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Completed

NCT Number: NCT05847621

Linking Individuals Needing Care for Substance Use Disorders to Peer Coaches

This is a 3-arm randomized controlled trial. Participants will be randomized via a maximally tolerated imbalance randomization procedure using NCI's Clinical Trial Randomization Tool with 1:1:1 allocation to each group: in-person peer recovery coaching (PRC) with linkage to recovery resources, telemedicine-based peer recovery coaching with linkage to recovery resources, or usual care.

In the PRC arms, PRCs will meet patients at bedside (in person) or via a tablet-based video call (telemedicine). They will assess the participant's state of change, engage in motivational interviewing techniques, and link the participant to community-based recovery resources according to the needs of the participant. They will also schedule and perform follow up calls after the participant is discharged from the ED to provide ongoing support and facilitate re-linkage to recovery resources, if needed.

Participants in the usual care arm will be provided with a list of community recovery resources, but there will be no PRC interaction or direct linkage to resources through the study.

Follow up visits will take place at 7, 30, and 90 days after enrollment. Most will take place via telephone, but participants will be given the option of an in-person visit if they so desire.

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Key information

Conditions

Substance Use Disorders Chemically-Induced Disorders Mental Disorders Substance-Related Disorders

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Grady Memorial Hospital

Atlanta, Georgia, 30303, United States

About this study

Deaths from drug overdose have risen to record levels since the onset of the COVID-19 pandemic, disproportionately impacting Black individuals and people experiencing homelessness. Fewer than one-third of the 8.3 million individuals living with an illicit drug use disorder in 2019 reported receiving treatment. Telemedicine services have increased access to care for many patients living with substance use disorders (SUD), but the long-term role of this treatment approach in SUD care is uncertain. Multifaceted strategies are needed to build recovery capital and link vulnerable individuals to recovery resources.

Emergency department (ED) visits are an opportunity to screen for SUDs, initiate treatment, and link to recovery resources. Observational studies have noted that consultation with a peer recovery coach (PRC) was well-received in EDs, with high rates of engagement and satisfaction. PRCs facilitate conversations allowing patients to express their ideal pathway to recovery, provide linkage to services across the social ecology, and follow up to support recovery, including re-linkage to resources as needed. Nonetheless, their role in ED screening and linkage to resources, including the potential role of telemedicine, has not been rigorously evaluated.

The investigators will conduct a randomized controlled trial enrolling 600 subjects across three arms: in-person peer coaching with linkage to recovery support services and callbacks, telemedicine-based peer coaching with linkage and callbacks, or usual care. Results will inform other EDs considering a peer recovery coach program for patients presenting with SUD-related conditions. By utilizing telemedicine, this model will be rapidly scalable and readily implemented at other facilities.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • ED patient or hospitalized through the ED within last 24 hours
  • Age 18 years or older
  • Able to speak and understand English
  • Clinically sober, able to provide informed consent
  • Score of 3 or greater - "moderate level", "substantial level", or "severe level" of problems related to drug abuse - on Drug Abuse Screening Test (DAST-10).(103, 104)
  • Willing to follow study procedures and complete research follow-up calls
  • Have at least one reliable contact number

Exclusion criteria

  • Medically or psychiatrically unstable as determined by treating physician
  • Prisoner or in police custody
  • Prior participation in the study

Treatment and study plan

Peer recovery coaching with linkage to recovery resources

Behavioral

Peer recovery coach (PRC) assessment of the participant's state of change, engage in motivational interviewing techniques, and link the participant to community-based recovery resources according to the needs of the participant. They will also schedule and perform follow up calls after the participant is discharged from the ED to provide ongoing support and facilitate re-linkage to recovery resources, if needed.

Usual Care

Behavioral

Participants will be provided with a list of community recovery resources.

Primary outcomes

  1. Change in number of participants with successful linkage to at least one recovery resource

    Time frame: Baseline, 30 and 90 days after enrollment

    Change in number of participants with successful linkage to at least one recovery resource (formal addiction treatment, Recovery Community Organization (RCO), or harm reduction organization) at 30 days and 90 days after enrollment.

Secondary outcomes

  1. Change in Brief Assessment of Recovery Capital (BARC-10)

    Time frame: Baseline, 7, 30, and 90 days after enrollment

    This outcome will be evaluated obtaining a score on a scale. The range of possible responses is 10-60. Higher score correlates with better outcome.

  2. Change in number of successful engagements with PRC after ED visit

    Time frame: Baseline, 7, 30, and 90 days after enrollment

    Change in number of successful engagements with PRC (peer recovery coach) after ED visit

  3. Change in number of episodes of re-linkage to recovery resources

    Time frame: Baseline, 7, 30, and 90 days post intervention

    Change in number of episodes of re-linkage to recovery resources

  4. Self-reported substance use in last 30 days

    Time frame: Baseline, 30 and 90 days post intervention

    Self-reported substance use in last 30 days as measured by Timeline Follow-back (TLFB). It will be reported in number of episodes per day.

  5. Number of fatal overdose events

    Time frame: 90 days post intervention

    Number of fatal overdose events will be collected

  6. Number of nonfatal overdose events

    Time frame: 90 days post intervention

    Number of nonfatal overdose events will be collected

  7. Number of Emergency Department (ED) visits

    Time frame: 90 days post intervention

    Number of ED visits will be collected

  8. Number of hospitalizations

    Time frame: 90 days post intervention

    Number of hospitalizations will be collected

  9. Change in employment status

    Time frame: 90 days post intervention

    Choices include: disabled, employed 32 hours or more per week, employed less than 32 hours per week, full-time student, homemaker, on medical leave, only temporarily laid off/sick leave/maternity leave, other, part-time student, retired, unemployed, and unknown. This outcome would measure a change in employment status from any of the choices to another one.

  10. Change in number of participants based on Housing status

    Time frame: Baseline, 7, 30, and 90 days post intervention

    Housing status will be reported specifying one of the categories: apartment, Single family house, homeless, shelter, dormitory, multifamily house. Number of participants will be reported in each category at 0, 7, 30, 90 days post intervention.

  11. Change in Social connections and isolation score

    Time frame: Baseline, 7, 30, 90 days post intervention

    Social isolation scores range from 0 to 4, with 0 representing the highest level of social isolation and 4 representing the lowest level.

Sponsors and collaborators

Lead sponsor

Emory University

Other

Collaborators

  • Centers for Disease Control and Prevention

Registry information

Official study title

Linking Individuals Needing Care for Substance Use Disorders in Urban Emergency Departments to Peer Coaches (LINCS UP): RCT Component

Acronym: LINCS UP: RCT

Important dates

Study start
2024
Primary completion
2025
Study completion
2025
First posted
May 6, 2023
Registry last updated
Dec 17, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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