URI psychology Professor Nicole Weiss’s study, funded by $5.5 million NIH grant, aims to prevent return to use, overdose deaths
Continuity of care is critical to success following residential treatment for opioid use disorder—especially for those also experiencing posttraumatic stress disorder—but due to barriers like access to care, exorbitant healthcare costs, and the potential for societal stigma, many individuals do not continue care after they leave residential treatment, putting them at risk for return to use and potential overdose death.
University of Rhode Island psychology Professor Nicole Weiss is aiming to provide patients with an easy, effective alternative to help them continue getting the treatment they need. Funded by a $5.5 million, six-year grant from the National Institute on Drug Abuse, Weiss and her team are working to develop a mobile app specifically designed for individuals who have PTSD and are transitioning out of residential opioid use disorder treatment. The interactive app would offer resources, advice, and support specifically targeted to the individual, provided at precise times that the personalized app determines the individual needs it most.
“We know the period immediately following residential services is a really vulnerable time because patients go from a restricted environment where they don’t have access to substances and where they are getting 24-hour access to care and resources, to then moving back into their communities where they previously used,” Weiss said. “A lot of folks return to use pretty quickly, and we know that period is really vulnerable for folks because they no longer have tolerance to opioids so their return to use is also associated with risks for overdose and, ultimately, death. Because we saw that people returned to use so quickly, we determined it would be critical to give patients a tool they had access to at the tip of their fingers.”
Weiss is in the first phase of the project, a two-year period during which her team is recruiting 150 patients preparing to leave residential treatment facilities in Rhode Island to help identify risk factors for return-to-use, and protective factors that help prevent it. Study participants will complete multiple daily surveys designed to identify and evaluate factors that both increase and decrease risk for opioid use and related harms. The surveys will ask individuals about their current experiences—their emotions; what they’re doing and who they’re with at that moment; whether they are experiencing cravings; whether they have used opioids, etc. After 30 days, study participants return to Weiss’ lab to share their experiences following residential treatment, helping build an adaptive app tailored specifically to their needs.
“The uniqueness of the study is that it uses a community-engaged, ground-up approach,” Weiss said. “People with histories of lived trauma and opioid use disorder have often been excluded from the research process. By including these individuals in the research process, we can develop interventions that consider their needs and priorities, and thus improve outcomes.”
Once Weiss and her team develop the initial app, the second phase of the study will focus on examining the utility of the mobile app intervention. Over the next four years, 300 individuals leaving residential opioid treatment facilities will use the app to test its effectiveness. It will contain on-demand content that is available at all times, including psychoeducational, treatment, and harm reduction resources. Uniquely, it will also include automated content that will be triggered by the app when there is a real-time need. The automated messages will be tailored to a person’s current risk of return to use and related harm.
“The final result will be a just-in-time adaptive intervention, which is a type of intervention that provides tailored support during moments of need. It will undergo micro-randomized trials to evaluate the efficacy of the automated messages, and to ultimately optimize the intervention,” Weiss said. “The content will be highly personalized, using contextual, person-specific and time-varying information to determine whether and how to intervene to reduce opioid use and related harms.”
The app will be tailored specifically to those experiencing PTSD, which is common among those with opioid use disorder, affecting roughly half of the population, Weiss said. The interventions will be designed to provide strategies and resources to individuals dealing with both conditions.
“Traumatic experiences are more the norm than the exception among those with opioid use disorder, especially interpersonal traumas,” Weiss said. “It’s important for us to address PTSD in our treatments for individuals with opioid use because many report that their opioid use primarily serves to relieve PTSD symptoms; they’re basically self-medicating. If we don’t address the trauma, then persistence of PTSD symptoms after residential opioid use treatment can ultimately result in return to use. It’s crucial that we address this comorbidity to help optimize outcomes for individuals with opioid use disorder.”