Overview
This study is a 3-arm randomized clinical trial to evaluate the effectiveness of hospital-initiated Alcohol Use Disorder treatment, involving a Brief Negotiated Interview (with referral and telephone booster) alone, BNI+facilitated provision of MAUD, BNI+facilitated provision of MAUD+CBT4CBT on AUD treatment engagement, alcohol use and healthcare utilization.
Description
The proposed 3-arm randomized clinical trial will initiate interventions during hospitalization and evaluate outcomes at 34- and 90-days following hospital discharge to compare the effectiveness of 1) BNI, 2) BNI+facilitated provision of MAUD, and 3) BNI+facilitated provision of MAUD+CBT4CBT on AUD treatment engagement, alcohol consumption, and healthcare utilization among 450 racially and ethnically diverse hospitalized individuals with AUD.
Using a hybrid type 1 effectiveness-implementation design the investigators will also conduct an implementation- focused process evaluation to yield relevant data to inform future implementation, including process measures, clinician and staff (n=150) perspectives and cost effectiveness.
This proposed study is directly informed by rigorous prior research by this group and others demonstrating: 1) a need for new strategies to engage patients, particularly Black and Hispanic individuals, with AUD in treatment; 2) benefits of engaging patients in addiction treatment during acute care;3) benefits of MAUD and the potential to integrate its provision in general medical settings; and 4) benefits of CBT as an adjunct to MAUD with strong support for CBT4CBT across diverse populations
Eligibility
Inclusion Criteria:
- hospitalized at Yale New Haven Hospital (YNHH)
- meet Diagnostic and Statistical Manual (DSM-5) criteria for a moderate to severe AUD (regardless of primary reason for hospitalization) consistent with clinical guidelines for MAUD initiation
- >1 heavy drinking day by TLFB in 30 days prior to hospitalization
- willing to consider MAUD
- willing and able to be contacted for follow-up
- provide written informed consent
Exclusion Criteria:
- have been engaged in formal AUD treatment in the past 30 days (i.e., excluding mutual help groups, such as Alcoholics Anonymous)
- meet DSM-5 criteria for untreated moderate to severe opioid use disorder
- self-reported or urine testing confirming pregnancy, nursing, or trying to conceive
- life-threatening or unstable medical, surgical, or psychiatric condition that prohibits study participation
- inability to provide >1 collateral contact for a friend or family member
- anticipate being unable to return for follow-up assessments for any reason, such as travel, incarceration, planned procedure
- inability to understand English or Spanish.