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IIR 16-235 – HSR&D Study

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IIR 16-235
Improving Outcomes for Emergency Department Patients with Alcohol Problems
Frederic C. Blow PhD MA
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: June 2018 - May 2022

BACKGROUND/RATIONALE:
Hazardous use of alcohol is a linchpin at the core of post-deployment health. It is directly related to high volume and high morbidity problems in Veterans. Many Veterans seen in Veterans Health Administration (VHA) Emergency Departments (EDs) report problematic drinking that is either tied directly to their presenting problem or complicates the care of medical and/or psychiatric symptoms. Despite data demonstrating effectiveness and significant investment in alcohol screening and brief interventions (BIs) in the VHA, many high-risk Veterans are not utilizing needed services and/or changing alcohol use patterns. The VHA has a large network of peer specialists across the country. Given the constraints of existing ED provider resources, peer support specialists could serve a vital role in delivering alcohol brief interventions (BIs) plus additional supportive contacts for Veterans with hazardous or harmful alcohol use detected in the ED.

OBJECTIVE(S):
1. Determine the efficacy of a peer-delivered alcohol intervention and mentorship to facilitate reduction in hazardous drinking.
2. Determine the impact of peer-delivered alcohol intervention and mentorship on linkage to primary care or specialty alcohol treatment services, if needed.
3. Explore the aspects of peer-delivered intervention that influences change, as well as the barriers and facilitators of implementation through qualitative interviews.

METHODS:
To achieve these objectives, we are conducting a randomized clinical trial (RCT) of a brief Alcohol Peer Mentorship (APM) intervention starting in the ED combined with 6 strengths-based booster sessions compared to enhanced usual Brief Advice (BA). Veterans receiving care in the Ann Arbor VA Emergency Department who indicate hazardous drinking behaviors will be enrolled in the study. Patient assessments regarding alcohol use, healthcare utilization, and other mental health and wellness factors will occur at baseline, 3-, 6-, and 12-months following enrollment. Qualitative interviews with a subset of Veterans, peers, clinicians, and clinical leaders will assess potential barriers and facilitators to the implementation of this approach in the VA Emergency Department setting.

FINDINGS/RESULTS:
No findings are available as this project has not begun enrollment.

IMPACT:
Reducing alcohol problems among Veterans is an urgent imperative within the Department of Veterans Affairs. There is a clear need to link individuals with more serious alcohol problems to available VA resources that can improve their mental and physical health outcomes. This study is one of the first attempts to directly test the impact of peer-delivered alcohol interventions and mentorship to link with and engage in VA primary and specialty care. In addition, this RCT will evaluate the feasibility and effectiveness of a low-cost and easy-to-deliver intervention designed to encourage the use of resources. Because the VA ED is an important portal for entry into the VA health care system, particularly for Veterans who are experiencing hazardous or harmful drinking, the delivery of an efficacious alcohol peer-mentor intervention with minimal use of staff resources could have a major public health impact. This peer mentorship intervention has the potential to have a significant and substantial impact on the Veterans with more serious alcohol problems treated in the VHA and could be modified and exported to other populations and settings.

PUBLICATIONS:
None at this time.


DRA: Substance Abuse and Addiction
DRE: Treatment - Efficacy/Effectiveness Clinical Trial, TRL - Applied/Translational
Keywords: Addictive Disorders, Substance Use and Abuse
MeSH Terms: none