{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T08:13:47Z","timestamp":1783412027214,"version":"3.54.6"},"reference-count":50,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA057608-01"],"award-info":[{"award-number":["R01DA057608-01"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ongoing cocaine use is common during methadone treatment and is associated with poorer outcomes. Digital health tools offer promising new ways to enhance methadone treatment through remote delivery of adjunctive behavioral health interventions. The experiences of patients on methadone who also use cocaine are under-represented in the recent literature. This qualitative study of recently admitted patients on methadone who also used cocaine examines their experiences and views on drug use and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-one participants were purposively sampled from the intervention arm of an ongoing multi-site clinical trial of a digital behavioral intervention. Qualitative interviews were carried out approximately 3\u2009months after randomization into the parent study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Three themes emerged from the analysis: (1) Cocaine Use as a Response to Physical and Emotional Factors; (2) Cycles of Use and Recommitment to Treatment; and (3) Active Efforts to Sustain Engagement in Treatment. Participants were able to identify and share reasons for entering treatment and their persistent cocaine use. Many participants emphasized a hope that methadone treatment would be temporary. Several participants highlighted the role of internal factors (eg, stress, shame, and desire for stability) related to treatment engagement, and the role of adjunctive behavioral supports in targeting internal factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Individuals with opioid and cocaine use enter methadone treatment for different reasons, often with co-occurring substance use disorders. Aligning care with their individual goals can potentially improve outcomes. Grounding treatment strategies in individuals\u2019 lived experiences can deepen understanding of how adjunctive digital behavioral interventions can best support engagement, retention, and recovery during the critical early phases of treatment, especially as the illicit drug supply becomes more complex.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342261460411","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T13:49:25Z","timestamp":1783172965000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug Use, Treatment, and Hopes for the Future: A Qualitative Study of Patients on Methadone Who Use Cocaine in the Age of Fentanyl"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0379-2974","authenticated-orcid":false,"given":"Rachel","family":"French","sequence":"first","affiliation":[{"name":"University of Pennsylvania School of Nursing, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3941-947X","authenticated-orcid":false,"given":"Karen","family":"Alexander","sequence":"additional","affiliation":[{"name":"Friends Research Institute, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjalee","family":"Sharma","sequence":"additional","affiliation":[{"name":"Friends Research Institute, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Gryczynski","sequence":"additional","affiliation":[{"name":"Friends Research Institute, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0017-1858","authenticated-orcid":false,"given":"Allison","family":"Schachter","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Friends Research Institute, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"U.S. Overdose Deaths Decrease Almost 27% in 2024. 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