A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment
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Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment. Available evidence suggests that primary care may play a crucial role in the identification of patients with an alcohol use disorder, delivery of interventions, and the success of treatment.
The principal aims of this study were to test the effectiveness of a primary care-based Alcohol Care Management (ACM) program for alcohol use disorder and treatment engagement in veterans.
The design of the study was a 26-week single-blind randomized clinical trial. The study was conducted in the primary care practices at three VA medical centers. Participants were randomly assigned to treatment in ACM or standard treatment in a specialty outpatient addiction treatment program.
One hundred and sixty-three alcohol-dependent veterans were randomized.
ACM focused on the use of pharmacotherapy and psychosocial support. ACM was delivered in-person or by telephone within the primary care clinic.
Engagement in treatment and heavy alcohol consumption.
The ACM condition had a significantly higher proportion of participants engaged in treatment over the 26 weeks [OR = 5.36, 95 % CI = (2.99, 9.59)]. The percentage of heavy drinking days were significantly lower in the ACM condition [OR = 2.16, 95 % CI = (1.27, 3.66)], while overall abstinence did not differ between groups.
Results demonstrate that treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking.
KEY WORDSaddiction primary care treatment randomized clinical trial
We thank the primary care providers who fully participated in the study and their dedication to improving outcomes for addictive disorders.
Supported, for the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript, by the following sources:
• Health Services Research and Development Program of the Department of Veteran Affairs (IIR)
• The VISN 4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center
• The VISN 2 Center for Integrated Healthcare
• Career Development Award [K05 AA16928 (Dr. Maisto)]
• NIDA (K24 DA029062) and NIAAA (P01-AA016821) (Dr. McKay)
There have been no prior presentations of the outcome data.
Conflicts of Interest
Potential conflicts of interest include funding from the Caron Foundation (McKay); Hazelden Foundation (Oslin and McKay); Treatment Research Institute (McKay), University of Wisconsin (McKay), Wright State University (McKay), Research Foundation for Mental Hygiene (McKay), National Quality Forum (McKay), Altarum (McKay), the State of Pennsylvania (Oslin, Lynch) and the Human Service Center (McKay). The remaining authors declare that they do not have a conflict of interest.
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