Current Projects

Angela Hagaman, Co-Director for the East Tennessee State University College of Public Health’s Addiction Science Center, has received a new award from the National Institutes of Health (NIH) to support research focused on the growing role of peer support specialists in health and recovery settings.

The project, titled “Developing an Index of Peer Support Specialist Work Settings and Activities,” was officially awarded on March 19, 2026. Dr. Hagaman serves as principal investigator. Dr. Craig Henderson of Sam Houston State University will serve as co-principal investigator.

“This study builds on previous community based participatory research conducted by the Addiction Science Center team in partnership with peer support specialists in Central Appalachia and across the nation. The final index will address a key barrier to the accurate assessment of peer recovery support service provision and will open the door for high-quality scientific exploration into the effectiveness of peer support,” said Angela Hagaman, Co-PI and Research Assistant Professor in the College of Public Health.

Peer support specialists are individuals with lived experience of substance use or mental health challenges. They play a vital role in recovery-oriented systems of care. Despite their increasing integration into healthcare and community-based settings, there remains limited standardized information about the environments in which they work and the range of activities they perform within these varied settings.

This NIH-funded project aims to address that gap by developing a comprehensive index that categorizes peer support specialists’ work settings and core responsibilities within a social ecological systems framework. The resulting tool will help researchers better understand and evaluate the peer support workforce, ultimately contributing to more effective program design and service delivery.

“The ETSU Addiction Science Center has been nationally recognized for its commitment to community engagement,” said Dr. Randy Wykoff, Dean of the College of Public Health.  “This grant will further support their life-saving work in our region and beyond.”

Funded through the NIH’s research portfolio, the award underscores the college’s continued leadership in substance use and behavioral health research, particularly within the Appalachian region.

The ETSU/NORC Rural Health Research Center’s mission is to conduct robust rural health services research that informs strategies and recommendations for policy makers, rural health care providers, and rural communities to improve health and well-being by improving access to health care and behavioral health services and advancing health.

RHRC website

Expanding and Strengthening the Behavioral Health Workforce

Project Leads: Rob Pack and Jodi Polaha
Provost Office

We will hire new addictions-focused faculty members in Social Work (2), and one each in Counseling, Psychology, and Nursing. Three fellows and two PhD students will expand the Integrated Behavioral Health Fellowship. One staff member will be hired to manage the processes for the project. On average, each new faculty member will train 30 new members of the behavioral health workforce each year. $2,000 scholarships for up to 150 students each year will incentivize participation. Priority will be offered to those with lived experience with substance use disorder who commit to working in the region after graduation.

Northeast Tennessee REACH: Recovery Ecosystem – Access to Care and Health

Project Leads: Angela Hagaman and Marissa Kluk
Public Health

Northeast Tennessee REACH (Recovery Ecosystem – Access to Care and Health) will significantly improve facilitated connections to recovery support services, or linkages to care, for underserved individuals who use substances and/or have substance use disorder (SUD) in the 10 counties of Northeast Tennessee (NE TN). REACH will enhance cross-system collaboration across the NE TN “recovery ecosystem,” defined as a comprehensive network of local recovery assets. The primary goals of the NE TN REACH Initiative are to:

• Align existing assets across and within Northeast Tennessee’s recovery ecosystem to enhance equitable pathways to recovery.
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  Integrate existing technologies and/or develop new platforms or processes that improve connection to care for underserved individuals seeking support for their SUD or related needs.
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  Develop and sustain a REACH training module led by certified peer recovery specialists to better connect persons seeking engagement within the interconnected recovery ecosystem.
  Implement a REACH-branded media campaign utilizing best-practice strategies to reach underserved populations.

Continuation of Early Intervention Services for Opioid Use Disorder Within Nurse-Led Health Clinics

Project Leads: Amanda Moorhouse and Whitney Carrier
Nursing

This project will continue the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) services with Certified Peer Recovery Support Specialists (CPRSSs) at East Tennessee State University’s (ETSU) College of Nursing (CON) Community Health Centers (CHCs). Individuals identified through SBIRT will receive referrals to appropriate treatment and support services. CPRSS will receive certified training and ongoing educational opportunities to provide adequate peer support and SBIRT services. Evaluation efforts will measure the efficacy of this SBIRT program by tracking the number of individuals screened, the percentage referred to treatment, and the long-term outcomes, such as reductions in opioid misuse and overdose rates. This project combines the evidence-based practices of SBIRT with the unique support system of CPRSS to comprehensively address the opioid epidemic. By focusing on prevention, timely referral to treatment, community education, and evaluation, this project will make an impact in reducing opioid-related harm and promoting recovery in Tennessee.

Stigma Reduction to Facilitate Adoption of Evidence-Based Treatment for Opioid Use Disorder in Northeast Tennessee Jails 

Project Lead: Kelly Moore
Psychology

Incarcerated people with OUD have a markedly increased risk of relapse and fatal overdose after release if they do not receive treatment, making them a high treatment priority (Binswanger et al., 2013). However, correctional staff often believe that addiction is controllable and are skeptical about medications for OUD, making it difficult to implement evidence-based care in jails (Grella et al., 2020). Stigma reduction strategies that are tailored to correctional staff are necessary to improve support for evidence-based OUD treatment in these settings. This project proposes to partner with correctional leadership (e.g., sheriff, chief, nurse/behavioral health supervisor) in Northeast Tennessee (NE TN) jails to implement stigma reduction strategies tailored for correctional staff, with the goal of increasing support for evidence-based treatment of OUD. This project has three aims:

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  Conduct a needs assessment with NE TN jails to understand gaps in OUD screening/treatment, identify stigma-related barriers, and collaboratively decide on a stigma reduction plan.
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  Develop three innovative stigma strategies (i.e., training for leadership, training for staff, site visit to an exemplary jail OUD program) to address stigma concerns among correctional staff working in our region's jails.
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  Implement and evaluate the impact of stigma reduction strategies in NE TN jails.

Recover with Nature

Project Lead: Bethany Novotny
Counseling and Human Service/ Clemmer

“I just feel better when I’m outside.” An often-repeated phrase with evidence to back it up. Intentional and meaningful connection with nature has significant physical and psychological health benefits, and yet, there have been few attempts to formally incorporate nature-based therapeutic strategies into the opioid treatment and recovery continuum. NE TN Recover with Nature will pilot a series of nature-based recovery interventions as an adjunctive support for persons participating in residential recovery living programs in Northeast Tennessee. Male and female participants residing in transitional housing will engage in a 4-week intervention or one 3-day intensive immersion experience designed to enhance mindfulness, reduce stress, improve quality of life and self-esteem, and boost recovery capital. While the activities are fun and challenging, they also serve to help participants learn about themselves and how they relate to others and the world around them. The interventions put forward in this program have demonstrated effectiveness for co-occurring disorders such as reduced symptoms of depression and anxiety. Empirical research and this funding announcement signify that treatment of co-occurring conditions can lead to improved outcomes for persons with SUD. This proposal is one of several coordinated by the Northeast Regional Recovery Ecosystem Advisory Council (RREAC). 

Educating and expanding the paid and volunteer SUD workforce

Project Lead: Andrea Clements
ETSU/Ballad Health Strong BRAIN Institute (SBI)

The far northeast region of Tennessee has a well-developed network of organizations working toward reducing substance use disorders (SUD). One of SUD's primary drivers is adverse childhood experiences (ACEs). The proposed project will be carried out by the ETSU Ballad Health Strong BRAIN Institute (SBI) in partnership with Uplift Appalachia. The SBI is a research/training institute focused on ACEs/trauma informed practice (TIP). Uplift Appalachia is a religious nonprofit mobilizing churches to address addiction and mental health challenges. We will use the strategy of education/training in ACEs, TIP, and SUD, and apply the concepts to two primary audiences. First, a broad cross section of the treatment and recovery workforce, including healthcare workers, first responders, and others who interact with people with SUD will be equipped to have more helpful, kinder, and less stigmatizing interactions with people with SUD. Second, community members, including the faith community, will be trained on these same topics and equipped to form a large volunteer workforce to support people with SUD and their families. The goals are to:

• Increase the use of TIP
• Reduce stigma toward people who use substances
• Increase the behavioral health workforce to prevent and treat SUD through equipping volunteers

Expansion of Baby Steps: An Interdisciplinary Clinic and Care Coordination Program to Improve Outcomes for Opioid-Exposed Infants and Children and their Families

Project Lead: Alyson Chroust
Psychology and Pediatrics

The ETSU Baby Steps project will ensure comprehensive and evidence-based recovery support for infants and children with prenatal opioid/substance exposure including health, developmental, and behavioral screening and follow-ups for during the first five years of life in Northeast Tennessee. Baby Steps is a two-generational, trauma-informed, patient and family-centered perinatal care coordination program and follow-up clinic started in 2020 at ETSU Health for families affected by prenatal opioid/drug use and exposure. The proposal includes expanding Baby Steps to serve more families in the region. Expansion efforts include an additional care coordinator and offering an additional half day of interdisciplinary clinic. The project plans to engage with families and infants with prenatal opioid/drug exposure in the hospital and within the home during the first three months of life. Finally, the project plans to integrate behavioral health specialists into the program and follow-up clinic to provide additional mental health support to caregivers and children. Baby Steps proposes to grow programmatically by creating an impactful advisory board to help oversee expansion efforts, creating a foundation for future financial sustainability, and creating an alumni network of parents of Baby Steps for peer-to-peer recovery support and community building.

Development and Implementation of a Fentanyl Adulterated with Xylazine (FAX) Overdose Prevention and Response Education Program Research related to fentanyl overdose and calling 911

Project Lead: Bill Brooks
Public Health

Using a validated approach to assess public health needs toward the design, implementation, and evaluation of prevention programs, the ETSU Addiction Science Center will develop a community-based approach to preventing overdose deaths from fentanyl adulterated with xylazine (FAX) in TN. The project includes 3 phases: 1) community needs assessment, 2) program development, and 3) program implementation and evaluation. Phase 1 will occur during the first half of year 1, in which interviews and surveys with people who use drugs (PWUD) will be conducted in the 5 high impact areas (HIAs) plus 3 additional counties with syringe services programs (SSPs) to collect data on knowledge of FAX in the illicit drug market, identifying a FAX overdose, managing Narcan administration during a FAX overdose, fentanyl and xylazine test strip usage, willingness to call 911, and knowledge of rescue breathing methods. This information will support the development of training and education programs to prevent FAX overdose (Phase 2) in the second half of year one. Program implementation and evaluation (Phase 3) will occur in year 2 in partnership with the TDH Overdose Response Coordination Office, HIA taskforce coordinators, and SSP program directors.

VICTOR: Veterans Improving Connections in Tennessee for Opioid Recovery Recovery Support

Project Lead: Manik Ahuja
Public Health

VICTOR addresses recovery support for U.S. military Veterans, in response toRemediation List Strategy BB13. Between 2010 to 2019, drug overdose mortality rates among Veterans increased by >53%, with suicide rates twice that of the general population. The opioid epidemic has severely impacted Veterans, a highly vulnerable group. The risk of relapse for opioid use among Veterans ranges from 60-90%. Our project aims to recruit Veterans in East Tennessee diagnosed with opioid use disorder (OUD), and provide them with recovery support centered around both social connectedness as a preventive tool against relapse. We will collaborate with our community partners to establish a comprehensive system of care that promotes social connectedness and connects Veterans to specialized recovery organizations that also integrates the use of mobile technology. Program facilitators will actively connect Veterans with a range of recovery-focused programs, including support groups, counseling/therapy, peer mentoring, recreational/therapeutic activities, music therapy, and education/skill-building programs. This project’s primary objective is to assess the effectiveness of this strategy in providing support to Veterans undergoing treatment for OUD. If successful, we anticipate a decrease in rates of relapse and other adverse outcomes, while also expecting an increase in rates of service use and treatment compliance among Veterans.

F.I.G- Filling in the Gaps 

Project Lead: Veronica Vann-Ray
Addiction Medicine

OAC funding will be used to develop and implement Filling in Gaps (FIG), a comprehensive recovery support program for patients served by the ETSU Addiction Medicine Fellowship. Research shows that resources such as housing, transportation, and a valid driver’s license are critical cornerstones needed to begin and maintain successful treatment for Opioid Use Disorder and related SUD. Based on the premise that case management is health care, the project will foster community outreach to create a resource network for an eight-county service delivery area in rural Northeast Tennessee, dramatically enhancing current efforts to provide recovery support for ~100 OUD patients and extending our reach to additional people in this underserved Appalachian region. The majority of our patient population lives below poverty level and routinely find themselves in the revolving door of socioeconomic disadvantages, including the justice system. In addition to ensuring that patients benefit from comprehensive wrap-around services to meet basic human needs, FIG will decrease recidivism and relieve the burden on the justice system by financially linking clients to resources needed to complete court-ordered judgments. This project represents an innovative, effective approach to revitalizing a population of individuals who suffer from OUD and co-occurring SUD, generational pain, and poverty.

Principal Investigator: Amanda Moorhouse, MSN, FNP-C, BSN, RN
Program Manager/Peer Supervision: Michelle Donaldson, Program Manager, CPRS, RCP

Dates: July 2024-June 2026

This project will continue the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) services with Certified Peer Recovery Support Specialists (CPRSSs) at East Tennessee State University’s (ETSU) College of Nursing (CON) Community Health Centers (CHCs). Individuals identified through SBIRT will receive referrals to appropriate treatment and support services. CPRSS will receive certified training and ongoing educational opportunities to provide adequate peer support and SBIRT services. Evaluation efforts will measure the efficacy of this SBIRT program by tracking the number of individuals screened, the percentage referred to treatment, and the long-term outcomes, such as reductions in opioid misuse and overdose rates. This project combines the evidence-based practices of SBIRT with the unique support system of CPRSS to comprehensively address the opioid epidemic. By focusing on prevention, timely referral to treatment, community education, and evaluation, this project will make an impact in reducing opioid-related harm and promoting recovery in Tennessee.

ETSU CON SBIRT Video

ETSU, Virginia Tech awarded $2.6 million grant for opioids research

JOHNSON CITY (Aug. 10, 2020) – The National Institute on Drug Abuse recently awarded a $2.6 million grant to researchers at East Tennessee State University and Virginia Tech to develop studies on how best to provide support services for individuals being treated for opioid use disorder.

The Studies To Advance Recovery Support (STARS) Network, which will involve researchers across multiple universities and health care systems, will center on the urgent need for research to advance recovery support services in Central Appalachia.

The goal of the partnership is to build research networks and capacity around addiction recovery support services in general and specifically around those people who are using medications to treat their opioid use disorder in combination with counseling and other support services.

The principal investigators for this project are Dr. Robert Pack, associate dean and professor in the ETSU College of Public Health and executive director of ETSU’s Addiction Science Center, and Dr. Kimberly Horn, professor at the Fralin Biomedical Research Institute at VTC and in the department of population health sciences in Virginia Tech’s Virginia-Maryland College of Veterinary Medicine.

STARS webpage

The East Tennessee State University College of Public Health has received a $641,590, five-year NIH R25 award from the National Institute of Drug Abuse (NIDA) to support the program ‘Summer Undergraduate Addiction Research Training Program in Central Appalachia.’ This transdisciplinary initiative is designed to prepare the next generation of addiction researchers and practitioners. The project builds on the success of ETSU’s pilot initiative, the East Tennessee Mentored Substance Use Research (EMSUR) program, which launched in 2021. The research team is led by Dr. Manik Ahuja, principal investigator, with co-investigators Dr. Angela Hagaman from the Addiction Science Center and College of Public Health, and Dr. Brooke Schmeichel from the Department of Biomedical Sciences.

The program will recruit 10 undergraduate students each year for five years from East Tennessee State University, the University of Tennessee, Virginia Tech, and other partner institutions in the Central Appalachian region. Students will participate in individualized, faculty-mentored research experiences and formal training focused on substance use and addiction, especially relating to the unique challenges facing rural communities in Central Appalachia.

A central feature of the program is the use of a digital curriculum adapted from national partners at New York University. ETSU faculty will expand this curriculum with new, regionally focused training modules addressing addiction and rural health, as well as the implementation of recovery support services in rural communities. Students will also engage with guest speakers and experts in rural health, treatment and recovery research, and individuals with lived experience of substance use disorder.

Central Appalachia continues to experience some of the highest opioid-related mortality rates in the nation. Participants will be trained in scientific rigor and critical thinking, as well as dissemination of research through traditional presentations and innovative formats.

The long-term goal of the program is to develop and retain a skilled workforce of addiction researchers and practitioners who are committed to living and working in Central Appalachia, helping communities address persistent and complex substance use challenges across the region.