Unhealthy alcohol use is present in up to 1.4 million survivors of critical illness in the U.S. each year. A severe acute illness requiring admission to medical intensive care unit (MICU) has been advocated as a teachable moment where appropriate interventions may lead to decreased morbidity related to alcohol. Although screening, brief intervention, and referral to treatment (SBIRT) has been extensively studied in the healthcare setting, prior studies do not address unique aspects of MICU survivors including a high prevalence of alcohol use disorders, reversible cognitive dysfunction, psychiatric co morbidities, and intimate involvement of family and loved ones in daily care and discharge planning. This proposal outlines a 5-year training program that will adapt and pilot SBIRT for MICU survivors and ultimately develop Dr. Brendan Clark into an independent academic clinical investigator. An integrated curriculum will build a tailored SBIRT system for MICU survivors and provide Dr. Clark with the necessary tools to be a leader in alcohol health services and critical care research. This program will consist of formal mentoring from four internationally renowned local experts in addition to coursework in clinical sciences and addiction. A multidisciplinary team will form an internal advisory committee to ensure that the goals and benchmarks of the proposal will be met. An external advisor whose expertise extends beyond that found at the University of Colorado Denver will provide feedback and input relevant to Dr. Clark's short and long-term goals. This structured curriculum will help Dr. Clark gain expertise in qualitative studies, learn how to design and conduct a randomized controlled trial, and develop knowledge in addiction psychiatry focusing on psychosocial aspects of addiction. The formal curriculum will coincide with practical experience gained through conducting the first prospective mixed methods study of MICU survivors with unhealthy alcohol use. Using a qualitative approach to engage important stakeholders including patients, friends/family, and healthcare providers/hospital systems, the proposed study will build on preliminary data to adapt SBIRT for MICU survivors. Because a high proportion of MICU survivors with unhealthy alcohol use have an AUD, this adapted SBIRT will focus on refining referral to treatment by developing a feasible role for a patient navigator. Subsequently, the feasibility and acceptability of this tailored SBIR system will be assessed in a pilot randomized controlled trial. The results of the proposed studies will tailor SBIRT for MICU survivors and leave Dr. Clark and the study team positioned to conduct a definitive multicenter clinical trial. An SBIRT system tailored to the needs of MICU survivors with unhealthy alcohol use would bridge the gap between treatment need and treatment utilization for a large population of patients at a time when they are uniquely motivated to change.
Unhealthy alcohol use is present in up to 38% of the 4 million patients admitted to an American intensive care unit (ICU) each year in the US. Despite the high prevalence of unhealthy alcohol use in ICU survivors, routine interventions targeted at reducing alcohol consumption, alcohol-related consequences, and illness related to alcohol is not currently part of the multidisciplinary approach to critical care. The training program outlined in this proposal will build a tailored system of screening, brief intervention, and referral to treatmnt that accounts for the unique characteristics of medical ICU survivors. The acceptability and feasibility of this SBIRT system will then be tested in a pilot clinical trial. The end result willbe a tailored SBIRT system for MICU survivors that are feasible and acceptable across a wide variety of hospital systems with a study team poised to determine its efficacy and effectiveness in a definitive multicenter clinical trial.
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