Anticipated Impacts on Veteran's Health: The availability of VHA ED care has expanded rapidly over the past decade. VHA Emergency Department (ED) often serves as a first stop for Veterans who are experiencing acute problems related to hazardous alcohol use and mental health problems. Many Veterans seen in VHA EDs report hazardous drinking that is either tied directly to their presenting problem or complicates the care of medical and/or psychiatric symptoms. Hazardous drinking is directly related to high volume and high morbidity problems in Veterans, including PTSD, suicidality and homelessness. Providing alcohol brief interventions in this fast-paced environment can be difficult due to competing staff time demands. Expanding the role of peer mentors used in the VHA to providing brief alcohol advice in the ED combined with post-ED continuing support designed to reduce hazardous drinking and help Veterans engage in care has the potential to fill this gap in ED care and improve outcomes for a vulnerable population. Project Background: Research indicates that a high proportion of patients seen in EDs have hazardous or harmful alcohol use. Due to limited provider time to screen for alcohol and deliver alcohol-related services in EDs, few individuals currently receive the needed assistance to cut-back, stop drinking, and/or link to needed services following an ED visit. Single-session alcohol brief interventions (BIs) alone are only modestly effective in the ED and thus more intensive, but sustainable, interventions are needed to facilitate engagement to the most appropriate VHA resource (e.g., substance abuse treatment, homeless program case management, embedded mental health in primary care, etc.). The VHA nationally has implemented the use of trained peer specialists in a number of areas. VHA EDs have the opportunity to use peer specialists to conduct standardized alcohol brief interventions, provide continuing support, and link Veterans to needed services. The widespread availability of peers within health care teams provides a potential method to overcome barriers for connecting Veterans with hazardous/harmful alcohol use to needed VHA services. Project Objectives: The objective of this proposed study is to conduct a hybrid randomized controlled trial to determine the efficacy of an intervention starting in the ED with peer- delivered brief alcohol advice (including a 6-session program of post-ED strengths-based peer mentorship) compared to clinician-delivered brief advice in the ED only to facilitate reductions in hazardous drinking, and linkage and engagement in primary and/or specialty care.
Aim 1 : Determine the efficacy of the ED Alcohol Peer Mentor (APM) intervention compared to Clinical Brief Advice (CBA) on subsequent AUDIT scores, including quantity/frequency of alcohol use, binge drinking, and alcohol consequences at 3-, 6-, and 12-months post-baseline.
Aim 2 : Determine the impact of the APM intervention on linkage to primary and specialty alcohol treatment services care, mental health symptoms and functioning at 3-, 6-, and 12-months post-baseline. Project Methods: The proposed study will screen VA ED patients for hazardous drinking. Those screening positive and who enroll in the study will be randomized to one of two conditions: 1) APM intervention (n=225), and 2) CBA (n=225) comparison condition. All participants will receive written community resource information. All individuals in the APM condition will receive peer support to reduce hazardous drinking, and those who meet alcohol use disorder criteria will be coached by the peer and will assist in a warm handoff to addiction treatment. Qualitative interviews with a subset of Veterans, peers, clinicians, and clinical leaders will assess potential barriers and facilitators to the implementation of this approach in the VHA. Because the VHA ED is an important portal for entry into the VA health care system, particularly for Veterans who are experiencing hazardous or harmful drinking, the delivery of an efficacious alcohol peer-mentor intervention with minimal use of staff resources could have a major public health impact.
Hazardous drinking is a large and growing problem for Veterans across age groups. Many Veterans with hazardous drinking and other mental health problems seek care in the Emergency Department (ED). This study is a randomized controlled trial (N=450) of an alcohol intervention starting in the VHA ED with peer support personnel delivering brief alcohol advice, combined with a continuing 6-session program of post-ED strengths-based peer mentorship to facilitate reductions in alcohol use and to link Veterans with alcohol problems to needed primary and specialty care including other needed services such as homeless outreach and case management where needed. If successful, the proposed study will provide key data on the effectiveness of using peer support specialists in the VHA to help Veterans with hazardous drinking who may have difficulty engaging in needed care that potentially improve their mental and physical health outcomes.
