I often talk about how substance use and substance use disorders (SUDs) change the brain, but that malleability (plasticity) is multifaceted. While drugs change the brain, lived experiences, aging, and treatment change it too.
Cessation or potentially even reduction of substance use, for example through treatment, can heal the brain and in doing so drive positive changes in emotion, cognition, and behavior that can facilitate recovery. When people enter treatment for an SUD, it should be with the knowledge and understanding that recovery is achievable.
But while treatments such as medications for opioid use disorder (MOUD) or behavioral approaches like cognitive behavioral therapy or contingency management address the biological and behavioral dimensions of an SUD, changes in the brain and behavior take time, as does resolving the radiating impacts of an SUD on an individual’s life. Those impacts may include job loss, loss of housing, fractured relationships with family and friends, and involvement in the criminal justice system. People may need ongoing support and help with these issues to maintain and sustain their recovery.
A wide range of services and supports have been developed, including recovery housing, recovery high schools (for adolescents and young adults), as well as the many community- and faith-based organizations such as mutual aid groups that have long augmented and in many cases substituted for treatment when the latter was not available or desired. These services not only provide essential social connection with peers who understand and support their recovery, they may also make it easier for people to continue with treatment or reenter treatment when needed.
Unfortunately, much less is known about recovery supports than about treatment, such as which kinds of services are most effective, how they work, and how they are best adapted to the needs of different people. Without that knowledge of efficacy, insurers and other payers may not cover these potentially useful components of the care spectrum, and people may not know which to choose.
NIDA has been supporting research on peer and community-based recovery supports, active recovery communities, and recovery modalities that integrate multiple services, such as recovery residences. But more focus is still needed on this topic, to build foundational knowledge of these services and thus better advance this part of the U.S. Department of Health and Human Services Overdose Prevention Strategy. To that end, the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, with funding from NIDA, is supporting several additional research projects that will add to our knowledge of recovery residences, clinical continuing care, linkage to recovery community centers, and peer interventions to increase retention in treatment with MOUD.
Three of the new grants will develop resources to study recovery support services. One will establish a collaborative Peer Recovery Innovation Network (PRIN) that will develop resources for training and mentoring, as well as infrastructure to advance the science on facilitating continuation of care through these services after people are initiated on MOUD, as well as on such services delivered via technology, specifically for Hispanic/Latino/a people near the US-Mexico border and in other underserved areas. Another project will develop a network of researchers, recovery support specialists, and young adults (ages 18-25) in recovery, to advance our understanding of recovery support services for people in that age group who take MOUD, especially those with co-occurring mental disorders and polysubstance use. Another project will focus on developing tools and methods to better study the effectiveness of recovery residences for individuals who take MOUD.
Three grants will support trials of the effectiveness of recovery supports or the planning of such trials. One will develop an integrated intervention involving peer recovery coaching and cognitive behavioral therapy for opioid use disorder to enhance retention in MOUD treatment. Another will study the effectiveness of peer recovery support in helping people living in recovery residences remain in MOUD treatment or reengage in treatment after dropping out or after being discharged from a recovery residence. And another grant will support the planning of a multi-site trial to examine the effectiveness of recovery community centers serving Black communities to support people using MOUD.
A supplement to an existing grant will develop a coordinated infrastructure and a research agenda for the Consortium on Addiction Recovery Science (CoARS), which was initiated by five research teams previously funded by NIDA that will be expanded with funds from HEAL. This supplement provides sufficient resources to help the researchers coordinate their research and training efforts, harmonize their data and metrics, support diversity in the consortium, and ensure its sustainability, as well as organize the first national meeting on recovery support services science.
One of the themes that has emerged from the NIDA focus on recovery and recovery supports is the impressive ingenuity and proactiveness of people working in the field to develop novel solutions to address the rapidly evolving addiction and overdose crisis. Many of these researchers and other participants in these projects are themselves in recovery or have lived experience of addiction.
One of the cross-cutting themes of NIDA’s new FY 2022-2026 Strategic Plan is greater involvement of people with lived experience in research design, and the science of recovery supports is emblematic of how successful that mindset can be.
It is people on the front lines of the addiction and overdose crisis, peers finding innovative ways to help peers. NIDA’s role is to support research to determine which new approaches are most effective, and these new grants will facilitate the translation of that knowledge into interventions to help individuals with SUDs achieve recovery.