Brief History of Early Addiction Research

In the mid-1960s, investigators at Friends Research Institute (FRI) sought to understand and address the emerging heroin addiction epidemic. Dr. David Nurco, who joined FRI during this period, began studying the impact of drug abuse on families and the community. Over the course of the next 30 years, this body of research led by Dr. Nurco and his colleagues examined the etiology, course, correlates, and consequences of heroin addiction. It further examined the application of specialized self-help support groups for patients treated with methadone maintenance, measurement of drug use outcomes using urine drug testing, and the use of opioid antagonist medications to treat individuals with opioid use disorder under justice system supervision through probation and parole. Three particularly notable achievements of FRI at that time were the:

1. Demonstration of the link between heroin addiction and crime By examining self-reported criminal activity over the lifetime of heroin-addicted individuals, researchers determined that higher crime rates were associated with periods of active addiction, while markedly lower crime rates were associated with periods of recovery,
2. Clarification of the drug-crime nexus through the development of a typology of addiction that distinguished individual from situational determinants of addiction-related behavior, and
3. Determination of the impact of early developmental risk factors underlying vulnerability to addiction including associations with deviant peers, early onset of substance use and addiction, and high rates of poverty and unemployment in low-resource communities.

Recent Research Achievements

Building upon the work of Dr. Nurco and his colleagues, FRI’s addiction research agenda turned to services research and clinical trials to study the prevention, identification, and treatment of substance misuse and addiction and their correlates including HIV infection, criminal behavior, and decreased quality of life. These studies were conducted in healthcare settings, schools, community substance use treatment programs, probation and parole offices, jails, and prisons.

Five notable achievements during this period emerged from clinical trials demonstrating the effectiveness of treatment approaches, including studies showing that:

1. Interim methadone treatment (access to methadone without counseling in lieu of waiting list placement) was effective in reducing heroin use, HIV risk behavior, and arrest,
2. Initiating methadone treatment prior to release from prison was associated with better treatment linkage and reduction in heroin use in the community compared to referral to treatment,
3. Initiating sublingual buprenorphine treatment prior to release from prison was feasible and effective in facilitating post-release treatment entry,
4. Extended-release naltrexone treatment for opioid dependent adults with justice involvement, compared to referral to treatment without medication, was associated with a greater reduction in heroin use in a multi-site study, and
5. Supportive services for hospital patients with comorbid substance use disorders using proactive patient navigation were effective in facilitating linkage to treatment and reducing all-cause hospital readmissions.

Additional studies conducted by FRI investigators have focused on the following research areas:

Medication Studies. FRI investigators have conducted impactful implementation studies and clinical trials in the areas of medications for substance use disorders, including studies focused on:

• Effectiveness of patient-centered methadone treatment,
• Use of buprenorphine treatment as a reentry strategy for pre-release prisoners,
• Efficacy of buprenorphine implants for opioid use disorder,
• The safety and effectiveness of extended-release naltrexone for adolescents and young adults with opioid use disorder,
• Potential efficacy of multiple medications to treat cocaine use disorder, and
• Multiple trials focused on the implementation and effectiveness of different medications for opioid use disorder in justice settings.

Treatment Research within the Justice System. FRI investigators have conducted a broad range of treatment research within the justice system, including feasibility studies and randomized trials, aimed at reducing relapse and improving treatment engagement among justice-involved individuals.

• Effectiveness study of extended-release naltrexone in prison and continued medication delivery at place of residence,
• An open label pilot study of extended-release naltrexone for individuals in prison,
• A randomized controlled trial and cohort study of HIV testing and linkage to care at community corrections,
• HIV care cascade in community corrections: Implications for HIV treatment outcomes among justice involved populations,
• Implementing interim buprenorphine on-site at probation and parole,
• Testing client linkage to buprenorphine treatment from community corrections,
• Comparative effectiveness trials of extended-release naltrexone vs. extended-release buprenorphine.

Prevention Studies. FRI investigators have also been engaged in a number of prevention studies that have evaluated:

• An after-school prevention program designed to reduce the initiation and escalation of substance use, risky sexual behaviors, and violence among vulnerable African American youth in under-resourced communities,
• The relationship between specific risk and protective factors and perceptions of HIV risk and involvement in risky sexual behaviors among vulnerable African American youth in under-resourced communities,
• The effectiveness and cost-effectiveness of computer- and nurse practitioner-delivered interventions for cannabis and sexual health among high school students seen in school-based health centers,
• Educational curricula on cannabis in high school settings, and
• De-implementing opioid prescribing in dentistry to reduce exposure to unnecessary opioid analgesics.

Screening and Brief Intervention in Health Care Settings. FRI investigators have conducted studies to evaluate screening and brief intervention approaches in general health care settings including:

• Development and validation of a screening instrument (BSTAD; Brief Screener for Tobacco, Alcohol, and other Drugs) for adolescent primary care patients,
• Development of a computerized alcohol screening and intervention tool for adolescent primary care patients based on the NIAAA practitioner’s guide,
• Evaluation of a screening and brief assessment instrument for substance misuse [Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool] among adult primary care patients through the NIDA Clinical Trials Network,
• Effectiveness of a computer- vs. clinician-delivered brief intervention for substance misuse in primary care in New Mexico,
• Effectiveness of a brief intervention for adolescents in primary care in multiple rural healthcare sites in Tennessee and New Mexico, and
• Implementation of specialist vs. generalist models of brief intervention for substance use among adolescent primary care patients.

Substance Use Disorder and Treatment Studies. In addition to the studies described above, FRI scientists have conducted a number of service-focused studies including:

• The effectiveness of intensive outpatient vs. outpatient counseling for opioid-dependent African Americans receiving buprenorphine treatment,
• The effectiveness of initiating methadone treatment with vs. without counseling,
• The role of patient preferences for fentanyl in shaping risk and outcomes in residential treatment for opioid use disorder,
• Research on experiences with diverted medication during incarceration,
• Research on technology-based interventions to support individuals in treatment for substance use disorders, and
• Multi-site studies using implementation facilitation to improve timely accessibility to methadone treatment.

Treatment Linkage and Care Coordination Studies. FRI investigators have conducted research on ways to better coordinate care and improve outcomes for patients with complex health conditions and addiction comorbidities. This body of work includes studies on:

• The role of hospital-based addiction consultation services in managing patients with opioid use disorder,
• The effectiveness of patient navigation (the NavSTAR intervention) for hospital patients with comorbid substance use disorders,
• Patterns of acute care utilization among people who use drugs, and
• The effectiveness of deploying peer coaches in hospital emergency departments for facilitating treatment linkage and reducing subsequent acute care utilization.

Current Research Studies

Currently, FRI investigators are continuing the rich tradition of conducting rigorous research with practical impact for individuals affected by substance use disorders. For a list of current FRI research studies, please see Research Projects.