Heavy alcohol use represents a significant risk for morbidity and mortality among primary care patients. These risks are compounded among those who experience chronic pain, one of the most common problems among those presenting to primary care. Pain represents an important trigger for alcohol use among heavy drinkers with chronic pain in primary care settings and is linked with the experience of negative alcohol-related consequences and heavy drinking over time. Moreover, pain has been shown to be associated with poorer responses to alcohol interventions. Similarly, heavy alcohol use interferes with pain management efforts among those with chronic pain and is associated with earlier dropout from treatment. Efforts to address these co-occurring problems represent a significant challenge for clinicians given restricted visit time and resources, limitations of available pharmacological approaches to adequately address these conditions, and patient motivation to engage in treatment regimens that may require multiple clinic visits. Given the rates of chronic pain and heavy drinking among patients in primary care, an integrated approach to address these conditions with low utilization of health care resources and minimal patient burden may significantly improve health outcomes. The objective of this R34 (Behavioral and Integrative Treatment Development Program) proposal is to develop an integrated, multimodal technology-based intervention to reduce heavy alcohol use and chronic pain among primary care patients. This cognitive behavioral self-management intervention will be implemented by making use of web-delivered content and app-based automated and synchronous messaging features. This project will consist of two phases. The first will consist of intervention development through an iterative process of patient and staff interviews, intervention construction, and preliminary testing. The second phase will be a randomized controlled pilot trial conducted with patients identified through screening in primary care. In this second phase, the main objectives are to develop study procedures, collect preliminary data on drinking and pain outcomes, and assess intervention feasibility in preparation for a Stage 2 efficacy trial. This intervention approach has the potential to provide an efficacious, low-cost, low participant burden strategy for addressing heavy alcohol use and chronic pain that may be readily integrated into primary care settings.
Heavy drinking and chronic pain represent two commonly co-occurring conditions in primary care that significantly impact health and well-being. This research seeks to develop an integrated, technology-based approach to address these issues in a manner that will minimize health care resource use, reduce patient burden, and enhance patient engagement, thereby having a significant potential to improve patient outcomes.
