Adapting Trauma-Informed Interventions to Reduce Overdose Risk in Justice-Involved Women (TRUST)

(MPIs: M. Stanton – UKY, K. Knight-TCU; Co-I D. Knight-TCU)

NIH Grant #1R61DA061365

Overdose deaths in the United States have reached an all-time high, disproportionately impacting women, particularly those involved in the criminal legal system (CLS). Overdose deaths among women have risen nearly 500% over the past two decades—a much higher increase than among men. Justice-involved women face compounded risks due to histories of substance use, violent victimization, and trauma, which further increase the likelihood of overdose during the critical period of community re-entry.

TRUST is a 5-year project designed to address these challenges through the adaptation and testing of a trauma-informed, relational intervention known as Trust-Based Relational Intervention® (TBRI®), an intervention developed by TCU’s KPICD.  The study will modify TBRI to meet the unique needs of CLS-involved women in prison-based substance use disorder (SUD) treatment, focusing on building trust, emotional regulation, and healthy coping skills as they prepare for re-entry.

The project is structured in two phases:

• R61 Phase (Year 1): Led by Dr. Danica Knight and her team at TCU’s KPICD, TBRI will be adapted for this population through focus groups with key stakeholders, including justice-involved women with lived experience. Pilot test the adapted intervention, TBRI-Women’s Re-entry Approach (TBRI-WRA), with a small group of women in Kentucky to refine feasibility.
• R33 Phase (Years 2-5): Led by Drs. Michele Staton at UKY and Kevin Knight at TCU’s IBR, the study will include a larger clinical trial across four sites, enrolling 264 women. Compare outcomes between standard treatment (Treatment as Usual), in-prison TBRI sessions, and TBRI combined with Re-entry Recovery Support.

Primary outcomes include reduced overdose risk and improved trauma-related symptoms, emotional regulation, and recovery support during the six months following prison release.

TRUST’s experienced team of NIDA-funded investigators ultimately aims to develop scalable strategies for reducing overdose risk and enhancing recovery outcomes for CLS-involved women with a history of trauma and victimization.

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