Implementation-science strategies for scaling trauma-informed substance-use interventions in U.S. behavioral-health organizations

The prevalence of trauma exposure among individuals who are receiving substance-use treatment is significant in the United States, yet the implementation and scale-up of trauma-informed interventions in behavioral-health organizations remain uneven. Despite extensive evidence of the clinical value of trauma-informed substance-use care, there is also limited understanding of the adoption, implementation, and maintenance of these interventions in practice-based service environments. The study conducted a systematic review of peer-reviewed empirical studies published between 2020 and 2025 on the implementation-science strategies of the scaling of trauma-informed substance-use interventions at U.S. behavioral-health organizations. The search was conducted in ScienceDirect and Google Scholar and enriched with manual screening of references. The implementation-science paradigms were used to identify organizational, workforce, and system-level factors that impacted implementation processes and outcomes through the application of a thematic synthesis approach. The five key themes identified included: organizational readiness and leadership engagement; workforce training, support, and clarity, adaptation and contextual fit; multi-level implementation strategies, and long-term integration and sustainability. In the literature, organizational capacity, workforce support, and policy and financing alignment were more likely to be success factors influencing the implementation success than the design of the intervention. The results highlight the fact that national implications of trauma-informed substance-use interventions at the systems level are challenging. The aspect of scale-up needs to be effectively implemented with thought-through implementation and leadership commitment and incorporating trauma-informed care in standard organizational and policy frameworks.