Research on mechanisms of behavior change (MOBCs) has identified several processes that appear to facilitate successful drinking outcomes in alcohol use disorder (AUD) treatments. Often, different evidence- based treatments appear work through similar mechanisms, suggesting that constructs such as drink-refusal self-efficacy, craving, social support for abstinence, and other MOBCs are key variables that should be assessed, targeted in treatment, and monitored for change. Although the research base on MOBCs continues to expand, more work is needed to understand how to utilize MOBCs in real-world practice settings. In non- AUD contexts, measurement-based care research has shown that mental health symptoms improve more quickly and to a greater degree if they are routinely assessed, presented to patients, and discussed with clinicians. However, the impact of a similar approach for MOBCs - i.e., assessing, providing feedback, and discussing MOBCs as routine practice during treatment sessions- has not been tested. Moreover, the specific manner in which assessment, feedback, and discussion of MOBCs could be facilitated in real-world practice has not been explored. MOBC-based assessment tools could be particularly appealing to frontline clinicians given that (1) theoretical approaches often vary between clinicians despite the underlying MOBCs often being similar and (2) movement toward outcome-based performance measures and healthcare reform will require increased measurement and documentation of relevant treatment targets. The proposed K01 career development award provides training to support a research career focused on developing and testing tools that assist frontline clinicians and enhance the quality of their service delivery. Carefully devised training plans will provide training in (1) implementation science in addiction treatment, (2) user centered technology design, and (3) cross-disciplinary collaboration, research dissemination, and grant writing. These goals will be achieved through several means including mentorship from experts, coursework, clinical training, and hands-on experience. The proposed research project complements these training aims by developing a computer-based clinical support tool that is implementation-focused and helps frontline clinicians assess and review patient MOBC data during their treatment sessions. The project will include phases to (1) assess opinions, needs, and desires of stakeholders around developing such a clinical support tool, (2) iteratively test and modify a software prototype to increase the ease of using the tool and understanding its feedback, and (3) test the tool's feasibility, acceptability, and impact on clinicians' within-session behavior. The research will take place at a publicly-funded treatment setting with frontline clinicians and patients. The award will complement the candidate's existing strengths in MOBC research by providing training in new domains involving cross- disciplinary research partnerships, user-centered design, and implementation-focused research.

Public Health Relevance

Research is increasingly improving our understanding of the mechanisms that facilitate better alcohol use disorder treatment outcomes; however, little is known about how to improve clinicians' attention toward assessing, monitoring, and planning treatment goals around these mechanisms. This career development award proposal supports research and training to develop technology that assists frontline clinicians assess, monitor, and develop treatment plans around mechanisms of change in alcohol use disorder treatment.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Neuroscience Review Subcommittee (AA)
Program Officer
Hagman, Brett Thomas
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University of Washington
Schools of Medicine
United States
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Witkiewitz, Katie; Kranzler, Henry R; Hallgren, Kevin A et al. (2018) Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 42:2453-2465
Epstein, Elizabeth E; McCrady, Barbara S; Hallgren, Kevin A et al. (2018) A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women. Psychol Addict Behav 32:1-15
Hallgren, Kevin A; Delker, Brianna C; Simpson, Tracy L (2018) Effects of Initiating Abstinence from Alcohol on Daily Craving and Negative Affect: Results from a Pharmacotherapy Clinical Trial. Alcohol Clin Exp Res 42:634-645
Hallgren, Kevin A; Wilson, Adam D; Witkiewitz, Katie (2018) Advancing Analytic Approaches to Address Key Questions in Mechanisms of Behavior Change Research. J Stud Alcohol Drugs 79:182-189
Witkiewitz, Katie; Kirouac, Megan; Roos, Corey R et al. (2018) Abstinence and low risk drinking during treatment: Association with psychosocial functioning, alcohol use, and alcohol problems 3 years following treatment. Psychol Addict Behav 32:639-646
Hallgren, Kevin A; Dembe, Aaron; Pace, Brian T et al. (2018) Variability in motivational interviewing adherence across sessions, providers, sites, and research contexts. J Subst Abuse Treat 84:30-41
Maisto, Stephen A; Hallgren, Kevin A; Roos, Corey R et al. (2018) Course of remission from and relapse to heavy drinking following outpatient treatment of alcohol use disorder. Drug Alcohol Depend 187:319-326
Hallgren, Kevin A; Ries, Richard K; Atkins, David C et al. (2017) Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care. J Am Board Fam Med 30:150-160
Wendt, Dennis C; Hallgren, Kevin A; Daley, Dennis C et al. (2017) Predictors and Outcomes of Twelve-Step Sponsorship of Stimulant Users: Secondary Analyses of a Multisite Randomized Clinical Trial. J Stud Alcohol Drugs 78:287-295
Witkiewitz, Katie; Pearson, Matthew R; Hallgren, Kevin A et al. (2017) Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials. Addiction 112:2112-2121

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