss was associated with higher odds of hospitalization and higher total hospitalization costs. In addition, hearing loss was associated with higher cost per inpatient day in several sensitivity analyses. These findings suggest that youth with hearing loss may have greater clinical or care coordination needs at ED presentation or during hospitalization. Strategies to improve communication access, support earlier SUD identification, and strengthen accessible outpatient behavioral health services may help address acute care needs in this population.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210126"},"PeriodicalIF":2.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting treatment recovery and adherence in alcohol behavioral couple therapy using natural language processing.","authors":"Jiaxu Han, Alexa Boland, Rosalie E Ruhlmann, Catharine E Fairbairn, Julianne C Flanagan","doi":"10.1016/j.josat.2026.210133","DOIUrl":"https://doi.org/10.1016/j.josat.2026.210133","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for Alcohol Use Disorder (AUD). Research increasingly focuses on identifying predictors of treatment outcomes to guide the continued refinement of ABCT for diverse AUD populations and relationship typologies, with language spoken by couples emerging as a promising behavioral domain for understanding treatment success. Leveraging natural language processing (NLP) methods and a prospective design, the present study examined a broad range of linguistic features exhibited by couples as predictors and moderators of treatment outcomes.</p><p><strong>Method: </strong>Participants represent a subset (n = 84, 42 couples) of individuals enrolled in a larger parent study examining ABCT intervention efficacy. Patients' drinking behaviors were tracked throughout treatment and at 3- and 6-month follow-ups. Using NLP tools, linguistic features of patients' and partners' speech during session 1 of ABCT were extracted, respectively.</p><p><strong>Results: </strong>Partners' behaviors moderated patients' drinking trajectories, with patients whose partners more frequently referenced alcohol, β = -0.0015, SE = 0.0006, p = 0.0075, and paired alcohol-related statements with positive sentiment, β = -0.0717, SE = 0.0183, p < 0.001, reporting more pronounced declines in drinking quantity over time. After accounting for patients' effects, patients whose partners used more collective pronouns showed more pronounced declines in drinking frequency over time, β = -0.0140, SE = 0.0060, p = 0.0204. In contrast, patients' behaviors predicted treatment adherence, with more frequent use of positively-valenced overall, OR = 0.984, 95% CI = [0.971, 0.998], and alcohol-specific statements, OR = 0.924, 95% CI = [0.858, 0.994], associated with lower likelihood of treatment completion.</p><p><strong>Conclusions: </strong>Both AUD patients and their partners' language - particularly how couples discuss alcohol - may shape patients' treatment outcomes in different ways, with partners' language influencing drinking trajectories and patients' language influencing treatment adherence. Findings point to both what is said (alcohol-related language) and who said it (treatment role) as key predictors of ABCT treatment success.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210133"},"PeriodicalIF":2.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging partnerships to address substance use among American Indian and Alaska Native populations: A commentary on research within the NIDA Clinical Trials Network.","authors":"Maria C Crouch, Melanie Nadeau, Paulette A Baukol, Frankie B Kropp, Christi Patten, Mark Standing Eagle Baez, Alessandra C Angelino, Allison Kelliher, Jennifer Shaw, Angel Vasquez","doi":"10.1016/j.josat.2026.210071","DOIUrl":"10.1016/j.josat.2026.210071","url":null,"abstract":"<p><p>American Indian and Alaska Native (AI/AN) communities experience a disproportionate burden of substance use disorders (SUDs) alongside persistent barriers to culturally responsive care and research participation. Despite this need, AI/AN populations remain underrepresented in substance use research, in part due to historical and ongoing systemic inequities, including research practices that have not adequately respected Tribal sovereignty or incorporated Indigenous knowledge systems. This commentary synthesizes research conducted within the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) focused on AI/AN communities, identifies key lessons learned from this body of work, and offers recommendations for future research. First, we provide an overview of CTN-supported studies involving AI/AN populations, highlighting both the diversity of substance use patterns across communities and the feasibility of conducting rigorous, culturally responsive research. Second, we synthesize lessons learned from these studies and related literature, including the importance of long-term relationship building, the need for culturally responsive research frameworks, structural barriers to implementation, and workforce and infrastructure challenges. Third, we present recommendations for the field, emphasizing the central role of community-based participatory research (CBPR) and Tribal participatory research (TPR), the integration of Indigenous knowledge systems, and the importance of Tribal data sovereignty and community-led dissemination. Collectively, this commentary argues that sustainable progress in addressing SUDs among AI/AN populations requires a fundamental shift toward community-engaged, culturally responsive, and equity-focused research partnerships. The experiences of the CTN AI/AN Special Interest Group demonstrate that such approaches are not only feasible but essential for advancing both scientific knowledge and community health.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210071"},"PeriodicalIF":2.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming low representation: Lessons from an integrative data analysis of CTN studies for assessing treatment effectiveness among Black people who use cocaine and/or opioids.","authors":"Lesia M Ruglass, Adriana Espinosa, Caravella McCuistian, Angela M Haeny, Joel Lopez, Christopher Roundtree, Ashley Vena, Antonio A Morgan-López, A Kathleen Burlew","doi":"10.1016/j.josat.2026.210022","DOIUrl":"10.1016/j.josat.2026.210022","url":null,"abstract":"<p><p>Given the disproportionate impact of substance use on individuals, families, and communities from populations underrepresented in clinical trials, increasing their enrollment in treatment research is critical for ensuring that the findings inform policies and programs that are inclusive of all communities, thereby advancing health equity. However, since underrepresented groups continue to be underenrolled in clinical trials testing the efficacy and effectiveness of psychosocial treatments for substance use disorder, substance use researchers are still grappling with this challenge. In this commentary, we describe rigorous methodological approaches, such as integrative data analysis (IDA) and related methods (e.g., moderated nonlinear factor analysis and propensity score weighting), that can help address the challenges posed by the underrepresentation of certain populations. By combining individual-level data from multiple studies into a pooled dataset, these methods increase sample size and statistical power while addressing covariate imbalance across treatment groups. We describe how we employed these methods to address the aims of our recently completed secondary data analysis project conducted within the National Drug Abuse Treatment Clinical Trial Network (CTN-0125; Integrative Data Analysis of CTN Studies to Examine the Impact of Psychosocial Treatments for Black People Who Use Cocaine and/or Opioids). Our study used these methods to pool and analyze data from nine completed CTN trials to assess the comparative effectiveness of psychosocial treatments for Black adults who use cocaine and/or opioids, a group underrepresented in registered trials of the NIDA. We illustrate the application of these methodological approaches in CTN-0125 and demonstrate how they complement each other to address unique analytic challenges. We describe how we addressed data harmonization challenges due to variations in data formats and inconsistencies or gaps in the supportive documentation available on the NIDA Data Share website. We conclude with recommendations for the research field on how to further address sample size and data integration challenges.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"210022"},"PeriodicalIF":1.9,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}