A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction…

Randomized trialAddiction (Abingdon, England)· Jun 2026

A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial.

Megan S Schuler, Rebecca Weir, Colleen M McCullough … Katherine E Watkins

Addiction MedicineRandomized trialQ1IF 4.6

Collaborative care linked to lower depression severity only in low-complexity opioid use disorder patients

A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial.

Megan S Schuler … Katherine E Watkins

Addiction (Abingdon, England) · Jun 2026 · Q1 in General Medicine

Purpose

Individuals with opioid use disorder (opioid use disorder) frequently present with co-occurring mental health conditions such as depression and posttraumatic stress disorder (posttraumatic stress disorder), along with other mental health substance use disorders, physical health conditions and social determinants that together comprise 'clinical complexity.' Collaborative care (collaborative care), a primary care-based behavioral health integration model, aims to improve outcomes through coordinated, patient-centered treatment.

Methods

Secondary analysis of CLARO, a pragmatic randomized clinical trial (n = 797) of collaborative care versus enhanced usual care for adults with opioid use disorder and depression and/or posttraumatic stress disorder, conducted in 18 low-resourced primary care clinics in New Mexico and California, USA.

n = 797

Results

Low clinical complexity subgroup, who showed depression benefit, made up 43% of participants

Low complexity

43%

Mental health complexi

34%

High dual complexity

23%

More results

Compared with enhanced usual care, collaborative care was associated with lower depression severity at follow-up for the low-complexity class, but not for other classes.

Collaborative care and enhanced usual care did not differ statistically significantly with respect to posttraumatic stress disorder outcomes in any class.

More results

Buprenorphine utilization and prescribing duration outcomes were similar across collaborative care and enhanced usual care treatment arms.

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Conclusion · 1 of 2

The effects of collaborative care may vary according to patients' baseline clinical complexity.

Conclusion · 2 of 2

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.

A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial.

A latent class analysis of clinical complexity: Secondary analysis of the collaboration leading to addiction treatment and recovery from other stresses (CLARO) randomized trial.

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