Development of a Tailored Alcohol Screening, Brief Intervention, and Referral to Treatment Protocol for Older Adults with Chronic Pain

PROJECT SUMMARY/ABSTRACT Hazardous alcohol use is highly prevalent among the millions of older adults who have chronic pain. This is alarming, given that hazardous drinking can exacerbate chronic pain and associated health risks and interfere with pain treatment. Therefore, it is imperative to identify and intervene upon hazardous drinking in

older adults with chronic pain. Alcohol screening, brief intervention, and referral to treatment (A-SBIRT) reduces hazardous drinking and is a promising approach to delivering early alcohol intervention within medical settings. However, to meet the unique needs of older adults with chronic pain, A-SBIRT content needs to be

tailored to account for: salient consequences of drinking in older adults with chronic pain, including the effects of alcohol use on pain and associated outcomes; pain as a barrier to alcohol reduction, given that older adults frequently report drinking to cope with pain; and multimorbidity, use of opioid analgesics, and polypharmacy, all

of which are highly prevalent in older adults with chronic pain. The current lack of an A-SBIRT that is specifically tailored for the millions of older adults with chronic pain represents a major gap in research and clinical care. Therefore, the goal of this study is to develop, refine, and pilot test an alcohol screening, brief

intervention, and referral to treatment protocol that is tailored for older adults with chronic pain (A-SBIRT-GCP). Our guiding hypothesis is that tailoring the protocol to meet the unique needs of older adults with chronic pain will increase motivation/self-efficacy to reduce drinking, decrease hazardous alcohol use, and, consequently,

improve chronic pain and important aging-related outcomes. In the proposed Stage 1 work, we will: 1) develop A-SBIRT-GCP with clinician and patient stakeholder input; 2) refine A-SBIRT-GCP using a mixed methods open pilot trial; and 3) evaluate the feasibility and acceptability of A-SBIRT-GCP in a pilot RCT. Findings from

this K23 project will inform a subsequent application for R01-level funding to conduct a Stage 2 RCT testing the efficacy of A-SBIRT-GCP in reducing hazardous drinking and consequently improving pain and aging- related outcomes (e.g., physical and cognitive function, quality of life) among older adults with chronic pain. If

efficacious, A-SBIRT-GCP offers great potential to be an affordable, scalable, and efficient intervention. The proposed work builds on the applicant’s background as a clinical psychologist with unique expertise in chronic pain and addiction and will provide advanced mentored training in: 1) the use of qualitative

and mixed methods research; 2) the conduct of clinical trials; and 3) gerontological research. The applicant has a multidisciplinary mentorship team of experts who are uniquely well-suited to oversee the proposed research and training aims. In addition, the rich institutional environment at Massachusetts General Hospital and

Harvard Medical School will support the applicant in the successful completion of this project. The advanced training and preliminary data obtained through the proposed project will propel the applicant’s transition toward an independent, externally funded, productive gerontological research career.