# Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $360,250

## Abstract

Project Summary
Many individuals with substance use disorders (SUDs) also experience significant psychological distress or
meet the criteria for common mood and anxiety disorders with potentially significant implications for SUD
outcomes and SUD treatment effects. Examining these implications is important for identifying optimal
treatments for patients with comorbid conditions. Past research on the impact of such comorbidities has
produced mixed results, mainly due to small sample sizes or reliance on observational studies. In this
proposal, a large-scale study of the impact of 1) mood and anxiety disorder as well as 2) psychological distress
comorbidity on SUD outcomes and SUD treatment effects is proposed using data from over 5,000 patients
from 20 randomized controlled trials (RCTs) of pharmacological and psychosocial treatments of SUDs
sponsored by the National Institute on Drug Abuse. Our aims include the use of modern individual participant
meta-analytic methods to combine the individual level data and to examine whether and to what extent SUD
outcomes and SUD treatment effects vary among patients with and without comorbidity. Outcomes will include
retention in treatment to the end of the trial, continued use of drugs ascertained by urine toxicology and self-
report, and social outcomes (including occupational outcomes and criminal justice involvement). In Aim 1, data
from RCTs will be combined to examine the impact of psychiatric comorbidity (i.e., mood and anxiety disorders
as well as psychological distress, jointly and separately) on the SUD outcomes, irrespective of treatment arm,
using mixed effect regression models. The RCT samples will be balanced with regards to socio-demographic
and clinical factors that may vary across studies using propensity score methods. Aim 2 will use a similar
methodology to examine the moderating effect of comorbidity on SUD treatment effects by examining
interaction terms of SUD treatment by comorbidity in mixed regression models. In Aim 3, we will examine
whether concomitant medication treatment of mood and anxiety disorders will change the impact of these
disorders on the SUD outcomes and SUD treatment effects. In Aim 4, we will reweight the RCT samples to
resemble target samples of individuals with SUDs receiving treatment in the general population to address
exclusion (and possible under-representation) of patients with severe psychiatric conditions from SUD RCTs.
The results from reweighted samples will be compared with the results of the original unweighted samples. The
project significantly advances research on the impact of these comorbidities on SUD outcomes and SUD
treatment effects using individual participant data from an unprecedentedly large group of rigorously conducted
trials that have used a core set of standardized assessments and consistent outcome measures.

## Key facts

- **NIH application ID:** 10837070
- **Project number:** 5R01DA058008-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Rosa M. Crum
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $360,250
- **Award type:** 5
- **Project period:** 2023-05-15 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10837070

## Citation

> US National Institutes of Health, RePORTER application 10837070, Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity (5R01DA058008-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10837070. Licensed CC0.

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