$6.4M From NIH to Fund ‘Big Picture’ Look at Substance Use Treatment

HIV and depression often accompany substance use, but knowing which came first, or how to untangle these companion problems to provide effective treatment, presents a chicken-and-egg question.

Thanks to more than $6 million in federal funding to a University of Maryland College of Behavioral and Social Sciences researcher and colleagues, care providers may be closer to understanding how to address these “comorbidities” for people with drug- and alcohol-use disorders. The awards from the National Institutes of Health (NIH) will fund two studies co-led by Jessica Magidson, an MPower Professor.

“Living with HIV can make people more susceptible to substance use disorder and vice versa, and many people face challenges in staying engaged in HIV care,” said Magidson, who directs the Center for Substance Use, Addiction and Health Research (CESAR) and is an associate professor in the Department of Psychology. “We also know mental health comorbidities, such as depression, are commonly associated with substance use.”

With $3 million in support from the NIH’s National Institute on Drug Abuse, the first study will explore how to support adherence to pharmaceutical interventions with new, long-acting injectable forms of HIV treatment and prevention among 186 Baltimore and Washington, D.C., residents currently struggling with substance use disorders.

“New long-acting treatments can be less burdensome for people than having to take an oral medication every day—particularly for people who aren’t stably housed, who may still be using substances regularly, or who are struggling with mental health problems,” Magidson explained.

The new study will test whether a therapy method called behavioral activation, when delivered by peers who’ve struggled with substance use and are in recovery, will improve adherence to and retention in care. The method helps those receiving treatment identify things they value that are not connected to drugs or alcohol, and create day-to-day activities around those values that help them stay the course.

Elana Rosenthal, an associate professor at the University of Maryland School of Medicine and co-director of the Research Initiative on Infectious Diseases and Substance Use, will lead the study with Magidson. Andrea López, an associate professor in the UMD Department of Anthropology, and Typhanye Dyer, an associate professor in the UMD Department of Epidemiology and Biostatistics, will lend their expertise to other parts of the project. Because the study will focus specifically on individuals with marginalized identities, it will also seek to understand how structural factors like racism, stigma, inequities in access to health care and other factors affect treatment.

"Rigorous qualitative methods used in concert with other approaches are essential to understand how structural factors show up in everyday lives as barriers to care. These methods are also critical to capturing contextual factors in local contexts that are critical to how marginalized people navigate substance use and care,” said López. “We will be triangulating data in multiple forms, which only enhances the potential impact of our findings."

The second study is supported by a $3.4 million grant from the NIH’s National Institute of Mental Health. It is co-led by Julia Felton, a licensed clinical psychologist at Henry Ford Health in Detroit, and includes Charles Ma, an associate professor in the UMD Department of Epidemiology and Biostatistics.

The study will test whether the same peer-delivered behavioral activation approach will lessen symptoms of depression among 250 individuals struggling with substance use in a historically underserved area of Detroit. It is the third such study that Magidson and Felton have led together, this time with a larger sample size and a geospatial mapping component to understand how neighborhood factors will influence patient outcomes.

Specifically, Magidson and Felton will be able to see what participants’ neighborhoods look like—for example, whether they have green space, a public park or community resources—to better understand how residential settings could be affecting individuals’ struggles with depression and substance use, and their responses to the behavioral activation intervention.

“With behavioral activation, so much of it is helping people engage in their environments in different ways and identifying new things to do that bring them joy and pleasure. We want to understand to what extent does where people live, and how much they have access to meaningful activities, impact their outcomes,” Magidson said.

Clinical trials are often so individual-focused that they overlook “big picture” structural and environmental factors, she said.

“It doesn't matter how much support someone has to help them change how they're spending their time if they're living in a context where there's nothing for them to utilize,” she said.

Results from both studies, including cost effectiveness evaluations to understand how to sustain these types of approaches long-term, are expected in spring 2029.