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Principal Investigator: Michael Anthony Cucciare
Organization: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
Fiscal Year: 2024
Funding agency: Veterans Affairs
Project Summary/Abstract
Background: Relatively few Veterans screening positive for hazardous drinking in primary care (PC) receive
alcohol care in the year following their alcohol screening. This suggests that existing VHA options for linking
Veterans in need of alcohol care, including those with comorbid hazardous drinking and PTSD and/or
depression (A-MH), are not effective. To that end, we have identified and propose to pilot test a promising
evidence-based intervention, Strengths-based Linkage to Alcohol Care (SLAC). SLAC has the potential to
increase linkage to alcohol care, as well as to improve drinking and mental health outcomes, among Veterans
with A-MH in PC.
Significance: Existing VHA options such as VHA-recommended brief alcohol counseling do not improve
linkage to alcohol care, suggesting a critical need for more intensive but practical efforts to link Veterans with
A-MH to care. This proposal directly addresses HSR&D priorities in the areas of Access to Care, Mental Health
(PTSD), and Primary Care by testing a novel approach (SLAC) to linking Veterans with A-MH to VA and non-
VA alcohol care and to improve their drinking and mental health outcomes.
Innovation and Impact: The proposed project is highly innovative because it offers a solution to the critical
gap in VHA care in which most Veterans in need of alcohol care do not receive it. It tests a strategy to increase
linkage to alcohol care that is both intensive enough to produce change, yet feasible to use in busy clinical
settings with too-high demand on too-few staff members. A highly innovative feature of SLAC is that it teaches
PC providers how to link Veterans with A-MH to alcohol care, which may help normalize conversations about
patients’ alcohol use and their care options in PC as part of the provider role. PC providers’ lack of knowledge
on how to treat hazardous drinking is a substantial obstacle to Veterans receiving alcohol care. Additional
unique and innovative features of SLAC are that it uses patients’ self-identified strengths, abilities, and skills to
help them link to an alcohol care option.
Specific Aims: Our two aims are (Aim 1): To adapt SLAC for use among Veterans with A-MH and for delivery
by telephone in the VHA PC setting. We will conduct qualitative interviews with Veterans, PC staff, and our
VACO operational partners to ensure that the content and format of SLAC are adapted so they are relevant
and acceptable to these stakeholders. (Aim 2): To determine (a) the feasibility of conducting a larger scale
randomized controlled trial (RCT) to test SLAC’s effectiveness and (b) SLAC’s acceptability among Veterans
with A-MH in PC, and to explore (c) the efficacy of SLAC in this Veteran population. To achieve Aim 2, we will
conduct a multi-site pilot RCT of SLAC at two VA medical facilities (Little Rock, AR and Palo Alto, CA). To
achieve Aims 2a-b, we will measure the feasibility (e.g., rates of enrollment and follow-up, fidelity to the SLAC
intervention) of conducting a subsequent larger RCT (to test SLAC’s effectiveness) and SLAC’s acceptability
(SLAC completion rates, satisfaction with SLAC) among Veterans. To achieve Aim 2c, we will explore the
efficacy of SLAC to improve Veterans’ linkage to and utilization of alcohol care, and their alcohol and mental
health outcomes, at 3-month follow-up.
Methodology: We will use (Aim 1) qualitative interviews to adapt SLAC for Veterans with A-MH and for PC,
and (Aim 2) conduct a multi-site, pilot RCT. Debriefing interviews with Veterans will follow the pilot RCT.
Next Steps/Implementation: Should our findings justify a subsequent project, we plan to propose a fully
powered, multi-site study, using a Hybrid design, to test SLAC’s clinical effectiveness when delivered in VHA
PC while observing and gathering information on the implementation potential of SLAC in this setting. Our
operations partners are committed to implementing SLAC nationally should it be found to be effective.
Terms: <Academy><Access to Care><Active Follow-up><Acute><Address><Age><Alcohol Chemical Class><Alcohol Drinking><Alcohol abuse><Alcohol consumption><Alcohols><Area><Behavioral><Caring><Chronic><Clinical><Clinical effectiveness><Counseling><Decision Making><Disease><Disorder><Educational process of instructing><Effectiveness><Enrollment><EtOH abuse><EtOH drinking><EtOH use><Evidence based intervention><Health Care Costs><Health Care Providers><Health Costs><Health Personnel><Health Services Accessibility><Healthcare><Healthcare Costs><Healthcare Providers><Healthcare worker><High Prevalence><Hybrids><Improve Access><Intervention><Intervention Strategies><Interview><Knowledge><Letters><Link><Measures><Medical><Mental Depression><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Methodology><Monitor><Motivation><Outcome><PTSD><Patients><Population><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Posttraumatic Neuroses><Primary Care><Provider><Psychological Health><Psychologist><Randomized, Controlled Trials><Recommendation><Reporting><Risk><Role><Services><Site><Social Workers><Specialty><Substance Use Disorder><Suicide precaution><Suicide prevention><Teaching><Testing><Uncertainty><Veterans><access to health services><access to services><access to treatment><accessibility to health services><active followup><adverse consequence><adverse outcome><ages><alcohol co-abuse><alcohol ingestion><alcohol intake><alcohol problem><alcohol product use><alcohol screening><alcohol use><alcohol use disorder><alcoholic beverage consumption><alcoholic drink intake><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><care access><care seeking><clinical care><co-morbid><co-morbidity><comorbidity><cost outcomes><delivered via telephone><depression><design><designing><diagnostic criteria><doubt><drinking><e-Health><eHealth><electronic health><enroll><ethanol abuse><ethanol consumption><ethanol drinking><ethanol ingestion><ethanol intake><ethanol product use><ethanol use><ethanol use disorder><evidence base><follow up><follow-up><followed up><followup><hazardous alcohol use><hazardous drinking><health care><health care personnel><health care worker><health provider><health service access><health services availability><health workforce><healthcare personnel><high risk><improved><improved outcome><information gathering><innovate><innovation><innovative><interest><interventional strategy><medical personnel><medical specialties><medication-assisted therapy><medication-assisted treatment><meeting><meetings><member><mental health care><mental healthcare><military veteran><new approaches><novel><novel approaches><novel strategies><novel strategy><obstacle to care><obstacle to healthcare><operation><operations><pilot test><pilot trial><post-trauma stress disorder><posttrauma stress disorder><prevent suicidality><prevent suicide><primary care provider><primary care setting><problem alcohol use><problem drinking><problematic alcohol consumption><problematic alcohol use><providers from primary care><providers of primary care><randomized control trial><satisfaction><screening><screenings><service availability><skills><social role><substance use><substance use and disorder><substance using><suicidality prevention><suicide intervention><telephone based delivery><telephone delivered><telephone delivery><traumatic neurosis><treatment access><treatment provider><veteran population>