Adapting the Public Health Disease Intervention Specialist (DIS) Model for Proactive Substance Use Disorder (SUD) Intervention

Project Summary There is a critical need to intervene with individuals affected by substance use disorder (SUD) earlier in their trajectory, even before they present to a location where screening or care could be possible. Rapid diagnosis and linkage to treatment (secondary prevention) is a cornerstone of any epidemic response but often very delayed for SUD. For communicable infectious diseases (ID), health departments employ disease intervention specialists (DIS) skilled in outreach to underserved and disproportionately affected populations identified via social contacts, who once located, disclose their own contacts, yielding “snowball” chain-referral for the most direct, rapid, and proactive approach to identify affected, but undetected, populations. SUD also exists within social networks and substance exposure spreads like contagion, but the DIS paradigm has not been adapted to the problem of SUD. With support from Funding Option B (develop, implement, and rigorously evaluate strategies), we will (AIM 1): Develop and implement promising operational models for adapting the conventional ID DIS model to provide secondary SUD prevention: In close collaboration with health department partners, we will create three service models: 1) Overlay of SUD intervention on current ID DIS: systematically screen clients (already being identified by ID diagnosis or exposure) for concurrent SUD; 2) SUD DIS: SUD specific DIS elicit social contacts with potential SUD from index clients with SUD who are identified in collaboration with other local service agencies; and 3) SUD DIS with peer-support: Peers embedded with the SUD DIS team. Model 1 will be operated separately from the SUD DIS program, with randomization by day to Model 2 or 3. In all 3 models, DIS will provide secondary prevention to those SUD screen+ (i.e., high risk score on NIDA-Modified ASSIST) and not already in care. (AIM 2): Rigorously evaluate models for incorporating SUD prevention into DIS programs. We will compare program-level outcomes using (i) data from DIS records, (ii) summary intake counts from regional SUD treatment centers, (iii) time and motion observations of DIS activities, and (iv) qualitative interviews with stakeholders (clients and staff) about the DIS program. We will also prospectively observe clients (n=400 each DIS program, for total n=1200) receiving DIS intervention who consent to research to enable comparison of the effectiveness of SUD secondary prevention provided by the different DIS program models. Assessment: Self-report at baseline (0),1, and 6 months, complemented by review of health records (via release of information) and vital statistics (i.e., mortality). Primary Outcome: severity of drug use at 6 months post initial DIS interview. Key Secondary Outcomes: participant characteristics; healthcare/service utilization; alcohol use; and overdose. This innovative, high-impact investigation will be the first to use this well-established public health approach, capitalizing on social networks, to offer early and more specifically targeted secondary prevention for SUD. Results will vastly improve public health practice, program planning, policy, and future intervention.