Few individuals with alcohol use disorder (AUD) engage in treatment. The goal of the proposed pilot study is to increase utilization of alcohol use disorder treatment services through gaining a better understanding of individuals who refuse referral to current forms of treatment. No previous studies have investigated treatment preferences of patients with AUD who refuse referral to treatment and none have systematically assessed such individuals' reasons for refusing treatment. Gaining a better understanding of reasons why individuals refuse current services and what services they might use is an essential first step towards the creation of a more responsive alcohol treatment system. The proposed study will assess 100 primary care patients at a private managed care facility and a VA facility who were identified as having a suspected AUD but refused intensive outpatient treatment. An interview will be used to obtain patient preference ratings for treatments of varying intensities (5 days a week, weekly, bi-weekly) and varying modes of delivery (individual, telephone, internet, books) and varying goals (abstinence, harm reduction). In addition, participants will be asked their reasons for not participating in traditional treatment to gain a sense of the relative importance of treatment barriers such as denial of problems, stigma, incompatible substance use goals, and alternative time demands. Finally, subjects will report their current levels of alcohol use/problems and rate the likelihood that they would engage in treatment if that treatment matched their preferences. The project is anchored in basic and applied research in behavioral economics. The project will test whether treatment barriers appear more consistent with behavioral economic theory or whether such barriers are consistent with the traditional """"""""denial of problems"""""""" hypothesis. This project also tests the hypothesis that a larger number of individuals with AUD can be engaged in treatment if they are presented with treatment options that are responsive to their desired treatment goals, modes, and intensity. In addition, it is hypothesized that increasing treatment options will be especially appealing to those with less severe drinking problems. Data on preferences for less intensive treatments will be used in a future study to inform implementation of the first step of a stepped care intervention.
