CHOSEN: The Columbia Center for Healing of Opioid and Other Substance Use Disorders—Intervention Development and Implementation
The Columbia Center for Healing of Opioid and Other Substance Use Disorders—Intervention Development and Implementation (CHOSEN), founded on crossdisciplinary collaboration among Columbia’s School of Social Work, Irving Medical Center’s Department of Psychiatry Division on Substance Use Disorders, and the Irving Institute for Clinical and Translational Research, is focused on the negative health consequences caused by opioid and other substance use disorders, including drug overdose and overdose deaths, the impaired functioning and lost productivity, co-occurring psychiatric and physical disorders (e.g., PTSD and trauma, HIV, and HCV), and the impacts on family and the community.
Addiction is a complex chronic illness. Approximately 2.5 million Americans have an opioid use disorder (OUD) and more than 47,000 people died from opioid-related overdoses in the U.S. in 2017, signifying an unprecedented public health crisis. Interventions need to be developed or improved across the natural history of addiction, from prevention and early detection, to treatment, to maintenance of recovery, and across levels from the individual to communities and systems of care. Further, training in addictions, both research and clinical, is needed across diverse disciplines to be able to develop and deliver efficacious treatments that will impact the opioid crisis. Intervention development proceeds across steps of a translational continuum from inception in basic and pilot work, to testing for efficacy and safety in controlled clinical trials, to trials testing effectiveness in community-based settings, and finally to dissemination and implementation across the health system.
However, many efficacious interventions never make it to the community because of the challenges of implementation, including medications to treat OUD. Typically, research at each translational step is conducted by teams from different fields and scientific backgrounds, working in relative isolation. The founding principle of CHOSEN is that to combat the opioid epidemic, research needs to integrate across disciplines. Initial efforts to develop new interventions need to be informed by implementation factors—that is, potential barriers and facilitators to implementation down the road. What are the current gaps in the health system? What types of interventions are most needed? How can new interventions be shaped to maximize the likelihood that they can be widely adopted into community-based practice? Efforts to implement proven-effective interventions across communities and health systems need to be guided by an understanding of the efficacy research, preserving the essential ingredients of the intervention. CHOSEN will assemble and foster just such a cross-disciplinary team across Schools, Departments and Divisions with the aim of developing and implementing interventions to measurably reduce the individual and societal harms of opioid and other substance use disorders.