K23 Novel Interventions for Alcohol Dependent Frequent ED Users

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DESCRIPTION (provided by applicant): The PI, Ryan McCormack, MD, is an emergency medicine physician whose broad clinical background and research experience, including board certification in Emergency, Internal, and Addiction Medicine, reflects his commitment to integrating health services using collaborative, patient-oriented approaches to enhance healthcare quality for individuals with alcohol use disorders (AUDs). His preliminary research has focused on alcohol dependent frequent emergency department (ED) users, a vulnerable population that has a disproportionate impact on healthcare and societal costs. These individuals are difficult to engage in their personal health and often receive care exclusively in EDs, rather than settings offering treatment for addiction and other chronic conditions. Despite its prevalence, treatment for AUDs is rarely initiated in the ED, and research to develop and implement effective interventions is even less common. Dr. McCormack adapted a validated algorithm to identify this target population and developed and tested a multidisciplinary, care management (CM) intervention that coordinates health and social services using existing resources through collaboration with public health agencies. He demonstrated feasibility and promising outcomes, including housing placement and reduced ED and inpatient use and mortality compared to controls. His proposed research will incorporate efficacious pharmacotherapy in the form of extended-release naltrexone (XR-NTX) to this intervention. Fifty participants will be randomized to receive XR-NTX+CM or standard care, which will be initiated in the ED and continued through coordination of care across departments and partnering agencies. He will assess feasibility and acceptability of implementing this intervention and of rigorously testing its 6- and 12- month effect on healthcare utilization and heavy drinking. Information gathered on its delivery as well as process evaluations and refinements will inform subsequent effectiveness-implementation trials. This K23 award will support Dr. McCormack in advanced research training and mentoring, allowing him to conduct his proposed research, which will form the basis for an R01 application on studies that integrate alcohol treatment in diverse clinical settings. His career development also includes structured mentorship and apprenticeships, comprehensive didactic training, as well as participation in academic conferences, research group meetings and studies, and reporting findings. Through his partnership with several public health agencies, the infrastructure of NYU, and his team of experienced and accomplished mentors that span emergency and internal medicine, psychiatry, population health, Dr. McCormack is well-positioned to become an independent investigator committed to developing and testing models of intervention and disseminating innovative practices and policies across health systems. The trans-disciplinary, collaborative nature of his work and his aim "to improve the effectiveness, efficiency and equity of services designed to reduce the public health burden of AUDs" are well aligned with the Mission and Vision of NIAAA.