Supporting Treatment Access and Recovery in COD

NCT ID: NCT05138614

Last Updated: 2025-06-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-11

Study Completion Date

2026-08-31

Brief Summary

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This 4-year study will randomize 1,000 people with co-occurring opioid use and mental health disorders (COD) at medication for opioid use disorder (MOUD) clinics to evaluate the effectiveness of MISSION, a multi-component team approach, or its components with MOUD versus MOUD alone, as well as the incremental benefits of MISSION or its components for improving outcomes. We expect that individuals receiving MISSION or its parts + MOUD will show greater improvement over MOUD alone on: engagement, substance use, and mental health.

Detailed Description

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This is a 5-arm randomized control trial with a fractional factorial design among 1,000 patients across Massachusetts. Patients will be randomized to: 1) MOUD alone; 2) full MISSION (CTI \& DRT \& PS) + MOUD; 3) CTI \& DRT + MOUD; 4) PS \& DRT + MOUD; or 5) CTI \& PS + MOUD (Arms 3-5 are the 3 combinations of 2 MISSION parts). MISSION is a time-limited, cross disciplinary, team-based wraparound approach that provides 6 months of psychosocial treatment combined with assertive outreach, empowering clients to access and engage in care and community services to promote recovery. The MISSION treatment curriculum integrates 3 evidence-based practices along with MOUD: 1) Critical Time Intervention (CTI), a time-limited form of assertive community treatment; 2) Dual Recovery Therapy (DRT), which is integrated mental health and substance use group therapy; and 3) Peer Support (PS), offering support for people in recovery by people in recovery. Participants will receive 6 months of treatment and be followed for 1-year.

Study aims include:

Aim 1: To evaluate the effectiveness of MISSION or its bundled parts with MOUD versus MOUD alone, as well as the incremental benefits of MISSION and its parts + MOUD to improve outcomes 1a-c for CODs.

Hypothesis 1.1: Individuals receiving MISSION or its parts + MOUD will show greater improvement over MOUD alone on: 1a. Engagement (measured by total days in treatment, percentage of days receiving MOUD, and total number of outreach and linkages sessions); 1b. Opioid use and other substance use (measured by self-report days of use and drug screens); and 1c. Mental health (measured by self-report mental health symptoms).

Hypothesis 1.2: MISSION + MOUD will outperform its parts + MOUD but at least one of the three combinations + MOUD will be at least 75% as effective compared to the full MISSION protocol on outcomes 1a-c.

Aim 2: To examine mechanisms of action of MISSION in CODs. Hypothesis 2.1: The effects of MISSION and its bundled parts on health outcomes (mental health, opioid and other substance use) are mediated by treatment participation and other measures (e.g., recovery capital, psychosocial supports, and quality of life). Hypothesis 2.2: The effects of MISSION and its parts on health outcomes are moderated by key patient characteristics (e.g., demographics, severity of COD, and MOUD type).

Aim 3: To conduct a comprehensive economic evaluation of MISSION or its bundled parts and MOUD.

Estimate cost of full MISSION or its bundled parts compared to MOUD alone, and to evaluate cost-effectiveness and return on investment from multiple perspectives, including patient, clinic, healthcare, taxpayer, and societal.

Exploratory Aim: 4. To construct a predictive model that can match optimum combined use of MISSION parts with specific patient's needs for greater improvements in health outcomes, which will inform a future randomized controlled trial on cost-effective patient-level precision intervention assignment.

Conditions

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Opioid Use Disorder Mental Health Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

MISSION is a time-limited, cross disciplinary, team-based wraparound approach that provides 6 months of psychosocial treatment combined with assertive outreach, empowering clients to access and engage in care and community services to promote recovery. The MISSION treatment curriculum integrates 3 evidence-based practices along with MOUD: 1) Critical Time Intervention (CTI), a time-limited form of assertive community treatment; 2) Dual Recovery Therapy (DRT), which is integrated mental health and substance use group therapy; and 3) Peer Support (PS), offering support for people in recovery by people in recovery
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Full MISSION

CTI + DRT + PS + MOUD

Group Type EXPERIMENTAL

Medication for Opioid Use Disorder

Intervention Type OTHER

medication management

MISSION Critical Time Intervention

Intervention Type BEHAVIORAL

offering intensive community-based services that decrease in intensity over time

MISSION Peer Support

Intervention Type BEHAVIORAL

including 11 recovery-oriented sessions from someone with lived experience of co-occurring disorders

MISSION Dual Recovery Therapy

Intervention Type BEHAVIORAL

comprised of 13 structured co-occurring disorders treatment sessions

CTI & DRT

CTI + DRT + MOUD

Group Type EXPERIMENTAL

Medication for Opioid Use Disorder

Intervention Type OTHER

medication management

MISSION Critical Time Intervention

Intervention Type BEHAVIORAL

offering intensive community-based services that decrease in intensity over time

MISSION Dual Recovery Therapy

Intervention Type BEHAVIORAL

comprised of 13 structured co-occurring disorders treatment sessions

CTI & PS

CTI + PS + MOUD

Group Type EXPERIMENTAL

Medication for Opioid Use Disorder

Intervention Type OTHER

medication management

MISSION Critical Time Intervention

Intervention Type BEHAVIORAL

offering intensive community-based services that decrease in intensity over time

MISSION Peer Support

Intervention Type BEHAVIORAL

including 11 recovery-oriented sessions from someone with lived experience of co-occurring disorders

DRT & PS

DRT + PS + MOUD

Group Type EXPERIMENTAL

Medication for Opioid Use Disorder

Intervention Type OTHER

medication management

MISSION Peer Support

Intervention Type BEHAVIORAL

including 11 recovery-oriented sessions from someone with lived experience of co-occurring disorders

MISSION Dual Recovery Therapy

Intervention Type BEHAVIORAL

comprised of 13 structured co-occurring disorders treatment sessions

MOUD only

MOUD

Group Type OTHER

Medication for Opioid Use Disorder

Intervention Type OTHER

medication management

Interventions

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Medication for Opioid Use Disorder

medication management

Intervention Type OTHER

MISSION Critical Time Intervention

offering intensive community-based services that decrease in intensity over time

Intervention Type BEHAVIORAL

MISSION Peer Support

including 11 recovery-oriented sessions from someone with lived experience of co-occurring disorders

Intervention Type BEHAVIORAL

MISSION Dual Recovery Therapy

comprised of 13 structured co-occurring disorders treatment sessions

Intervention Type BEHAVIORAL

Other Intervention Names

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MOUD CTI PS DRT

Eligibility Criteria

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Inclusion Criteria

* Are 18 years-old and older;
* Are fluent in English or Spanish;
* Have OUD who (a) are newly admitted into the program with OUD; or (b) who have been active in the program for the treatment of OUD with medications like buprenorphine or naltrexone, but experienced a recent relapse with any substance (e.g., alcohol, cocaine, opioids, or benzodiazepines). This second group is necessary to include because patients who may have been stable for a long period of time may have a relapse and need intensive treatment to help them regain their abstinence and facilitate the path towards recovery. Thus, by taking those newly enrolled and those who were stable on MOUD but had a recent relapse, the second group is clinically similar to the first group and the intervention will be meaningful.;
* Able to provide consent;
* Potentially have a concurrent substance use disorder in addition to opioids; and

Exclusion Criteria

* Are not fluent in English or Spanish;
* Are acutely psychotic, acutely suicidal with a plan, or homicidal;
* Are incompetent and unable to provide informed consent; and
* Have concurrent severe alcohol use disorder or high dose benzodiazepine needing detoxification. This exclusion factor is based on DSM-5 criteria, and those who are currently drinking or with a history of severe alcohol withdrawal (i.e., alcohol related seizures, and delirium tremens) will also be excluded. High dose benzodiazepine is defined as using Lorazepam equivalent of \> 10 mg/day; Diazepam \> 100 mg/day; Clonazepam 5 mg/ day; Alprazolam 5 mg/day.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of Massachusetts, Lowell

OTHER

Sponsor Role collaborator

Cornell University

OTHER

Sponsor Role collaborator

Harvard Medical School (HMS and HSDM)

OTHER

Sponsor Role collaborator

University of Massachusetts, Worcester

OTHER

Sponsor Role lead

Responsible Party

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David Smelson

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David Smelson, PsyD

Role: PRINCIPAL_INVESTIGATOR

University of Massachusetts, Worcester

Locations

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Behavioral Health Network

Holyoke, Massachusetts, United States

Site Status RECRUITING

Behavioral Health Network

Orange, Massachusetts, United States

Site Status RECRUITING

Behavioral Health Network

Springfield, Massachusetts, United States

Site Status RECRUITING

UMass Chan Road to Care Clinic

Worcester, Massachusetts, United States

Site Status RECRUITING

SaVida Health

Worcester, Massachusetts, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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David Smelson, PsyD

Role: CONTACT

508-713-5420

Abigail Helm, PhD

Role: CONTACT

413-313-2806

Facility Contacts

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Herschelle Reaves

Role: primary

Calla Harrington

Role: primary

Herschelle Reaves

Role: primary

Brittany Chapman

Role: primary

Shelley Modzeleski

Role: primary

Other Identifiers

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1R01MH128904

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H00023911

Identifier Type: -

Identifier Source: org_study_id

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