Improving the Sustainability of Recovery Housing Organizations to Facilitate Long-term Recovery from Substance Use Disorders
Substance Use Disorders are chronic conditions requiring intensive interventions and long-term care, but most treatments are time-limited and do not address structural barriers to recovery. One barrier is limited access to safe and stable housing. Recovery housing (e.g., recovery homes, sober living homes, and Oxford Houses) addresses this critical need by providing supportive living environments for people in recovery from substance use disorders. Numerous research studies have documented that recovery housing facilitates positive outcomes for residents through substance use recovery, decreased criminal justice involvement, and higher employment. However, housing costs in recovery residences are not presently covered by private or public health insurance, which presents barriers to individuals who need recovery housing. Lack of insurance coverage may also threaten the quality and sustainability of recovery housing at the provider level.
In partnership with the CLEAN Cause Foundation, researchers at The Addiction Research Institute will establish a consortium of experts across The University of Texas System to develop innovative funding models that facilitate recovery housing sustainability and address the financial gap created by insurance coverage ineligibility. The generation of this empirical research will also inform new policy initiatives that advocate for recovery housing organizations’ insurance coverage eligibility.
Principal Investigators: Fiona Conway, Ph.D., Julie McElrath, MSSW
Project Sponsor: FIRST Fund
Alcohol, Approach-Avoidance, and Neurocircuitry Interactions in PTSD
Individuals with posttraumatic stress disorder (PTSD) have a greater prevalence of alcohol use disorders (AUDs). This comorbidity is associated with worse illness outcomes. Yet there remains limited mechanistic understanding of how PTSD confers risk for AUD. This project aims to identify alcohol-induced changes in approach-avoidance decision-making and mediating neural networks that predict alcohol use and symptoms of AUDs over a one-year follow-up period in adults with PTSD, compared to adults with interpersonal violence exposure but no PTSD, and healthy comparison adults. Essential to successfully improving clinical prognosis in PTSD are research results that enable better prediction, diagnosis, and treatment based on the individual. Data could identify brain and behavioral mechanisms explaining how alcohol alters an important domain of PTSD, contributing to the risk for alcohol misuse and the development of alcohol problems. Results could pave the way for developing novel behavioral and pharmacological methods to treat PTSD and decrease the risk for developing comorbid AUDs.
Role: Co-Investigator, Principal Investigator: Elizabeth Lippard, Ph.D.
Project Sponsor: National Institute on Alcohol Abuse and Alcoholism
An intersectional examination of early tobacco use among White and Black adolescents
Tobacco use is a prominent cause of preventable health disparities between White and Black individuals. Although the lifetime prevalence of tobacco use is lower for Black than it is for White individuals, Black adolescents are less likely to quit tobacco once they initiate use. In the long run, Black individuals suffer disproportionately from tobacco-related death and diseases. In this study, we employ a theoretically grounded and innovative conceptual model to examine Black-White differences in tobacco use across multiple intersecting domains and levels of influence. Our analyses aim to elucidate unique patterns of risk and protective factors over time and their relation to tobacco use in the long run. This study’s findings will advance our understanding of diminished gains for Black individuals from standard tobacco control approaches. Further, this developmental study will identify new potential therapeutic targets for clinical and public health intervention development.
Role: Co-Investigator, Principal Investigator: Dr. Adriana Espinosa
Project Sponsor: National Institute on Minority Health and Health Disparities
Completed Projects
Opioid Use Mobile Heart Rate Biofeedback Intervention
Most evidence-based treatments for opioid use disorders (OUD) require face-to-face interactions with individuals who comprise a recovery support network. These individuals include but are not limited to, clinicians who provide individual therapy sessions, physicians who manage medication-assisted treatments (MAT), support groups, peer recovery coaches, and sponsors. Decades of research have enhanced the effectiveness of these services. However, at the specific moment when people in recovery relapse, they are often not in the presence of these trusted individuals. They may also be unable or unwilling to contact individuals who support their recovery by phone or text messages. They are alone, or they are with others who facilitate their drug use.
This Texas Targeted Opioid Response (TTOR)-funded project aims to address this issue by providing people in recovery with a heart-rate biofeedback smartphone app to guide them through slow-paced breathing exercises at the specific moments they feel compelled to use. Consistent use of these breathing exercises can also reduce stress, general anxiety, depression, and drug cravings. We are partnering with peer-specialist recovery coaches from the Recovery Support Services of the Texas Health and Human Services Commission to provide this intervention to people in their networks.
Principal Investigator: Fiona Conway, Ph.D.
Project Sponsor: Texas Health and Human Services Commission
Project CONNECT: Developing a State-of-the-Art Response to Overdose Reporting and Prevention in Texas
Over 70,000 overdose deaths occurred in the United States in 2017. Public data indicate that Texas does not have a significant opioid problem relative to the rest of the nation; however, qualitative data from healthcare providers, first responders, and harm reduction organizations indicate that Texas does have a more significant opioid problem than the data represents. Several reasons may contribute to underreporting, including misdiagnosing cause of deaths (e.g., “respiratory failure” vs. “opioid overdose”); stigma (many overdoses are unreported to EMS, law enforcement, or healthcare providers); and multiple, disjointed reporting systems. Since there is a lack of accurate, consistent, and timely statewide data available on overdoses and other related variables (e.g., Narcan administration), it is essential to design a tool to track drug overdoses, both fatal and non-fatal, by location, as they happen.
Project Connect aims to improve overdose reporting and prevention efforts through an innovative community-academic-industry partnership. This study uses community-engaged research methods to understand gaps in overdose reporting and prevention response in Texas. The community is at the center of this work. We have established community advisory boards across four counties: Bexar, El Paso, Travis, and Williamson. Preliminary research data will inform the development of a digital platform uniquely tailored to harm reduction organizations, first responders, healthcare providers, and the community of people who use drugs. We will pilot the platform across our four counties prior to launching statewide. A robust tracking system has the potential to inform preventative methods and optimize the expenditure of State funds through informed, data-driven decisions.
Role: Co-Investigator, Principal Investigator: Kasey Claborn, Ph.D.
Project Sponsor: Texas Health and Human Services Commission
Neurophysiological Responses to Stress: A Biomarker of Risk for Suicide in Bipolar Disorder
Suicide is among the leading causes of death amongst adolescents/young adults. Despite the importance of understanding the development of suicide risk, little data exists on neural circuitry predictors of suicide, especially during adolescence/young adulthood when suicide behavior often emerges. Bipolar disorder is associated with an increased risk for suicide, with estimates that up to 50% of individuals with bipolar disorder will attempt suicide in their lifetime. Research on the development of suicide behavior in bipolar disorder is critically needed to prevent suicide and identify biomarkers of risk for targeted intervention(s).
This project investigates the relations between neurophysiological responses to stress and suicide thoughts and behavior in euthymic adolescents and young adults with bipolar disorder type I to test the hypothesis that altered neurophysiological response to stress assessed through functional MRI and physiological monitoring is an early trait marker of risk for suicidal thoughts and behavior. Relations with suicide ideation, hopelessness, impulsivity, attempt lethality, and executive functioning will be investigated. The relations between responses to stress, childhood maltreatment, and substance use (alcohol, marijuana, and tobacco) will be explored. Results could greatly contribute to understanding the role(s) of variation in response to acute stress in suicide risk, and potentially neural predictors of suicide, in bipolar disorder, during adolescence/young adulthood when suicidal behaviors often emerge, and more generally, the relations with childhood maltreatment and substance use.
Role: Co-Investigator, Principal Investigator: Elizabeth Lippard, Ph.D.
Project Sponsor: American Foundation for Suicide Prevention
Biological Mechanisms of Behavior Change: The Baroreflex and Stress Reactivity
Posttraumatic stress disorder (PTSD) is commonly co-morbid with alcohol use disorders (AUD). Individuals who have both conditions have more physical health problems, greater social and functional impairment, higher risk for suicide, and weaker treatment outcomes than those who have either condition alone. Stress can exacerbate symptoms of posttraumatic stress disorder and substance use disorder. Although there are numerous interventions for each disorder, few employ a transdiagnostic approach that provides treatment for both conditions at the same time. This project investigates the potential of a novel intervention that utilizes a biological mechanism (the baroreflex) to modulate stress among individuals with co-morbid PTSD and AUD.
The baroreflex is a biological mechanism that maintains communication between the heart and the brain and operates outside of conscious awareness. It is associated with involuntary physiological reactions to environmental cues, modulation of emotional arousal, and cognitive control of behavior. It is easily manipulated by resonance frequency breathing and may be uniquely appropriate as a vehicle for the management of reactivity to daily stressors. During this study, the effect of baroreflex manipulation on stress reactivity will be quantified to provide empirical support for controlled breathing interventions for posttraumatic stress and substance use disorders.
Principal Investigator: Fiona Conway, Ph.D.
Project Sponsor: The University of Texas at Austin Office of the Vice President for Research