Toward measures and behavioral trials for effective online AUD recovery support

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PROJECT SUMMARY/ABSTRACT Alcohol Use Disorder (AUD) is a common and serious health condition. The COVID-19 pandemic worsened AUD trajectories and heightened barriers to accessing treatment and peer support that are effective in improving AUD outcomes. A growing number of people are seeking AUD recovery support via popular Online AUD Recovery Support (OARS) forums on social media platforms. OARS forums lower barriers to social support in recovery, are widely available, and show promise for improving AUD outcomes. However, as there are no rigorous clinical trials focusing on OARS forum participation, there is insufficient evidence to recommend them as effective in supporting AUD recovery. Such trials are challenging, given the variety of OARS forums and the myriad approaches to participation (e.g., frequency of use, support sought or given). My long-term career goal is to become an independent investigator and leader in development, implementation, and assessment of behavioral approaches to OARS that are effective in improving AUD recovery outcomes. To fill crucial gaps in my expertise, I have four training objectives: (1) Conceptual frameworks of AUD and AUD recovery processes, to provide strong conceptual foundations for this work; (2) Training in focus group methods for concept mapping and human-centered design, to collect data from OARS forum users that informs subsequent self-report scale and intervention development; (3) Training in advanced methods for Natural Language Processing (NLP) text classification, to advance rigorous observational research of OARS behaviors in naturalistic settings; and (4) Training in clinical trial design for behavioral interventions, to develop and conduct trials that assess the effectiveness of OARS participation on AUD outcomes. I have assembled a multidisciplinary mentoring team of AUD and addiction recovery researchers with a strong track record of NIAAA funding and mentorship. My consultants provide necessary expertise in social processes of recovery, psychometrics, advanced methods in NLP, and clinical trial development and statistical analysis. The proposed K01 research builds upon my prior work focusing on patterns of OARS participation and social support. I propose an OARS Behavioral Pathway Model (OARS-BPM) to characterize observable behavior of OARS participation and social support, which are associated with development of AUD coping skills and a recovery-oriented social identity. I will develop self-report scales and corresponding NLP text classifiers to identify latent constructs of OARS behavior. To assess and refine OARS-BPM, I will elicit focus group feedback from OARS users and apply NLP text classifiers to characterize user behavior from public OARS forums. Based on these findings, I will conduct a pilot randomized clinical trial to assess feasibility and acceptability of an OARS-BPM based intervention to encourage structured OARS participation over 3 months. Thus, I will develop necessary self-report and NLP-based measurement tools as well as a behavioral clinical trial framework, which will potentiate the first randomized controlled trials of OARS participation on improving AUD outcomes.