Funding Source
NIDA, K01DA064818
Project Period
8/1/26 – 7/31/31
Principal Investigator
Samuel W. Stull (Geisel School of Medicine at Dartmouth)
Other Project Staff
Primary Mentor: Lisa A. Marsch, Co-mentors: Nicholas C. Jacobson, Susan Murphy, and Willibald Ruch
Consultants: Andy Gold, Katie Witkiewitz
Project Summary
Finding enjoyment from daily experiences that do not involve drugs can be a powerful facilitator of opioid use disorder (OUD) recovery, but this can be challenging to foster in treatment. Humor-based interventions are effective for clinical populations such as people with depression: they enhance enjoyment and psychological flexibility. Although they offer promise for targeting key processes of recovery, humor-based interventions for OUD have yet to be developed. Dr. Stull conducted a qualitative study on humor in OUD recovery and found that people with OUD were enthusiastic about the importance of humor in recovery. He then received NIDA pilot funding (P30DA029926) to develop the Humor and Addiction recovery (HA!) app with mentor Marsch and co-mentor Jacobson. The pilot study included a mixed-method interview (n = 21) to gain feedback on features of the app: themes relating humor to recovery; stand-up clips and therapeutic takeaways; and our podcast, the Levity Lounge, hosted by comedian in recovery Andy Gold. Participants met for a follow-up visit to install the HA! app on their phones and test it for 6 days. Overall, participants gave high scores on humor appreciation (i.e., funniness) of stand-up clips and usability, and all participants “agreed” or “completely agreed” that the HA! intervention was acceptable.
For this K01, we propose to expand the intervention content for the full, four-week HA! mobile app intervention (Aim 1), evaluate the HA! app, and to examine the effect of humor interventions (stand-up clips plus teachable moments) on proximal outcomes in adults in early recovery (< 6 months) receiving MOUD (n = 150) (Aims 2 and 3). Weekly intervention activities include an episode of the Levity Lounge; randomized twice-daily humor content; three ecological momentary assessments per day; and weekly ratings of acceptability, usability, engagement, and recovery outcomes (i.e., substance use, quality of life). The effect of humor on momentary outcomes will be examined through an innovative micro-randomized trial (MRT) wherein participants serve as their own control.
This application addresses NIDA’s cross-cutting priority to develop personalized interventions informed by people with lived experience. Dr. Stull has lived experience of OUD and has an exceptional mentorship team that aligns precisely with his research aims and training goals. Dr. Marsch (primary mentor; Dartmouth) is a renowned expert in digital therapeutics for OUD (Training Goal 1); Dr. Murphy (Harvard) is a pioneer in MRTs and just-in-time adaptive interventions (Training Goal 2); Dr. Jacobson (Dartmouth) is an expert in designing and programming user-centered mobile interventions (Training Goal 3); and Dr. Ruch (Zurich) is an eminent scholar in positive psychology and humor interventions (Training Goal 4). This application will support Dr. Stull’s transition to an independent researcher developing novel interventions for OUD. Results will inform a randomized controlled trial (R01) of the HA! mobile app with a between-person control group, examining efficacy in distal recovery outcomes (substance use, quality of life).
Public Health Relevance
Finding enjoyment in daily experiences that do not involve drugs can be a powerful facilitator of recovery from addiction, yet this remains a largely untapped opportunity. Humor-based interventions are highly effective in clinical populations (e.g., individuals with severe depression), enhancing both enjoyment and coping skills (i.e. psychological flexibility), but they have not been examined in people with addiction. The proposed work aims to evaluate the novel Humor and Addiction recovery (HA!) mobile intervention and examine the effects of humor content on improving mood and coping for people recovering from opioid addiction, while providing the PI with training and experience to continue this line of research as an independent researcher.