Can Engagement-First Care Change Addiction Outcomes?

For the first time in more than a decade, national overdose deaths are declining — a hopeful sign in the long fight against addiction. But experts caution that progress remains fragile. Polysubstance use, stimulant overdoses and early disengagement from care continue to threaten recovery efforts heading into 2026.

In a new 2026 Annual Outcomes Report, Groups Recover Together, led by CEO Cooper Zelnick, shares data showing significantly lower mortality rates, stronger treatment retention, near-complete remission among long-term participants and meaningful cost savings compared with national benchmarks. The findings point to one consistent driver of success: engagement. According to the report, keeping people connected to care, especially during the vulnerable early months, can dramatically change outcomes for individuals living with opioid use disorder (OUD).

Groups’ model combines medication for OUD with weekly community-based support, offering both in-person and virtual care across more than 130 locations nationwide. In 2025 alone, the organization provided intake appointments for more than 21,000 individuals, many of whom face steep barriers to care, including rural residence, justice involvement and severe OUD diagnoses.

In a Q&A with The Educated Patient, Zelnick explains what’s driving national progress, why stimulant use remains especially dangerous and what “engagement-first” addiction care looks like in practice. He also outlines what must happen in 2026 to protect gains and prevent backsliding.

National overdose deaths are finally declining. What’s driving that progress, and how fragile is it heading into 2026?
Cooper Zelnick: It’s encouraging to see overdose deaths decline — but important to note they remain higher than prepandemic levels. Expanded access to evidence-based treatment, particularly medications for [OUD], has been essential, and harm reduction tools like naloxone have saved countless lives. Still, this progress is fragile, especially if access to care or coverage is disrupted.

In our latest Annual Report, we shared that Groups’ mortality rates are more than 3.5 times lower than the national benchmark for individuals treated with buprenorphine or methadone, and eight times lower than for individuals not in treatment. We attribute these outcomes to our integrated model, which combines evidence-based medication with consistent psychosocial support through weekly group meetings.

Why do polysubstance use and stimulant overdoses remain such serious threats, even as opioid deaths fall?
CZ: Stimulant and polysubstance use are more complex to treat. Unlike [OUD], there are no U.S. Food and Drug Administration-approved medications for stimulant use, making engagement and retention in care even more essential — and more challenging.

Your data point to early disengagement as a major risk. Why do people drop out of treatment so quickly, and what actually keeps them engaged?
CZ: Disengagement often stems from real-world barriers like transportation challenges, unstable housing, return to use and shame. What keeps people engaged is care that reduces friction, meets them where they are and responds quickly when setbacks happen.

At Groups, we deliver care through a hybrid model that supports members in person at one of our 130-plus office locations or virtually — whatever works best for them. By meeting members where they are and surrounding them with community and personalized support, we help keep them actively engaged in treatment. Our community-powered care model drives 93% monthly engagement.

What does “engagement-first” care look like in practice, and how does it differ from more traditional models?
CZ: Engagement-first care prioritizes connection. Our community-based model helps members build peer networks alongside their care teams, creating accountability and reinforcing healthy routines. We also use incentives — such as longer prescription intervals and contingency management — to reward consistent attendance and participation.

What stands out most in Groups’ latest Outcomes Report compared with national benchmarks?

CZ:

• Substantially lower mortality: In 2025, Groups’ mortality rate was more than 3.5 times lower than the national benchmark for individuals treated with buprenorphine or methadone — and eight times lower than for individuals with OUD who were not in treatment.
• Stronger retention: Six-month treatment retention was three times higher than the national benchmark, a key clinical milestone to unlocking long-term recovery and ancillary health benefits.
• Near-complete remission with sustained engagement: Members retained for 180-plus days achieved near 100% remission, defined as 90 days without illicit opioid use confirmed by toxicology testing versus only 34% for members in treatment less than 180 days, showcasing the importance of treatment retention.
• Meaningful cost savings: Claims-based analyses show 30% to 40% lower total cost of care compared with other outpatient and residential treatment options, driven by higher retention and fewer emergency and inpatient episodes.

As we look toward 2026, what changes are most urgently needed to sustain progress and prevent backsliding?
CZ: Protecting access to health coverage is essential — especially for people who already face barriers to care. At the same time, we’re committed to expanding affordable treatment options for those who are uninsured or underinsured, so progress doesn’t depend on coverage alone.