VA Center for Clinical Management Research
Improving Outcomes for Emergency Department Patients with Alcohol Problems: Project GOAL (Guiding Outcomes for ALcohol)
Fred Blow, PhD
Amy Bohnert, PhD
Paul Pfeiffer, MD
Becca Sripada, PhD
Maureen Walton, PhD
Deb Manderachia, MSW
Rose Ignacio, MS
Vanessa Pruitt, MSW
6/1/2018 – 5/31/2022
VA Psychosocial Rehabilitation and Recovery Services, Office of Patient Care Services
Background: Research indicates that a high proportion of patients seen in Emergency Departments (EDs) have hazardous or harmful alcohol use, making EDs an ideal setting to provide assessment and initiate interventions and referrals for alcohol problems. Problematic alcohol use is an even greater problem in VHA EDs compared to community medical centers, increasing the utilization of VHA ED services and affecting all age cohorts of Veterans. There is good evidence that patients with hazardous/harmful alcohol use come to the VHA ED but do not receive interventions to reduce their drinking or links to needed services.
Alcohol brief interventions (BIs), typically consisting of a single session, have been shown to be effective in primary care settings and have been implemented variably across the VHA. Despite this, research suggests that BIs in the ED produce smaller effects than those in primary care. Following an alcohol BI in the ED, few patients who need more intensive specialty alcohol treatment services receive them. Recent data indicates that telephone monitoring and brief care management are potentially effective higher intensity options to overcome barriers to substance use treatment. The VHA has a large network of peer specialists across the country. Given the constraints of existing ED provider resources, peer support specialists could serve a vital role in delivering alcohol BIs plus providing additional supportive contacts for Veterans with hazardous or harmful alcohol use detected in the ED.
Objectives: This study, to be conducted at the VA Ann Arbor Healthcare System, will test the potential for peer support specialists to provide brief alcohol advice during an ED visit and mentorship after the ED to assist in supporting reduced hazardous drinking and/or linking patients to needed services. The specific aims include the following: (Aim 1) Determine the efficacy of a peer-delivered alcohol intervention and mentorship to facilitate reduction in hazardous drinking. (Aim 2) Determine the impact of peer-delivered alcohol intervention and mentorship on linkage to primary care or specialty alcohol treatment services, if needed. (Aim 3) Explore the aspects of peer-delivered intervention that influences change, as well as the barriers and facilitators of implementation through qualitative interviews.