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.
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