Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

Emily N Satinsky, Kelly Doran, Julia W Felton, Mary Kleinman, Dwayne Dean, Jessica F Magidson, Emily N Satinsky, Kelly Doran, Julia W Felton, Mary Kleinman, Dwayne Dean, Jessica F Magidson

Abstract

Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. CDC. Drug Overdose Death Data. Atlanta, GA2017 [cited 2018]; .
    1. KFF. Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted). Henry J Kaiser Family Foundation, 2017.
    1. NIH. Opioid Summaries by State: Maryland. National Institute on Drug Abuse, 2018.
    1. Hogan L, Rutherford BK, Neall RR. Unintentional Drug- and Alcohol-Related Intoxication Deaths in Maryland Annual Report 2017. Maryland Department of Health, 2017.
    1. Baltimore City’s Response to the Opioid Epidemic. Baltimore City Health Department, 2018.
    1. Asante-Muhammed D. The Racial Wealth Divide in Baltimore. Prosperity Now, 2017.
    1. Williams CT, Latkin CA. Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine. American Journal of Preventive Medicine. 2007;32(6):S203–S10.
    1. Bosworth B. Increasing disparities in mortality by socioeconomic status. Annual Review of Public Health. 2018;39:237–51. 10.1146/annurev-publhealth-040617-014615
    1. Flores YN, Yee HF, Leng M, Escarce JJ, Bastani R, Salmeron J, et al. Risk factors for chronic liver disease in Blacks, Mexican Americans, and Whites in the United States: results from NHANES IV, 1999–2004. The American Journal of Gastroenterology. 2008;103(9):2231–8.
    1. Yang AL, Vadhavkar S, Singh G, Omary MB. Epidemiology of alcohol-related liver and pancreatic disease in the United States. Archives of Internal Medicine. 2008;168(6):649–56. 10.1001/archinte.168.6.649
    1. James K, Jordan A. The opioid crisis in black communities. Journal of Law, Medicine & Ethics. 2018;46(2):404–21.
    1. CDC. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016. Atlanta, GA: Centers for Disease Control and Prevention, 2018.
    1. IRP. The opioid epidemic and socioeconomic disadvantage. Madison, WI: Institute for Research on Poverty, 2018.
    1. Interactive NSDUH State Estimates. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017.
    1. Community Health Assessment. Baltimore City, MD: Baltimore City Health Department, 2017.
    1. Wakeman SE, Barnett ML. Primary care and the opioid-overdose crisis—buprenorphine myths and realities. The New England Journal of Medicine. 2018;379(1).
    1. Carusone SC, Guta A, Robinson S, Tan DH, Cooper C, O’Leary B, et al. "Maybe if I stop the drugs, then maybe they’d care?"—hospital care experiences of people who use drugs. Harm Reduction Journal. 2019;16(16).
    1. Liebling EJ, Yedinak JL, Green TC, Hadland SE, Clark MA, Marshall BDL. Access to substance use treatment among young adults who use prescription opioids non-medically. Substance Abuse Treatment, Prevention, and Policy. 2016;11(38).
    1. van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence. 2013;131(1–2):22–35.
    1. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. U.S. Department of Health & Human Services, 2016.
    1. McGovern MP, Carroll KM. Evidence-based practices for substance use disorders. Psychiatric Cinics of North America. 2003;26(4):991–1010.
    1. Glasner-Edwards S, Rawson R. Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy. 2010;97(2–3):93–104. 10.1016/j.healthpol.2010.05.013
    1. Schmidt LA, Rieckmann T, Abraham A, Molfenter T, Capoccia V, Roman P, et al. Advancing recovery: Implementing evidence-based treatment for substance use disorders at the systems level. Journal of Studies on Alcohol and Drugs. 2012;73(3):413–22. 10.15288/jsad.2012.73.413
    1. Reif S, Braude L, Lyman R, Dougherty RH, Daniels AS, Ghose SS, et al. Peer recovery support for individuals with substance use disorders: Assessing the evidence. Psychiatric Services. 2014;65(7):853–61. 10.1176/appi.ps.201400047
    1. Bassuk EL, Buckner JC, Perloff JN, Bassuk SS. Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry. 1998;155(11):1561–4. 10.1176/ajp.155.11.1561
    1. Jack HE, Oller D, Kelly J, Magidson JF, Wakeman SE. Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches. Substance Abuse. 2017:1–8.
    1. Magidson JF, Joska JA, Regenauer KS, Satinsky E, Andersen L, Seitz-Brown CJ, et al. "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. International Journal of Drug Policy. 2019;70:61–9. 10.1016/j.drugpo.2018.11.004
    1. London K, McCaffrey M, McDowell L, Maughan M, Tourish J. Recovery Coaches in Opioid Use Disorder Care. University of Massachusetts Medical School Commonwealth Medicine Division, 2018.
    1. SAMHSA. What are Peer Recovery Support Services? Rockville, MD: U.S. Department of Health and Human Services, 2009.
    1. Cabral RR, Smith TB. Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology. 2011;58(4):537–54. 10.1037/a0025266
    1. Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL. Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behavior Modification. 2011;35(2):111–61. 10.1177/0145445510390929
    1. Daughters SB, Magidson JF, Anand D, Seitz-Brown CJ, Chen Y, Baker S. The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial. Addiction. 2017;113(3):535–44. 10.1111/add.14049
    1. Mimiaga MJ, Closson EF, Pantalone DW, Safren SA, Mitty JA. Applying behavioral activation to sustain and enhance the effects of contingency management for reducing stimulant use among individuals with HIV infection. Psychology, Health & Medicine. 2019;24(3):374–81.
    1. Mimiaga MJ, Reisner SL, Pantalone DW, O’Cleirigh C, Mayer KH, Safren SA. A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care and STDs. 2012;26(11):681–93. 10.1089/apc.2012.0216
    1. Magidson JF, Gorka SM, MacPherson L, Hopko DR, Blanco C, Lejuez CW, et al. Examining the effect of the Life Enhancement Treatment for Substance use (LETS ACT) on residential substance abuse treatment retention. Addictive Behaviors. 2011;36:615–23. 10.1016/j.addbeh.2011.01.016
    1. Magidson JF, Lejuez CW, Kamal T, Blevins EJ, Murray LK, Bass JK, et al. Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq. Global Mental Health. 2015;2(e24).
    1. Ekers D, Richards D, McMillan D, Bland JM, Gilbody S. Behavioural activation delivered by the non-specialist: phase II randomised controlled trial. British Journal of Psychiatry. 2011;198(1):66–72. 10.1192/bjp.bp.110.079111
    1. Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis. PLoS One. 2014;9(6):e100100 10.1371/journal.pone.0100100
    1. Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, et al. The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials. 2014;15(101).
    1. Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389:176–85. 10.1016/S0140-6736(16)31589-6
    1. Daughters SB, Magidson JF, Schuster RM, Safren SA. ACT HEALTHY: A combined cognitive-behavioral depression and medication adherence treatment for HIV-infected substance users. Cognitive Behavioral Practice. 2010;17(3):309–21. 10.1016/j.cbpra.2009.12.003
    1. Daughters SB, Magidson JF, Anand D, Seitz-Brown CJ, Chen Y, Baker S. The effect of a behavioral activation treatment for substance use on post-treatment abstinence: a randomized controlled trial. Addiction. 2017.
    1. Magidson JF, Gouse H, Psaros C, Remmert JE, O’Cleirigh C, Safren SA. Task shifting and delivery of behavioral medicine interventions in resource-poor global settings: HIV/AIDS treatment in sub-Saharan Africa In: Vranceanu AM, Greer JA, Safren SA, editors. The Massachusetts General Hospital Handbook of Behavioral Medicine: A clinician’s guide to evidence-based psychosocial interventions for individuals with medical illness. New York, NY: Human Press; 2017. p. 297–320.
    1. Magidson JF, Andersen L, Satinsky EN, Myers B, Kagee A, Joska JA. "Too much boredom isn’t a good thing": Adapting behavioral activation for substance use in a resource-limited South African HIV are setting. Psychotherapy. In press.
    1. Papas RK, Sidle JE, Gakinya BN, Baliddawa JB, Martino S, Mwaniki MM, et al. Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction. 2011;106(12):2156–66. 10.1111/j.1360-0443.2011.03518.x
    1. Papas RK, Sidle JE, Martino S, Baliddawa JB, Songole R, Omolo OE, et al. Systemic cultural adaptation of cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in western Kenya. AIDS and Behavior. 2010;14(3):669–78. 10.1007/s10461-009-9647-6
    1. Myers B, Carney T, Browne FA, Wechsberg WM. A trauma-informed substance use and sexual risk reduction intervention for young South African women: A mixed-methods feasibility study. BMJ Open. 2019;9.
    1. Myers B, Petersen Williams P, van der Westhuizen C, Lund C, Lombard C, Joska JA, et al. Community health worker-delivered counselling for common mental disorders among chronic disease patients in South Africa: A feasibility study. BMJ Open. 2019;9(1):e024277 10.1136/bmjopen-2018-024277
    1. Myers B, Sorsdahl K, Morojele NK, Kekwaletswe CT, Shuper PA, Parry CD. "In this thing I have everything I need": Perceived acceptability of a brief alcohol-focused intervention for people living with HIV. AIDS Care. 2017;29(2):209–13. 10.1080/09540121.2016.1211242
    1. Sorsdahl K, Myers B, Ward CL, Matzopoulos R, Mtukushe B, Nicol A, et al. Adapting a blended motivational interviewing and problem-solving intervention to address risky substance use amongst South Africans. Psychotherapy Research. 2015;25(4):435–44. 10.1080/10503307.2014.897770
    1. Parry CD, Morojele NK, Myers BJ, Kekwaletswe CT, Manda SO, Sorsdahl K, et al. Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes—a randomised controlled trial protocol. BMC Infectious Diseases. 2014;14:500 10.1186/1471-2334-14-500
    1. Wingood GM, DiClemente RJ. The ADAPT-ITT model: A novel method of adapting evidence-based HIV interventions. Journal of Acquired Immune Deficiency Syndrome. 2008;47:S40–S6.
    1. WHO-ASSIST. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility. Addiction. 2002;97(9):1183–94. 10.1046/j.1360-0443.2002.00185.x
    1. Resnick B, Gruber-Baldini AL, Pretzer-Aboff I, Galik E, Buie VC, Russ K, et al. Reliability and validity of the evaluation to sign consent measure. 2007;47(1):69.
    1. MacPhillamy DJ, Lewinsohn PM. The pleasant events schedule: Studies on reliability, validity, and scale intercorrelation. Journal of Consulting and Clinical Psychology. 1982;50(3):363.
    1. Linehan MM. DBT Skills Training Manual. 2 ed New York, NY: The Guildford Press; 2015.
    1. Boyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development: Sage Publications, Inc; 1998.
    1. Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment. 2016;63:1–9. 10.1016/j.jsat.2016.01.003
    1. Tobin KE, Kuramoto SJ, Davey-Rothwell MA, Latkin CA. The STEP into Action study: a peer-based, personal risk network-focused HIV prevention intervention with injection drug users in Baltimore, Maryland. Addiction. 2011;106(2):366–75. 10.1111/j.1360-0443.2010.03146.x
    1. Eddie D, Hoffman L, Vilsaint C, Abry A, Bergman B, Hoeppner B, et al. Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in psychology. 2019;10(1052).
    1. Hammett TM, Jarlais DCD, Kling R, Kieu BT, McNicholl JM, Wasinrapee P, et al. Controlling HIV Epidemics among Injection Drug Users: Eight Years of Cross-Border HIV Prevention Interventions in Vietnam and China. Plos One. 2012;7(8).
    1. Rashid RA, Kamali K, Habil MH, Shaharom MH, Seghatoleslam T, Looyeh MY. A mosque-based methadone maintenance treatment strategy: implementation and pilot results. The International journal on drug policy. 2014;25(6):1071–5. Epub 2014/08/12. 10.1016/j.drugpo.2014.07.003
    1. Samuels EA, Baird J, Yang ES, Mello MJ. Adoption and utilization of an emergency department naloxone distribution and peer recovery coach consultation program. Academic Emergency Medicine. 2019;26(2):160–73. 10.1111/acem.13545
    1. Samuels EA, Bernstein SL, Marshall BDL, Krieger M, Baird J, Mello MJ. Peer navigation and take-home naloxone for opioid overdose emergency department patients: Preliminary patient outcomes. Journal of Substance Abuse Treatment. 2018;94:29–34. 10.1016/j.jsat.2018.07.013
    1. Scott CK, Grella CE, Nicholson L, Dennis ML. Opioid recovery initiation: Pilot test of a peer outreach and modified Recovery Management Checkup intervention for out-of-treatment opioid users. Journal of Substance Abuse Treatment. 2018;86:30–5. 10.1016/j.jsat.2017.12.007
    1. Watson DP, Brucker K, McGuire A, Snow-Hill NL, Xu H, Cohen A, et al. Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana’s Opioid State Targeted Response plan. Journal of Substance Abuse Treatment. 2019.
    1. Scott CK, Dennis ML, Grella CE, Kurz R, Sumpter J, Nicholson L, et al. A community outreach intervention to link individuals with opioid use disorders to medication-assisted treatment. Journal of Substance Abuse Treatment. 2019.
    1. Magidson JF, Blashill AJ, Safren SA, Wagner GJ. Depressive symptoms, lifestyle structure, and ART adherence among HIV-infected individuals: A longitudinal mediation analysis. AIDS and Behavior. 2015;19(1):34–40. 10.1007/s10461-014-0802-3
    1. Wagner GJ, Ryan GW. Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users. AIDS Patient Care and STDs. 2004;18(7):385–93. 10.1089/1087291041518238
    1. Petry NM, Lewis MW, Ostvik-White EM. Participation in religious activities during contingency management interventions is associated with substance use treatment outcomes. American Journal on Addictions. 2009;17(5):408–13.
    1. van der Meer Sanchez Z, Nappo SA. Religious intervention and recovery from drug addiction. Revista de Saude Publica. 2008;42(2).
    1. Laudet AB, Morgen K, White WL. The role of social supports, spirituality, religiousness, life meaning and affiliation with 12-Step fellowships in quality of life satisfaction among individuals in recovery from alcohol and drug problems. Alcoholism Treatment Quarterly. 2006;24(1–2):33–73. 10.1300/J020v24n01_04
    1. Francis JM, Myers B, Nkosi S, Petersen Williams P, Carney T, Lombard C, et al. The prevalence of religiosity and association between religiosity and alcohol use, other drug use, and risky sexual behaviours among grade 8–10 learners in Western Cape, South Africa. PLoS One. 2019;14(2):e0211322 10.1371/journal.pone.0211322
    1. Wang D, Wang Y, Wang Y, Li R, Zhou C. Impact of physical exercise on substance use disorders: A meta-analysis. PLoS One. 2014;9(10):e110728 10.1371/journal.pone.0110728
    1. Zschucke E, Heinz A, Strohle A. Exercise and physical activity in the therapy of substance use disorders. The Scientific World Journal. 2012;2012.
    1. Acuff SF, Dennhardt AA, Correia CJ, Murphy JG. Measurement of substance-free reinforcement in addiction: A systematic review. Clinical Psychology Review. 2019;70:79–90. 10.1016/j.cpr.2019.04.003
    1. Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD. Drug and Alcohol Dependence. 2013;132(3):457–65. 10.1016/j.drugalcdep.2013.03.009
    1. Genberg BL, Gange SJ, Go VF, Celentano DD, Kirk GD, Latkin CA, et al. The effect of neighborhood deprivation and residential relocation on long-term injection cessation among injection drug users (IDUs) in Baltimore, Maryland. Addiction. 2011;106(11):1966–74. 10.1111/j.1360-0443.2011.03501.x
    1. Magidson JF, Seitz-Brown CJ, Safren SA, Daughters SB. Implementing behavioral activation and life-steps for depression and HIV medication adherence in a community health center. Cognitive and Behavioral Practice. 2014;21:386–403. 10.1016/j.cbpra.2013.10.002
    1. Daughters SB, Magidson JF, Schuster RM, Safren SA. ACT HEALTHY: A combined cognitive-behavioral depression and medication adherence treatment for HIV-infected substance users. Cognitive and Behavioral Practice. 2010.
    1. Connery HS. Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions. Harvard Review of Psychiatry. 2015;23(2):63–75. 10.1097/HRP.0000000000000075
    1. D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44. 10.1001/jama.2015.3474
    1. Clark RE, Baxter JD, Aweh G, O’Connell E, Fisher WH, Barton BA. Risk factors for relapse and higher costs among Medicaid members with opioid dependence or abuse: Opioid agonists, comorbidities, and treatment history. Journal of Substance Abuse Treatment. 2015;57:75–80. 10.1016/j.jsat.2015.05.001
    1. Catherine P, Nicholas M. Qualitative Research in Health Care: BMJ Publishing Group: BMJ Books; 2007.
    1. Dara M, Solovic I, Sotgiu G, D’Ambrosio L, Centis R, Tran R, et al. Tuberculosis care among refugees arriving in Europe: A ERS/WHO Europe Region survey of current practices. European Respiratory Journal. 2016;48(3):808–17. 10.1183/13993003.00840-2016

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