Reducing Alcohol use among Elective Surgical Patients using Adaptive Interventions

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Project Summary/Abstract Surgery is a pivotal life event during which the acuity and imminence of surgical risk can motivate patients to make major changes to behaviors and lifestyle factors to optimize surgical health. Preoperative alcohol consumption (>2 drinks a day) is a common surgical risk factor linked to increased postoperative complications. Appropriately timed interventions could promote short- and long-term alcohol use reduction and prevent excess surgical morbidity and mortality. However, the dearth of research in this area limits our ability to intervene effectively or leverage motivation at critical time points. This study uses a sequential, multiple assignment, randomized trial (SMART) to test the efficacy of adaptive interventions for elective surgical patients reporting high-risk alcohol use. These adaptive interventions use decision rules at critical points during the surgical episode of care to modify treatment type and intensity based on early treatment response. The specific aims are: 1) Test the efficacy of adaptive interventions that begin with preoperative ‘Virtual Coaching’ relative to Enhanced Usual Care on reducing alcohol use, surgical complications, and hospital length of stay; and 2) Identify the most efficacious second-stage intervention to sustained alcohol use reduction after surgery among early treatment responders and non-responders. Elective surgical patients (N = 440) will be randomized before surgery to either Virtual Coaching or Enhanced Usual Care. Initial treatment response will be assessed at the 2-month follow up for the perioperative period. Early responders (i.e., abstinence or low-risk alcohol use) will be re-randomized to postoperative strategies, either continued Virtual Coaching or stepped down to Usual Care. Early non-responders (i.e., not abstinent or low risk drinking), will be re-randomized to alternative postoperative strategies, either ‘On-track,’ a mobile health intervention that incorporates self- monitoring and progress feedback, or a combined intervention (Virtual Coaching + On-Track). Outcomes will be measured at 2-, 6-, and 12-month follow-ups and via electronic health records. Secondary aims are: 1) Identify the best performing adaptive interventions; and 2) Identify baseline and time varying moderators of intervention efficacy. Results of this study will have wide-ranging implications for innovating and moving beyond static alcohol interventions in healthcare settings and will advance surgical health optimization research. This study is consistent with the priorities of the National Institute of Alcohol Abuse and Alcoholism which seeks to advance addiction health services by integrating alcohol treatment into mainstream healthcare, thereby improving access and decreasing stigma. The adaptive interventions developed in this study enables real-time treatment tailoring based on individual’s response to first stage interventions, a critical advance in care consistent with national precision health priorities which seek to tailor treatment to individual needs.