Adaption of a posttraumatic stress disorder intervention for patients who use stimulants and opioids in the opioid treatment programme setting

Background: Polysubstance use of stimulants and opioids is prevalent among patients receiving methadone in opioid treatment programmes (OTPs) and has been linked with complex clinical profiles and poor outcomes, including psychiatric comorbidity, overdose death, and early attrition from treatment.Objective: The study goal was to adapt the evidence-based intervention Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT) for polysubstance populations informed by the ADAPT-ITT framework to gain preliminary information regarding intervention acceptability and implementation barriers.Method: To obtain feedback on adapting the intervention and approaches to integrate it, focus groups with key stakeholders (i.e. counsellors, clinical leadership) were conducted, as well as individual interviews with patients receiving treatment at OTPs in New York City, USA. Following decisions regarding intervention adaption, two protocol versions were tested using an open pilot.Results: Patients and key stakeholders were enthusiastic about the intervention and its potential to meet patient treatment needs, bridge gaps in mental health care, and improve outcomes. Specific strategies were identified to adapt the intervention related to session length, treatment delivery format, and choice of interventionist. This qualitative work informed the creation of a 6-week protocol that was tested in an open pilot. Patients were randomized to receive four STAIR sessions with two 90-minute NT sessions (one session per week) or four STAIR sessions with four 60-minute NT sessions delivered in a massed schedule over two weeks. Participants who completed treatment generally preferred the four-session NT format; however, substantial implementation barriers impacted retention. Barriers related to scheduling and patients' complex vulnerabilities, including housing instability and illness.Conclusions: Adapting and testing the STAIR-NT intervention within the OTP setting provided an opportunity to align the therapeutic format, content, and implementation with lived experiences and clinical needs of patients. The selected protocol will be tested in a pilot randomized controlled trial.