The Association Between Loneliness and Substance Use

Not Applicable

Completed

Interventions: Behavioral: Physical Health Education Training (PHET)
Behavioral: Cognitive Behavioral Therapy for loneliness (CBT-L)

Brief Summary: The proposed study will determine if cognitive behavioral therapy will help improve loneliness in people who use opioids.

Detailed Description: The proposed study will be the first to assess the cognitive, affective, and behavioral pathways by which loneliness impacts opioid use. Individuals with an opioid use disorder (OUD) reporting loneliness will be randomized to either a 6-session Cognitive- Behavioral Therapy for loneliness (CBT-L) or a 6-session education control condition, both delivered via telehealth. Telehealth delivery can be easily implemented and can increase reach and access to individuals not engaged in treatment. We will use an established brief CBT manual to address loneliness. We will assess loneliness, negative affect (i.e., depression and anxiety), and the quality and quantity of social interactions prior to, during, and after the intervention to evaluate the subsequent impact on opioid use trajectories. Participant will complete questionnaires pre-treatment, post-treatment, and at 1- and 2-months posttreatment.

Recruitment & Eligibility

Inclusion Criteria

Must be ages 18+
Understand English
Have internet access
Screen positive for an active OUD on the OUD Module of the Structured Clinical Interview for DSM-5 (Diagnostic & Statistical Manual of Mental Disorder, 5th edition) Research Version (SCID-5-RV)
Screen positive for loneliness by scoring at least a T-score > 60 on the NIH Toolbox Loneliness Scale

Exclusion Criteria

Consistent with previously used telehealth-delivered assessments, we will exclude any participant with cognitive impairment as measured by the Blessed Orientation-Memory-Concentration Test (BOMC)
Potential participants who are in the process of detoxifying as measured by the Subjective Opiate Withdrawal Scale will also be excluded

Arm && Interventions

Group	Intervention	Description
Health Education	Physical Health Education Training (PHET)	Health education sessions delivered over the course of 6, \~45 minute sessions delivered via telehealth.
Cognitive Behavioral Therapy (CBT)	Cognitive Behavioral Therapy for loneliness (CBT-L)	CBT delivered over the course of 6, \~45 minute sessions delivered via telehealth.

Primary Outcome Measures

Name	Time	Method
Mean Change in Loneliness	baseline to 2 months post-treatment	Loneliness will be measured using the University of California-Los Angeles (UCLA) Loneliness Scale. A 20-item scale designed to measure one's subjective feelings of loneliness as well as feelings of social isolation. Participants rate each item as 1 (never), 2 (rarely), 3 (sometimes) or 4 (often). The scores range from 20-80 with higher scores indicating worse outcome.

Secondary Outcome Measures

Name	Time	Method
Mean Change in Percent Days Abstinent From Opioids	baseline to 2 months post-treatment	Participants will complete a calendar indicating the type and frequency of drug use.
Mean Change in Percent Days Abstinent From Other Drugs	baseline to 2 months	Participants will complete a calendar indicating the type and frequency of drug use.
Mean Change in Social Support	baseline to 2 months post-treatment	Duke Social Support Index assesses several domains of perceived social support, including social network size, social interaction, social satisfaction, and instrumental social support. Higher scores indicate a higher quality of social interactions or perceived social support. Scores range from 6 to 18.