Title: ADEPT: Using complexity science and digital technology to improve co-morbid Alcohol use disorder and DEpression Prevention and Treatment
Funder: Department of Health and Social Care

Abstract: BACKGROUND Alcohol use disorder (AUD) and depression frequently co-occur, resulting in adverse impacts on individuals, communities, and the health and care system. Yet despite the existence of effective treatments for these conditions, evidence-based interventions remain poorly implemented, with users and providers reporting fragmented delivery of services. Improved integration of substance use and mental health services has been identified as a top UK and global policy priority. Better understanding the complex AUD and depression prevention and treatment system, and harnessing available digital technology, including electronic interventions, could potentially support this ambition. However, future initiatives must actively involve providers and users in their development to ensure relevance, feasibility, and legitimacy. AIMS To use complex systems approaches to better understand the challenges experienced by AUD and depression service users/providers, using the North East and North Cumbria Integrated Care System (NENC ICS) as a case study; To develop a system-level, digital intervention, to help individuals with co-morbid AUD and depression access and navigate appropriate prevention and treatment.METHODS WP1: Social network analysis of AUD and depression prevention and treatment I will conduct an electronic survey questionnaire of individuals/organisations providing AUD and depression care in the NENC ICS and use social network analysis methods to identify: which structural factors currently constrain/facilitate collaboration; and any 'key agents' that could promote future improvement strategies. WP2: Understanding the AUD and depression system user perspective Semi-structured interviews with 20-25 NENC ICS 'key agents'/other care providers, plus 35-40 patients/service users, will explore their views on/experiences of co-morbid AUD and depression services, and perspectives on using digital technology to improve care. Findings from WP1/2 will inform recommendations to improve AUD and depression prevention/treatment services in the NENC ICS and beyond. WP3: Develop a digital navigator to improve AUD and depression prevention and treatment I will employ user-informed design methods (Person Based Approach) to develop a digital navigator to improve access to/coordination of AUD and depression care. Specific features will be user-informed but likely to include: 1) personalization (secure, tailored interface); 2) support (signposting to/psychoeducation about health and care services; access to digital interventions); 3) coordination (digitally-enabled care pathways). WP4: Pilot feasibility study and mixed-methods evaluation Early stage piloting of the digital navigator to investigate the feasibility/acceptability of implementation in routine primary healthcare. Objectives are to: 1) assess frequency of use in consultations with eligible patients; 2) summarise patient characteristics/understand care pathways; 3) explore implementation barriers/facilitators patients/clinicians; 4) determine whether further refinements are required before full evaluation. ANTICIPATED IMPACT AND DISSEMINATION NHS/Patient impact: Development of recommendations and a piloted digital navigation tool to improve care for patients with comorbid AUD and depression, and their care providers, ultimately helping to reduce the substantial health and social care costs arising from this patient population. Career impact: Support my transition to being a prominent research leader in my field. Dissemination strategy: Substance use, mental health and implementation science academics; health and social care providers/organisations/commissioners; people with AUD and depression; national/international policymakers. Future research: NIHR funding for full evaluation of the digital navigator.

Lay abstract: WHAT IS THE PROBLEM?Heavy drinking and depression often happen at the same time, which harms those individuals, the communities they live in, and the health and social care system. Good treatments are available but not always offered by health and social care providers. The stigma attached to substance use and mental health can act as a major barrier to patients accessing the right help. Additionally, support services for alcohol and depression are often poorly coordinated, and health and social care providers do not always find it straightforward to work together. This means that some heavy drinkers are not able to access support for any additional mental health concerns. Improving the joint working of alcohol and mental health services is a top priority for the UK Department of Health & Social Care. Using new digital technology, such as websites and mobile phone applications, and sharing electronic information on patients, with their consent, could help achieve this. However we first need to fully understand the problems that heavy drinkers with depression, and their care providers, experience. We also need to be sure that any future solution meets the needs and concerns of the people that we hope to help.WHAT DOES THIS RESEARCH AIM TO DO? This research aims: To use the experiences of those receiving/delivering care to understand and evaluate the alcohol and depression prevention and treatment system in the North East and North Cumbria; To work with patients, the public, and care providers to develop an interactive digital tool to help people with heavy drinking and depression find their way around local services and access effective online therapy.HOW WILL THIS RESEARCH BE CARRIED OUT? The study will use a number of different research methods. I will map the alcohol and depression services currently available in the North East and North Cumbria, including who delivers these services, whether any online/mobile phone applications are available, and what data is collected by services. I will explore how different individuals, services and organisations are currently working together, and where there might be problems in the system. I will interview people involved in the delivery of alcohol and depression services in the North East and North Cumbria, as well as people with heavy drinking and depression themselves. The interviews will help me to understand what is/isn't working about the current system, and how digital technology might help improve the situation. I will use information from the interviews and the mapping exercise to produce recommendations for how the care system needs to change to better support heavy drinkers with depression. I will then work with patients and care providers to develop a digital tool to support people with heavy drinking and depression, which will be tested in primary healthcare. This will help policy makers, care providers, and researchers make decisions about whether it will be practical and helpful to use the digital tool more widely in health and social care.PATIENT AND PUBLIC INVOLVEMENT People with heavy drinking and depression have been involved in developing this research. I will form a PPI reference group, so they can play a meaningful part throughout the study, helping me make decisions about the research, and develop the dissemination strategy. DISSEMINATION The main outcome from this research will be the creation of a digital tool that could help people with heavy drinking and depression get better care. Articles will also be published in academic journals, summaries of the research will be made available for policymakers and the wider public, and the results will be presented at a number of conferences and events.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH