{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:06:22Z","timestamp":1789535182539,"version":"build-2803163510"},"reference-count":58,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["U01MH121954"],"award-info":[{"award-number":["U01MH121954"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Individuals with opioid use disorder (OUD) frequently present with co\u2010occurring mental health conditions such as depression and posttraumatic stress disorder (PTSD), along with other mental health substance use disorders, physical health conditions and social determinants that together comprise \u2018clinical complexity.\u2019 Collaborative care (CC), a primary care\u2010based behavioral health integration model, aims to improve outcomes through coordinated, patient\u2010centered treatment. This study examined heterogeneity in baseline clinical complexity among participants in the CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) trial and assessed whether the effects of CC versus enhanced usual care (EUC) differed across clinical complexity groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Secondary analysis of CLARO, a pragmatic randomized clinical trial (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009797) of CC versus EUC for adults with OUD and depression and\/or PTSD, conducted in 18 low\u2010resourced primary care clinics in New Mexico and California, USA. Latent class analysis of baseline data identified subgroups defined by mental health and substance use as the main characteristics along with physical health and social challenges. Six\u2010month treatment effects were estimated using one\u2010step models that jointly estimated latent class membership and class\u2010specific outcomes, incorporating class \u00d7 treatment interactions. Outcomes included depression symptom severity, PTSD symptom severity, and buprenorphine utilization and prescribing duration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three subgroups were identified: (1) low complexity (43%), with relative clinical and social stability; (2) mental health complexity (34%), with high psychiatric symptoms but lower substance use and moderate social adversity; and (3) high dual complexity (23%). Compared with EUC, CC was associated with lower depression severity at follow\u2010up for the low\u2010complexity class, but not for other classes. CC and EUC did not differ statistically significantly with respect to PTSD outcomes in any class. Buprenorphine utilization and prescribing duration outcomes were similar across CC and EUC treatment arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The effects of collaborative care may vary according to patients' baseline clinical complexity. Collaborative care appears to be associated with more favorable depression outcomes than enhanced usual care among participants with lower clinical complexity but not among those with higher clinical complexity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70503","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T03:37:55Z","timestamp":1781321875000},"page":"2833-2844","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6009-8367","authenticated-orcid":false,"given":"Megan S.","family":"Schuler","sequence":"first","affiliation":[{"name":"RAND  Arlington VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8579-1594","authenticated-orcid":false,"given":"Rebecca","family":"Weir","sequence":"additional","affiliation":[{"name":"RAND  Arlington VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen M.","family":"McCullough","sequence":"additional","affiliation":[{"name":"RAND  Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace M.","family":"Hindmarch","sequence":"additional","affiliation":[{"name":"RAND  Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2391-4601","authenticated-orcid":false,"given":"Beth Ann","family":"Griffin","sequence":"additional","affiliation":[{"name":"RAND  Arlington VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Becker","sequence":"additional","affiliation":[{"name":"RAND  Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa S.","family":"Meredith","sequence":"additional","affiliation":[{"name":"RAND  Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Watkins","sequence":"additional","affiliation":[{"name":"RAND  Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.15620\/cdc\/170565","volume-title":"Drug overdose deaths in the United States, 2003\u20132023 (NCHS data brief, no. 522)","author":"Garnett MF","year":"2024"},{"key":"e_1_2_11_3_1","unstructured":"Centers for Disease Control and Prevention.CDC reports nearly 24% decline in U.S. drug overdose deaths.2025Feb 25. 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