Alcohol dependence (AD) is a chronic disease. Patients with AD can be linked with specialty care and primary care (PC), but their health care often remains episodic and fragmented. As a result, adults with AD often enter AD treatment late, and with health consequences that require urgent care, rather than earlier when interventions of lower intensity but longer duration might prevent catastrophes. Chronic disease management (CDM) is a collaborative, longitudinal, proven effective approach to the treatment of chronic medical illnesses that addresses individual patient and health systems barriers to receipt of needed treatment. But the effectiveness of CDM for AD has not been tested. The objective of this Alcohol Health Evaluation And Disease management (AHEAD) Study, is to test the effectiveness of CDM for AD in primary care. The study will enroll 320 adults with AD who are not in alcoholism treatment, and randomize them to attend an AD CDM program (the AHEAD Unit) integrated into a real-world PC clinic or to referral to usual PC. All subjects will be assessed regarding alcohol diagnosis, consumption and problems, readiness to change, health-related quality of life, and medical and alcohol treatment utilization. Subjects will be evaluated 3, 6 and 12 months later, and health services utilization data will be collected for 2 years from a statewide database. Primary outcomes are alcohol use, alcohol-related problems, emergency department visits, and hospitalizations. Additional outcomes are health-related quality of life, readiness to change, medical and psychiatric comorbidity, HIV risk behaviors, and AD and PC treatment utilization and costs. The hypothesis is that compared with standard care, a health services intervention--chronic disease management for AD integrated in PC--will decrease alcohol use and related problems, and improve healthcare utilization patterns. Improved outcomes using the AHEAD approach would support the adoption of a health services delivery strategy, chronic disease management, to better care for patients with alcoholism.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA010870-10
Application #
7677819
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Lowman, Cherry
Project Start
1996-05-01
Project End
2011-08-31
Budget Start
2009-09-01
Budget End
2011-08-31
Support Year
10
Fiscal Year
2009
Total Cost
$687,295
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Park, Tae Woo; Samet, Jeffrey H; Cheng, Debbie M et al. (2015) The prescription of addiction medications after implementation of chronic care management for substance dependence in primary care. J Subst Abuse Treat 52:17-23
Park, Tae Woo; Cheng, Debbie M; Samet, Jeffrey H et al. (2015) Chronic care management for substance dependence in primary care among patients with co-occurring disorders. Psychiatr Serv 66:72-9
Upshur, Carole C; Weinreb, Linda; Cheng, Debbie M et al. (2014) Does experiencing homelessness affect women's motivation to change alcohol or drug use? Am J Addict 23:76-83
Saitz, Richard; Cheng, Debbie M; Allensworth-Davies, Donald et al. (2014) The ability of single screening questions for unhealthy alcohol and other drug use to identify substance dependence in primary care. J Stud Alcohol Drugs 75:153-7
Smith, Peter C; Cheng, Debbie M; Allensworth-Davies, Donald et al. (2014) Use of a single alcohol screening question to identify other drug use. Drug Alcohol Depend 139:178-80
Bertholet, Nicolas; Winter, Michael R; Cheng, Debbie M et al. (2014) How accurate are blood (or breath) tests for identifying self-reported heavy drinking among people with alcohol dependence? Alcohol Alcohol 49:423-9
Redmond, Nicole; Hicks, Leroi S; Cheng, Debbie M et al. (2014) Association of recent incarceration with traumatic injury, substance use-related health consequences, and health care utilization. J Addict Med 8:66-72
Mojarrad, Mohammadali; Samet, Jeffrey H; Cheng, Debbie M et al. (2014) Marijuana use and achievement of abstinence from alcohol and other drugs among people with substance dependence: a prospective cohort study. Drug Alcohol Depend 142:91-7
Saitz, Richard; Cheng, Debbie M; Winter, Michael et al. (2013) Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial. JAMA 310:1156-67
Beck, Cynthia A; Southern, Danielle A; Saitz, Richard et al. (2013) Alcohol and drug use disorders among patients with myocardial infarction: associations with disparities in care and mortality. PLoS One 8:e66551

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