A randomized clinical trial of alcohol care management delivered in Department of Veterans Affairs primary care clinics versus specialty addiction treatment.
BACKGROUND
Alcohol use disorder is one of the leading causes of disability worldwide. Despite the availability of efficacious treatments, few individuals with an alcohol use disorder are actively engaged in treatment. Available evidence suggests that primary care may play a crucial role in the identification of patients with an alcohol use disorder, delivery of interventions, and the success of treatment.


OBJECTIVE
The principal aims of this study were to test the effectiveness of a primary care-based Alcohol Care Management (ACM) program for alcohol use disorder and treatment engagement in veterans.


METHODS
The design of the study was a 26-week single-blind randomized clinical trial. The study was conducted in the primary care practices at three VA medical centers. Participants were randomly assigned to treatment in ACM or standard treatment in a specialty outpatient addiction treatment program.


METHODS
One hundred and sixty-three alcohol-dependent veterans were randomized.


METHODS
ACM focused on the use of pharmacotherapy and psychosocial support. ACM was delivered in-person or by telephone within the primary care clinic.


METHODS
Engagement in treatment and heavy alcohol consumption.


RESULTS
The ACM condition had a significantly higher proportion of participants engaged in treatment over the 26 weeks [OR = 5.36, 95 % CI = (2.99, 9.59)]. The percentage of heavy drinking days were significantly lower in the ACM condition [OR = 2.16, 95 % CI = (1.27, 3.66)], while overall abstinence did not differ between groups.


CONCLUSIONS
Results demonstrate that treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking.
Mental Illness Research, Education and Clinical Center at the Philadelphia VA Medical Center, University of Pennsylvania, Philadelphia, PA, 19104, USA, oslin@upenn.edu.
David W
DW
Oslin
Kevin G
KG
Lynch
Stephen A
SA
Maisto
Larry J
LJ
Lantinga
James R
JR
McKay
Kyle
K
Possemato
Erin
E
Ingram
Michael
M
Wierzbicki
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy*; D000553:Ambulatory Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D010349:Patient Compliance / Q000706:statistics & numerical data; D018579:Patient Selection; D011320:Primary Health Care / Q000458:organization & administration*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology
D009271:Naltrexone