R01AA029808

Leveraging Virtual Care Strategies to Improve Access and Treatment for Individuals with Alcohol Use Disorders - Project Summary/Abstract

Despite the efficacy of psychotherapies, approximately 90% of people with Alcohol Use Disorder (AUD) do not receive treatment for this chronic condition, and there are notable disparities in care. Access to and involvement in efficacious AUD care is even lower for women, Black/African American individuals, and people from other under-represented groups.

Novel virtual care approaches, such as telephone, video, and portal therapies, conceptually rooted in efficacious therapies like Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT), have the potential to improve treatment accessibility and appeal and reduce stigma. However, virtual approaches have had limited use in AUD care, with recent increases during the COVID-19 pandemic to provide ongoing care (telephone/video therapy) for current patients in specialty clinics, while treatment initiation remains low.

There is untapped potential for virtual approaches to engage individuals across health systems who otherwise do not receive treatment but could benefit from it. Virtual strategies, including telephone and video sessions and patient portals, show promise for reaching and engaging substance-using populations, including under-represented individuals, within health systems.

Using a portal messaging system and phone calls to virtually engage patients in AUD treatment outside of clinics and in their preferred locations is an innovative treatment model that can potentially be implemented in health systems. However, it must be tested to inform broader dissemination.

To identify critical adaptive intervention (AI) strategies for a virtually-delivered AUD engagement and care model, we will use a Sequential, Multiple Assignment Randomized Trial (SMART). Adults with AUD (50% women, 25% Black/African American, 5% Latinx) will be randomized to a 1st stage strategy for drinking reduction and AUD care engagement, integrating referral for AUD care: 1) a single telephone MI session (T-ENGAGE), or 2) 4 weeks of a MI-focused portal messaging (P-ENGAGE). At 4 weeks, non-responders will be randomized to a 2nd stage strategy: 1) step up to a video 8-session MI-CBT for AUD (phone delivery as needed), or 2) continued 1st stage (i.e., 4 weeks of P-ENGAGE with greater depth, a second T-ENGAGE session building on the first). Outcomes will be assessed at 4, 8, and 12 months.

Aim 1 will compare 1st-stage strategies (T-ENGAGE vs. P-ENGAGE) on alcohol outcomes and AUD treatment utilization. In Aim 2, among 1st-stage non-responders, we will identify the most efficacious 2nd-stage strategy. Aim 3 includes an implementation planning phase, with cost measures, and key stakeholder interviews and qualitative analysis of barriers and facilitators to implementation and adoption of a virtual care model. Secondary aims include examining the moderating effects of race/ethnicity and sex on outcomes given our enriched sample and examining the best sequence of AIs.

Our proposed project will have high public health impact by evaluating a novel virtual care model focused on increasing both treatment engagement and delivery that can be integrated into health systems to increase AUD treatment appeal and accessibility and help address treatment disparities.

Regents Of The University Of Michigan

NOT APPLICABLE

93.273 - Alcohol Research Programs

National Institute on Alcohol Abuse and Alcoholism (NIAAA) [HHS - NIH]

Ann Arbor, Michigan 481082744 United States

Single Zip Code

Improving Health Disparities in Alcohol Health Services (R01 Clinical Trial Optional) (RFA-AA-21-001)

Amendment Since initial award the total obligations have increased 391% from $701,919 to $3,445,401.