Decreasing the Engagement Gap for Addiction Treatment in Primary Care

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Project Summary Significance. Alcohol use disorders (AUDs) are common, costly, and life-threatening, but just 8 in 100 people with a past-year AUD receive treatment. Most individuals with AUDs visit primary care and prefer to receive AUD treatment in primary care. This represents a missed opportunity. Career Development Plan. Dr. Glass is a clinician researcher who has successfully answered important research questions by analyzing complex secondary datasets. His long-term goal is to conduct intervention trials in primary care in order to increase the reach and impact of addiction treatment. The proposed K01 career development award will ensure that he receives the mentoring, training, and research experience needed to achieve this goal. Because new mobile health (mHealth) programs offer a relatively novel—and potentially cost-effective and scalable—approach to increasing the reach of effective AUD treatments into primary care, Dr. Glass will focus his training on data collection and preparing for an effectiveness trial of a promising mHealth intervention for patients with AUDs. This will prepare him to lead rigorous, state-of-the-art trials of AUD interventions in primary care, and ensure he reaches his potential as a leader in AUD research. Research Plan. Dr. Glass's proposed research will evaluate the feasibility and acceptability of an existing mHealth tool (Square2) as a new option for managing AUDs in primary care. The Square2 program includes several evidence-based electronic tools for addiction treatment and associated comorbidity (depression, anxiety and tobacco use), and is designed to address the needs of primary care patients irrespective of their AUD severity or readiness to change. However, Square2 has not yet been empirically tested in primary care or for AUD treatment, and developmental research is needed to identify the optimal approach to engaging a generalizable primary care sample of patients with AUDs in a trial of Square2. Specific aims for the proposed K01 are: (Aim 1) Assess the needs of primary care patients with AUDs, and clinicians who care for them, for use of mHealth as part of primary care management of AUDs (n = 40); and (Aim 2) Pilot a randomized controlled trial (RCT) to inform a future effectiveness trial by assessing a) the feasibility and acceptability of delivering Square2 in primary care with clinician assistance, and b) the feasibility of the RCT design (n = 60). Mentorship and Environment. Expert investigators in AUDs in primary care (Primary Mentor Dr. Bradley); mHealth (Co-Mentors Drs. Marsch and McClure); data collection (Co-Mentor Dr. Curran); and pragmatic trials (advisor Dr. Simon) will support this research. The research will be conducted at the Group Health Research Institute, an innovative research institution embedded in a large primary care system in the Pacific Northwest. Public Health Impact: The proposed activities will ensure the development of Dr. Glass into an innovative independent researcher. Moreover, the proposed research will lay the groundwork for future R01s of mHealth tools to increase the reach of effective AUD treatments, thereby improving outcomes for patients with AUDs.