This is an observational, prospective case-control study evaluating the effects of an emergency department community health worker-peer recovery specialist program (PCHW), the Substance Misuse Assistance Response Team (SMART). Aims of this study are to 1) understand participant experiences working with a SMART PCHW and identify possible mechanisms for successful recovery linkage; 2) Evaluate SMART effectiveness on patient-centered outcomes, building recovery capital, and recovery linkage; 3) Evaluate SMART implementation and effectiveness on patient outcomes over time.

Using a combination of surveys and data linkages to state administrative databases, study investigators will prospectively compare changes in addiction treatment engagement, recovery capital, health related social needs, acute care utilization, and death between people receiving a ED PCHW and those who do not. After consenting to study participation, participants will complete surveys at time of study enrollment and 3 and 6 months after their initial ED visit. Primary outcomes include engagement in addiction treatment, social services engagement, acute care utilization, and mortality will be assessed through linkages to state administrative databases.

The emergency department (ED) is on the front lines of the overdose epidemic, treating an increasing number of people with substance use disorders (SUD). In the year after a substance use-related ED visit, risk of death is six time higher than other patients, and for people treated after an opioid overdose, more than one in twenty patients will die. Each substance use-related ED visit represents a crucial opportunity to link patients to recovery services, however there are significant gaps in service provision with less than one in three receiving behavioral counseling and only one in five linked to addiction treatment. To improve linkage to recovery and addiction treatment services from the ED, study investigators launched a multidisciplinary, ED community health worker-peer recovery specialist program (PCHW), the Substance Misuse Assistance Response Team (SMART), at a large, academic, urban medical center which cares for the majority of patients with SUDs in Rhode Island. Drawing from models of existing peer recovery specialist, CHW, and health promotion advocate programs, SMART is a novel ED-based program that provides people with a substance-use related ED visit individualized support, short term case management, navigation to social services, harm reduction, recovery, and addiction treatment services in and out of the ED. SMART distinguishes itself from other models of ED patient navigation and/or peer recovery specialist programs by working in and out of the ED and focusing on social determinants of recovery. In recent years there has been a proliferation of ED peer recovery programs, but little is known about their effectiveness. Study investigators will conduct a pragmatic, mixed methods study of an established ED PCHW program to evaluate program delivery, linkage to evidence-based recovery services, and short- and long-term patient outcomes. Aims of this study are to 1) understand participant experiences working with a SMART PCHW and identify possible mechanisms for successful recovery linkage; 2) Evaluate SMART effectiveness on patient-centered outcomes, building recovery capital, and recovery linkage; 3) Evaluate SMART implementation and effectiveness on patient outcomes over time. Participant interviews will examine participant experiences with SMART, recovery services engagement, and identify potentially effective engagement strategies. A RE-AIM framework will be used to evaluate program implementation (process outcomes) and effectiveness (patient outcomes). Surveys and data linkage to hospital and state administrative databases will be used to measure changes in recovery capital, social networks, receipt of social services, linkage to harm reduction, recovery, and addiction treatment services, and changes in acute care utilization and mortality among people receiving SMART. Results from this study will provide robust data about ED peer recovery specialist program process and patient-level outcomes needed for a subsequent multilevel, comprehensive study to identify and test effectiveness of ED peer recovery program components and implementation strategies for program enhancement, dissemination, and sustainability.

Inclusion Criteria:

1. Adults 18 years old or older
2. Seen and treated at Rhode Island or The Miriam Hospital ED for a substance use-related concern including intoxication, withdrawal, opioid overdose, opioid withdrawal, or substance use-related infection
3. Able to provide informed consent
4. Able to provide at least two forms of contact (personal phone, social media, email, or contact information for family or friends)
5. Participants may speak languages other than English but require use of interpreter services. Consents will be available in English, Spanish, and Portuguese, the three most spoken languages in the Providence metropolitan area.

Exclusion Criteria:

1. Unable to provide informed consent
2. In police custody, incarcerated, or have a court ordered treatment enrollment

The study will enroll 400 people with a substance-used related visit. Individuals will be approached after receipt of ED services.

1. 200 people who have received SMART services.

   - Participants will be approached for study participation after they have already received SMART services.

2. 200 people who did NOT receive SMART services.

   • Participants will be approached for study enrollment in this study arm when they are seen and treated on a day and time or ED site where SMART is not available.