Evaluating the Efficacy of Telehealth-Delivered Brief Family Involved Treatment (B-FIT) for Alcohol Use Disorder among Veterans

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ABSTRACT Improving alcohol use disorder (AUD) treatment access and outcomes among Veterans is an urgent public health priority. The lifetime prevalence of AUD among Veterans is twice that of civilians. Veterans also incur more severe and persistent AUD symptoms with more lengthy and complex treatment courses and negative outcomes compared to the general population. Despite the critical role that family members play in the etiology, course, and treatment of AUD, and the robust evidence base supporting the efficacy of several existing family AUD treatments, family treatment protocols are lengthy and burdensome for patients and clinicians. Thus, there is a critical need to develop efficacious family AUD treatments that are both brief and highly accessible to Veterans. Members of our team developed and refined the Brief Family Involved Treatment (B-FIT) protocol in an NIAAA-sponsored pilot trial among civilians. B-FIT is a 3-session cognitive behavioral therapy designed to be implemented in combination with any existing alcohol treatment program. The goals of B-FIT are to 1) increase reinforcement of treatment-facilitating behaviors, 2) increase the perceived reinforcement value of abstinence by increasing anticipated positive rewards from abstinence, and 3) reduce drinking cues by decreasing negative communication and increasing positive communication with family members. This study resulted in findings that support feasibility, acceptability, and preliminary efficacy of B-FIT. In a separate study, our team has demonstrated excellent feasibility and acceptability of delivering dyadic AUD treatment via home-based telehealth. Thus, the primary objective of this Stage II trial is to examine the efficacy of B-FIT in combination with treatment as usual (TAU; VA Substance Treatment and Recovery [STAR]) versus TAU alone in 1) reducing alcohol consumption, 2) improving family functioning, and 3) improving STAR treatment satisfaction, adherence, and retention among Veterans. To accomplish this, we will employ an open randomized controlled design and examine standardized, repeated, dependent measures of change at multiple time points. We will also leverage our team’s standard operating procedures for fully remote study implementation, close collaboration with regional VA STAR clinics, and a robust national VA telehealth infrastructure which is prepared to efficiently translate positive findings into treatment. The proposed study is directly aligned with NIAAA’s mission and Strategic Plan in that it will 1) employ electronic health technology to improve the effectiveness and accessibility of AUD treatment for Veterans, 2) will advance AUD treatment access among rural and underserved Veterans, who are a health disparity population, 3) focuses on Veterans in a real-world treatment setting (i.e., VA STAR clinics), 4) examines B-FIT for home-based telehealth delivery, and 4) will identify characteristics of Veterans and family members most likely to benefit from the addition of B-FIT to their recovery program. Our findings will directly inform clinical practice and accelerate treatment in this important but understudied area.