Alcohol Use Disorder
Conditions
Keywords
CBT4CBT, Brief Negotiated Interview (BNI), Medication for alcohol use disorder (MAUD), Phosphatidylethanol (PEth)
Brief summary
This study is a 3-arm randomized clinical trial to evaluate the effectiveness of hospital-initiated Alcohol Use Disorder treatment, involving a Brief Negotiated Interview (with referral and telephone booster) alone, BNI+facilitated provision of MAUD, BNI+facilitated provision of MAUD+CBT4CBT on AUD treatment engagement, alcohol use and healthcare utilization.
Detailed description
The proposed 3-arm randomized clinical trial will initiate interventions during hospitalization and evaluate outcomes at 34- and 90-days following hospital discharge to compare the effectiveness of 1) BNI, 2) BNI+facilitated provision of MAUD, and 3) BNI+facilitated provision of MAUD+CBT4CBT on AUD treatment engagement, alcohol consumption, and healthcare utilization among 450 racially and ethnically diverse hospitalized individuals with AUD. Using a hybrid type 1 effectiveness-implementation design the investigators will also conduct an implementation- focused process evaluation to yield relevant data to inform future implementation, including process measures, clinician and staff (n=150) perspectives and cost effectiveness. This proposed study is directly informed by rigorous prior research by this group and others demonstrating: 1) a need for new strategies to engage patients, particularly Black and Hispanic individuals, with AUD in treatment; 2) benefits of engaging patients in addiction treatment during acute care;3) benefits of MAUD and the potential to integrate its provision in general medical settings; and 4) benefits of CBT as an adjunct to MAUD with strong support for CBT4CBT across diverse populations
Interventions
BEHAVIORALBrief Negotiated Interview (BNI)
Brief Negotiated Interview (with referral and telephone booster) alone
BEHAVIORALBNI+facilitated provision of MAUD
Brief Negotiated Interview (BNI)+ Medication for Alcohol Use Disorder (MAUD)
BEHAVIORALBrief Negotiated Interview BNI+facilitated provision of MAUD+CBT4CBT
Brief Negotiated Interview (BNI)+Medication for Alcohol Use Disorder (MAUD)+Computer Based Treatment for Cognitive Behavioral Treatment (CBT4CBT)
Sponsors
Yale University
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* hospitalized at Yale New Haven Hospital (YNHH) * meet Diagnostic and Statistical Manual (DSM-5) criteria for a moderate to severe AUD (regardless of primary reason for hospitalization) consistent with clinical guidelines for MAUD initiation * \>1 heavy drinking day by TLFB in 30 days prior to hospitalization * willing to consider MAUD * willing and able to be contacted for follow-up * provide written informed consent
Exclusion criteria
* have been engaged in formal AUD treatment in the past 30 days (i.e., excluding mutual help groups, such as Alcoholics Anonymous) * meet DSM-5 criteria for untreated moderate to severe opioid use disorder * self-reported or urine testing confirming pregnancy, nursing, or trying to conceive * life-threatening or unstable medical, surgical, or psychiatric condition that prohibits study participation * inability to provide \>1 collateral contact for a friend or family member * anticipate being unable to return for follow-up assessments for any reason, such as travel, incarceration, planned procedure * inability to understand English or Spanish.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary outcome will be the percentage of participants engaged in AUD Treatment at the 34-day post hospital discharge timepoint, defined as any self-reported AUD treatment service assessed on the AUD Treatment Assessment. | Day 34 post hospital diacharge | AUD Treatment Engagement Assessment is a self-report used to assess if participants have participated in different types of treatment engagement for alcohol use over 34 days. That data is verified by an outside source. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in alcohol use by percentage of heavy drinking days at day 34 and 90. | Baseline, day 34 and day 90 | Change in alcohol use by percentage of heavy drinking days operationalized by the Timeline Followback (TLFB) method. TLFB is administered by an interviewer and involves asking clients to retrospectively estimate their alcohol and drug use 34 and 90 days prior to the interview date. |
| Change from baseline in alcohol use at days 34 and 90 using a Phosphatidylethanol (PEth) test | Baseline, day 34 and day 90 | Change from baseline in alcohol use at 34 and 90 days post discharge measured by PEth in the blood. PEth is a finger stick blood draw to detect alcohol use by detecting direct alcohol biomarkers in the bloodstream. A positive test indicates alcohol use. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORE. Jennifer Edelman, MD
Yale University
PRINCIPAL_INVESTIGATORBrian Kiluk, PhD
Yale University
Outcome results
None listed