Transition to Recovery

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RESEARCH PROJECT 3 ABSTRACT The primary goal of alcohol detoxification is to medically manage acute intoxication and withdrawal. Its secondary goal of fostering entry into longer-term alcohol treatment post-detoxification is often overlooked. This leads to a revolving door characterized by a cyclical pattern of discharges and readmissions to detoxification. This pattern is observed across the US among alcohol detoxification patients and is even more prevalent among Alaska Native people in Fairbanks where only 2% transition to alcohol treatment following detoxification and approximately 40% are readmitted within 1 year. The revolving door is costly to patients and providers. Current estimates associated with the cost of detoxification are not available. A study over 25 years ago indicated the average inpatient detoxification stay was over $3,300. Although the Substance Abuse and Mental Health Administration recognizes that better linkages are needed to transition people to treatment following detoxification, few interventions have tested ways to improve this transition; none of these prior studied included either Alaska Natives or American Indians. In partnership with the Fairbanks Native Association’s Gateway to Recovery (GTR), we propose to use patient navigators to guide and assist patients in transitioning to appropriate levels of treatment, and to help eliminate barriers that obstruct treatment entry. Our study first uses GTR’s electronic medical record data to identify factors that predict transition to treatment and readmission to detoxification among ~1,000 patients seen over the prior 5 years. Second, we will use this information, combined with focus groups comprised of key stakeholders, to identify appropriate navigator roles and processes for alcohol detoxification patients. We will then conduct a randomized controlled trial of the modified intervention with 700 patients. Third, we will estimate the costs of implementing and sustaining this intervention, Transition to Recovery, as well as its economic value. Our control condition will include 1 session of motivational interviewing that will include goal setting and strategies to reduce alcohol consumption after detoxification discharge. Our Specific Aims are to: 1) Use electronic medical record data from ~1,000 patients to identify factors associated with post-detoxification transition to alcohol treatment and readmission to detoxification; 2) Adapt Transition to Recovery to fit the GTR patient population and test its effectiveness in increasing transition to post-detoxification treatment within 30 days and prevent readmission within 1 year; and 3) Perform a comprehensive economic evaluation of Transition to Recovery by using cost-benefit and cost- effectiveness analyses. This is the first randomized controlled intervention to use patient navigators to enhance transition to alcohol treatment following detoxification. If effective, this intervention may be a cost-effective means of transitioning detoxification patients to treatment across health care systems nationally.