Clinical trial NCT06479681: A Peer Recovery Coaching Intervention for Hospitalized Alcohol Use Disorder Patients
Official title: A Peer Recovery Coaching Intervention for Hospitalized Alcohol Use Disorder Patients
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Alcohol Use Disorder
Lead sponsor: Clemson University
Sponsor class: OTHER
Collaborators: name: Prisma Health-Upstate
name: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
First posted: 2024-06-28
Enrollment: 750
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The project objective is to rigorously evaluate the effectiveness of a peer recovery coaching intervention (called RC-Link) in patients hospitalized with medical complications from alcohol use on recovery outcomes guided by the new NIAAA definition of recovery, examine mechanisms of heavy drinking using daily ecological momentary assessment (EMA), and determine the program's cost-effectiveness using an randomized controlled trial (RCT) design. The primary outcomes are frequency of heavy drinking, biopsychosocial functioning, and remission from AUD.

Detailed description: Alcohol Use Disorder (AUD) is the third leading cause of preventable deaths in U.S. and accounts for over 10% of U.S. hospital admissions. Treatment for this population often fails to address the underlying cause of the hospitalization: the AUD. Patients hospitalized with alcohol-related medical complications tend to have high-risk for recurrence of alcohol-related medical problems, high rates of hospital readmissions, and poor recovery outcomes. Methods that promote long-term recovery care are needed. Inpatient linkage to peer recovery coaching may bridge this gap in care by providing a method of continued care for AUD recovery that offers flexibility in recovery pathways, peer modeling opportunities, and strong social support. Pilot study results demonstrated the feasibility of inpatient linkage to peer recovery coaching and showed evidence of decreased alcohol consumption, increased engagement in treatment and recovery support programs, and decreased emergency department visits. However, pilot study sample size, outcomes, and methods were limited. This proposal seeks to overcome these limitations and build on these preliminary results by: using ecological momentary assessments, measuring recovery using the new NIAAA definition, examining cost-effectiveness, assessing alcohol consumption using an additional objective measure (breath alcohol content levels), and examining social support and self-efficacy as potential mechanisms of effectiveness. This proposal will rigorously test the effectiveness of an inpatient peer recovery coaching service called the RC-Link program on recovery outcomes in patients hospitalized with medical complications from AUD. The program involves a bedside introduction to a peer recovery coach during the patient's hospitalization plus continued, recovery support for six-months. The RC-Link program provides standardized peer recovery service that is both personalized to the patients' needs and generalized to provide socioemotional, instrumental, and informational social support during every patient encounter. Aim 1 will determine the effect of the RC-Link program on frequency of heavy drinking, biopsychosocial functioning, and remission from AUD compared to controls. Aim 2 will examine how daily changes in perceived social support and self-efficacy influence alcohol consumption and determine whether such associations differ between the RC-Link and control groups. Aim 3 will examine the cost-effectiveness of the RC-Link program; hospital utilization rates will be examined as secondary outcomes. These aims will be evaluated using a two-arm randomized controlled trial that compares the RC-Link program intervention to a control group that receives a brief intervention and connection to a peer recovery coach after the study period. Outcomes will be assessed at baseline, monthly during the 6-month study period, and 6-months post- intervention. This study has potential to advance recovery care for AUD by providing a better understanding of how long-term, inpatient-initiated peer recovery coaching influences recovery outcomes over time in this population.

Eligibility criteria: Inclusion Criteria:

* Live within 50 miles of the recruitment and plan to stay in the area for at least 6 months
* Current DSM-V criteria for moderate or severe AUD (measured by a score of ≥4 on the DSM-V Checklist)
* Hospitalized with a principal, primary, or secondary AUD-related diagnosis

Exclusion Criteria:

* Unable to provide informed consent
* Patients referred to hospice during hospitalization
* Women who are pregnant
* Comorbid diagnosis or at-risk for methamphetamine, cocaine, or opioid use disorder as determined by a score of ≥4 on the National Institute on Drug Abuse (NIDA) Modified Assist v3.0
* Current suicidal ideation
* Incarcerated at time of hospitalization
* Currently has a peer recovery coach
* Toxicology screen positive for opiates, cocaine, or methamphetamine
* Experiencing moderate/severe alcohol withdrawal based on physician assessment
* Psychotic disorders or bipolar disorder documented in chart

Primary outcomes:
measure: Change in Percentage of Heavy Drinking Days Per Month
timeFrame: one-month, 3-months, 6-months
measure: Remission from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) AUD Diagnosis
timeFrame: one-month, 3-months, 6-months, 12-months
measure: Change in Biopsychosocial Functioning
timeFrame: one-month, 3-months, 6-months
measure: Cost Effectiveness
timeFrame: 6-months
Secondary outcomes:
measure: Change in Coping
timeFrame: one-month, 3-months, 6-months, 12-months
measure: Change in linkage to and engagement in Evidence-Based Practices
timeFrame: one-month, 3-months, 6-months, 12-months
measure: Change in linkage to and engagement in Social Determinants of Health (SDoH) resources
timeFrame: one-month, 3-months, 6-months, 12-months
measure: Hospital Utilization
timeFrame: 6-months
measure: EMA: Heavy Drinking
timeFrame: 6-months
measure: EMA: Breath Alcohol Content (BrAC) Levels
timeFrame: 6-months
measure: EMA: Change in Craving
timeFrame: 6-months
Other outcomes:
Locations:
city: Greenville
country: United States
facility: Greenville Memorial Hospital
state: South Carolina
city: Seneca
country: United States
facility: Oconee Memorial Hospital
state: South Carolina
Study officials:
References: