Development and pilot testing of a novel treatment intervention for dual substance use disorder (DUD) in heterosexual couples

The National Institute on Drug Abuse awarded the University of Rochester $433,029 on March 15, 2026, under the Drug Use and Addiction Research Programs (CFDA 93.279) to develop and pilot test a novel couples-based treatment intervention for dual substance use disorder in heterosexual couples using opioids and/or stimulants.

The project addresses a critical gap in addiction treatment by developing a relational, rather than individual-focused, intervention model tailored to dual-DUD couples—those in which both partners have drug use disorders. Current treatment paradigms overlook the reciprocal influence partners exert on each other's substance use and recovery, despite evidence that dual-DUD couples experience significantly higher relapse rates and lower treatment engagement than individuals without drug-using partners. The intervention development will incorporate the Recovery Capital Framework and the SUD Couple System Model, grounded in a co-creation approach involving affected couples, treatment providers, and administrators. The research follows an R61/R33 phased structure, with the R61 phase conducting formative mixed-methods research to identify key determinants and recovery assets influencing drug use behavior and treatment outcomes in dual-DUD couples. The work integrates the Intervention Mapping + ADAPT framework for intervention development with the Consolidated Framework for Implementation Research to guide implementation strategies.

Performance occurs in Rochester, New York, with a period of performance through February 28, 2028. The University of Rochester passed through funding to sub-recipient NDRI-USA Inc. on August 13, 2026, for delivery of research and intervention development services under the award.

Abstract

Drug use disorders (DUDS), a subclassification of substance use disorders (SUDS) involving the misuse of non-alcohol illicit drugs, remain a major public health crisis in the U.S., affecting 27 million persons and contributing to over 100,000 overdose deaths annually. Among those with DUDS, 30% to 50% have a primary sexual partner who also has a DUD-dual-DUD couples. These couples experience significantly poorer treatment outcomes, including higher relapse rates and lower treatment engagement, compared to individuals without a drug-using partner. Despite the well-documented reciprocal influence of partners on each other's substance use, current treatment paradigms remain predominantly individual-focused, overlooking the relational context in which substance use and recovery occur. The absence of couples-based treatment models designed specifically for dual-DUD couples represents a critical GAP in the addiction treatment landscape. This study aims to address this GAP by developing and piloting a novel couples-based intervention tailored to the needs of dual-DUD couples who use opioids and/or stimulants. Grounded in the recovery capital framework and the SUD couple system model, this study will incorporate a CO-creation approach to intervention development, ensuring meaningful engagement from stakeholders, including affected couples, treatment providers, and administrators. The research design follows an R61/R33 phased structure, integrating the intervention mapping + adapt (IMA) framework for intervention development with the consolidated framework for implementation research (CFIR) to guide and evaluate implementation strategies. In the R61 phase, formative mixed-methods research will be conducted to identify key determinants and recovery assets influencing drug use behavior and treatment outcomes among dual-DUD couples (aim 1). These findings will inform the development and adaptation of a couples-based treatment program using an intervention mapping approach (aim 2). The R33 phase will involve finalizing intervention materials and implementation strategies (aim 3), conducting a dual-site pilot randomized controlled trial (RCT) at SUD treatment centers in rochester, NY, and newark, NJ (aim 4), and evaluating post-pilot data to refine the intervention and assess readiness for a confirmatory hybrid type 2 effectiveness trial (aim 5). This project aligns with the objectives of RFA DA-26-024 (R61/R33 exploratory/developmental phased award), which seeks to engage loved ones in the recovery process and enhance access to evidence-based care for those affected by DUDS. Develop and test dyadic approaches to support engagement in evidence-based care for individuals in DUD-affected relationships. By addressing a longstanding treatment GAP, this study aims to contribute to the broader goal of reducing substance use-related harm and improving public health through innovative, relationship-centered care models.