Laura Kwako, Ph.D.

Purpose

The Division of Treatment and Recovery Research (DTRR) seeks to expand the Division’s portfolio to advance five main areas in health services research listed below in the research goals/statement of work section.

Background

Alcohol consumption in the United States falls along a wide spectrum of drinking patterns, ranging from occasional and moderate to chronic heavy drinking. Approximately 65 percent (144 million) of adult Americans drank alcohol at some time during the past year. Of those, 59 million exceeded heavy drinking limits and 15 million, approximately six percent, were diagnosed with alcohol use disorder (AUD). Unfortunately, of those 15 million, only one in 10 received formal treatment for their disorder and those that did typically were offered limited options for evidence-based treatment, including FDA-approved medications for AUD.

Research shows that there are myriad reasons why so few individuals with AUD receive treatment, including problems with access to care, health care coverage/payment options, employment, childcare, stigma, and lack of awareness of care options, along with the misconception that treatment does not work. Critically, health disparate and vulnerable populations face unique and intersecting barriers to treatment.

Research Goals / Statement of Work

The future RFA will solicit applications that focus on, but not limited to:

Increase accessibility to treatment

Research shows that less than 10 percent of the U.S. population sought formal AUD treatment over the past year. Improving this deficiency requires a better understanding of barriers to treatment and strategies to overcome them. Identified solutions must address the needs of a diverse population of individuals with AUD and across varied treatment settings.

Make treatment and the settings where patients receive them more appealing

AUD patients often have multiple comorbidities; research shows it is more efficacious to address multiple disorders by integrating AUD treatment into mainstream health care. Identifying strategies to make treatments more efficient and effective, and in settings that lower thresholds for entering treatment, could increase motivation for patients to seek treatment

Address treatment costs to the patient

With regard to treatment, it is important to understand the cost and cost-effectiveness of treatment interventions and explore ways to make the costs more affordable to patients seeking treatment. Previous studies have shown that alcohol treatment can lead to reduced social costs, involvement of the criminal justice system, and motor vehicle crashes.

Evaluate, disseminate, implement, and sustain evidence-based behavioral and pharmacological treatments across the full range of professional healthcare practices

A variety of medications and behavioral therapies have shown effectiveness in treating AUD. In part because of the heterogeneity of AUD, these various medications and behavioral health therapies do not work the same for everyone. Ideally, individual patients could be matched to appropriate evidence-based services, including options for behavioral health and medications across the continuum of care and followed as necessary as their treatment needs change. Special attention should be paid to sustaining recovery.

Increase Research on Health Disparities

Health services research has lagged in certain groups of people, particularly racial, ethnic, and sexual/gender minority populations. There is a need for more research to find and implement effective behavioral interventions to reduce these disparities. In adapting and/or developing evidence-based treatments for vulnerable populations, research needs to take a candid and careful look at the determinants underlying health disparities (e.g., environmental, social, cultural, biological/genetic, psychosocial, and economic elements). In addition, special populations experience specific barriers that prevent them from seeking and receiving appropriate healthcare, including but not limited to stigma, mistrust, bias, and structural racism. A greater emphasis should be placed on developing novel, culturally grounded interventions in partnership with communities, which go beyond simply adapting existing mainstream interventions.

Outcome and Justification

A significant gap exists between the need for treatment and our ability to provide that care to those who need it, especially among health disparate populations. Closing this divide calls for significant advances in the field of health services research. Unfortunately, the number of health services applications submitted to the Department of Treatment and Recovery Research (DTRR) have not kept pace with the current need. In fact, applications have decreased over the past 5 years. DTRR received 42 applications in 2014 and, since then, the number has steadily decreased to 28 in 2019. Now, in 2020, with only one grant cycle remaining, we have received only 14 applications. This RFA will help to stimulate interest among researchers in health services and advance areas that are preventing individuals from seeking and receiving state of the art treatment interventions, with a special emphasis on health disparate and vulnerable populations.