Alcohol Use Disorder (AUD) is a major cause of morbidity and mortality in the U.S. Individuals of color are particularly impacted by more severe health and social consequences related to alcohol use and experience greater barriers to treatment. Hospitalization provides an untapped opportunity to initiate AUD treatment. While there are a range of behavioral and medication treatment options that may be started prior to hospital discharge, AUD-related care in hospital-settings often focuses on treatment of acute withdrawal and addressing associated medical complications without addressing the underlying AUD.
Supported by a $3.5M grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), faculty in the Yale Program in Addiction Medicine and the Yale Department of Psychiatry have partnered to implement a three-arm trial that will investigate the optimal approach to enhance post-discharge AUD treatment engagement and reduction of alcohol use. The trial will consider comparative and combined use of Brief Intervention, medications for AUD, and computer-based cognitive behavioral therapy (CBT) among a diverse sample of 450 patients hospitalized at Yale New Haven Hospitals. Furthermore, the research team will examine the influence of structural racism and other social determinants of health, such as housing instability and medical mistrust, on the target outcomes of treatment engagement and reduced alcohol use.
The study, entitled “Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications, and CBT4CBT,” furthers the innovative work of the late Dr. Kathleen Carroll, who led the development of CBT4CBT, a computerized CBT program that has been demonstrated in multiple clinical trials over several years to have the strongest evidence of any web-based CBT program for individuals with substance use disorder. Shares Brian Kiluk, PhD, a former mentee and long-time collaborator of Dr. Carroll's and one of multiple Primary Investigators (MPIs) of this study, “Kathy’s primary goal in developing [CBT4CBT] was to provide individuals struggling with substance use greater access to an evidence-based treatment. This project carries forward that goal by bringing CBT4CBT into the hospital setting, where individuals with AUD may be open to treatment but have historically had limited opportunity to engage with a CBT-trained counselor [...] Delivering this program during an acute medical hospitalization may provide the opportunity to reach underserved populations, including those most challenged by the social determinants of health and those with high disease severity, and engage them in high-quality treatment for their alcohol use."
Says the other MPI of this study, E. Jennifer Edelman, MD, MHS, with this research, “we hope to generate new knowledge about the incremental benefits of adding medications for AUD with and without CBT4CBT to brief intervention to address alcohol use among English and Spanish-speaking patients.” The study will recruit English- and Spanish-speaking participants in the Greater New Haven area, with a focus on Black and Latinx communities, and will offer culturally and socially adapted interventions in both languages. “These interventions are widely scalable and have potential to be implemented across a range of hospital settings,” remarks Edelman. “We are thrilled to have a team that brings together diverse perspectives and expertise to do this work.”