BACKGROUND:For decades knowledge about the etiology, epidemiology, neurobiology, typology, and treatment of addiction in various populations has been well documented and widely disseminated. In more recent years, there has been a growing interest in investigating the prevalence, multiple pathways, and mechanisms that facilitate sustained remission and long-term stable recovery. Such an endeavor is predicated on the belief that discovery of not just more effective short-term stabilization and addiction treatment protocols, but also how people achieve long-term recovery will help ameliorate current addiction crises. Such experiential knowledge could inspire and inform the testing of new service strategies to meet the dynamic recovery needs of diverse populations-services that could be coordinated with, or supplant, existing ones toward the goals of engaging affected individuals and families earlier and better supporting them across the long-term stages of recovery. ARGUMENT/ANALYSIS:The "why", "what" and "how", involved in creating and pursuing a recovery research agenda is described, with detailed attention given to twelve significant research dimensions that promise to enhance understanding of the multiple recovery pathways and mechanisms and thereby improve the precision, nature, timing, and scope of services. The article also describes how best to engage with recovery communities cross-culturally to obtain the most accurate, informative, and beneficial results. CONCLUSIONS:A new science of addiction recovery promises to reinvigorate and vitally inform clinical and public health efforts in ameliorating endemic harms related to addiction.
Background Although medications for opioid use disorder (MOUD) improve outcomes for persons with opioid use disorder (OUD), it is unclear whether augmentation with mutual help groups (MHGs), such as 12-Step programs, enhances abstinence following jail release. This study examined how MHG and MOUD together affect abstinence in persons with problematic opioid use in the 6 months post-incarceration. Method We subset to 328 adult participants who completed baseline, 3- and 6-month follow-ups. All screened positive for problematic opioid use upon discharge from jail, primarily in Chicago. Participants reported days of MHG and MOUD participation and days abstinent from illicit opioids. Both supports could be accessed in any combination. Beta-binomial models estimated the effects of MHG and MOUD participation at 3 months on abstinent days at 3 and 6 months, adjusting for relevant baseline factors. Results At 3 months, each day of MHG participation was associated with + 0.4 days of opioid abstinence. MOUD days showed a similar effect (+0.3 abstinent days). At 6 months, 3-month MHG and MOUD days continued to predict greater abstinence to a smaller degree (+0.3 and +0.1 days, respectively). Together, MHGs were associated with greater abstinence only among individuals receiving low levels of MOUD at 3-months. No MHG×MOUD interaction was observed at 6-months. Conclusion Our findings highlight the benefits of incorporating MHGs and MOUD to support abstinence from illicit opioids while extending prior work to a predominately Black, post-incarceration sample. Further research should examine factors influencing the combined effects of MHG and MOUD participation.
The overdose crisis continues to be a critical public health challenge in the United States and elsewhere. While funding has been provided at the federal, state, and municipal levels, implementation of strategies to address overdose is accomplished at the county level in most states. model-driven decision support, using tools like agent-based modeling, has emerged as a promising approach for predicting outcomes, tailoring interventions, and allocating implementation resources. While there are a number of examples of model development, there has been little study of the implementation of model-driven decision support to reduce overdose. This paper describes the lessons learned at the midpoint in an implementation study on the adoption of model-driven decision support to optimize overdose mitigation strategies by three counties. The Stages of Implementation Completion® is used within the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to describe the process of incorporating modeling into the decision-making process in three counties. Key lessons are that the process of developing, running, and discussing models with the community is of value regardless of model output, that useful models can be built with incomplete and less recent data, and that community decision makers are interested in using predictive models when they understand the inputs and assumptions that drive the output. This work highlights the potential for model-driven decision support’s incorporation into evidence-based planning in local communities and provides insight for future implementation.
Background Cysticercosis (CC) is a zoonotic disease transmitted between pigs and humans, caused by the larval stage of T. solium that leads to neurological morbidity in humans and economic losses in pig-farming communities in low-resource rural regions. Ring Treatment (RT) is an evidence-based intervention that integrates a community participatory approach to provide antiparasitic treatment to households within 100-meters of an infected pig. This study aimed to evaluate the multiphase implementation of RT as a public health program in northern Peru, with a focus on feasibility, adoption, and sustainability. Methods We conducted a multi-method, three-phase implementation study from 2019–2025 in Tumbes, Peru. Phase 1 involved a formative evaluation using the expanded Consolidated Framework for Implementation Research for low- and middle-income countries. We used semi-structured interviews (n = 169), social network surveys (n = 341), and two process-mapping workshops (n = 26) to describe barriers, facilitators, and RT protocol adaptations. In phase 2, we piloted RT in a small health district, reviewed registries, and conducted community surveys and interviews for quality improvement. In phase 3, we rolled out RT in two districts and applied the RE-AIM framework to assess implementation outcomes. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent rapid qualitative analysis and template analysis (thematic analysis for hierarchical coding). Results Key facilitators included adaptability of existing health programs and strong engagement with community health workers (CHW) and communities. Barriers included high staff turnover, workload, and resource constraints. The pilot study achieved 75% treatment coverage among eligible populations, increased community knowledge of the CC transmission cycle, and prompted regional-level policy changes. During the RT rollout, 100% of health facilities established RT procedures, with moderate participation in training and treatment (53% and 87%). However, the COVID-19 pandemic and political instability limited the effectiveness of assessments and the completeness of data. Conclusions RT is feasible and acceptable as a public health program for T. solium control in rural, endemic, low-resource settings. Success hinges on community and CHW involvement, adaptive protocols, and cross-sectoral partnerships. Continued investment in One Health approaches that view the human-animal-environment intersection as central to health is needed to sustain and expand progress in controlling zoonoses.
