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| Name | Class |
|---|---|
| United States Department of Defense | FED |
| Corporal Michael J. Crescenz VA Medical Center | FED |
| Medical University of South Carolina | OTHER |
| VA Pittsburgh Healthcare System |
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Veterans who are taking prescription opioids for chronic pain and are engaging in risky drinking are at heightened risk for drug interactions, including overdose and other negative effects, particularly if they are also using benzodiazepines. The investigators propose to test a prevention intervention, designed to reduce rates of risky drinking in veterans receiving prescription opioids to treat their chronic pain. This adaptive, patient-centered intervention provides clinical assessment, brief intervention, monitoring, and extended prevention services delivered through a combination of clinical visits, telephone calls, and text messages. The investigators propose to conduct a study in which veterans (N=300) who are on daily doses of prescription opioids will be randomized to receive 12 months of an adaptive prevention intervention (PI) or to standard care (SC), which consists of a Brief Intervention (BI) with 2 follow-up contacts. Potential participants will be veterans at the Philadelphia VA, and surrounding areas, or the Pittsburgh VA who, based on pharmacy records, are using opioids daily to treat chronic pain. An initial evaluation will identify individuals who also engage in risky alcohol use based on NIAAA-recommended guidelines and meet other inclusion criteria to be enrolled in the study. The evaluation will also identify the use of other medications (e.g., benzodiazepines) that could interact negatively with opioid use. For veterans randomized to the PI condition, a BI is first provided to reduce alcohol to non-hazardous levels and the effects are monitored for one month. Veterans who reduce alcohol use to non-hazardous levels during this one-month period continue in a monitoring track, consisting of tailored text messages and brief monthly telephone contacts. Veterans who continue to drink at risky levels are instead placed in a track that provides tailored text messages and more frequent telephone calls. In addition to monitoring, these calls provide further prevention/BI services to help the veteran reduce alcohol use to non-hazardous levels. Key components of these services are motivational enhancement and development of more effective ways to cope with stress and other triggers for risky alcohol use. All participants will be followed up at 3, 6, 9, 12 and 18 months after baseline. The primary outcome at each follow-up point will be a dichotomous measure of any risky drinking since the prior follow-up (yes/no). Secondary outcomes will include self-reported frequency of heavy drinking, biological measures of alcohol use, other drug use as determined by urine toxicology tests, opioid overdoses, and ratings of depression and pain. Repeated measures analyses will compare the PI and SC conditions on primary and secondary outcomes assessed across an 18-month follow-up. Analyses will also test hypothesized moderation and mediation effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Care | Active Comparator | In this arm, veterans receive the care that they would receive had they not enrolled in the research. No one will receive less than standard care. |
|
| Prevention Intervention | Experimental | An adaptive monitoring intervention, delivered through text messages and brief telephone calls, that can provide extended prevention services for veterans engaging in risky alcohol use. After a veteran receives a BI for risky drinking, we will monitor alcohol use for 4 weeks. Veterans who reduce alcohol use to safe levels will be placed in a monitoring track, which consists of tailored text messages and brief monthly telephone contacts. Conversely, veterans who continue to use alcohol at hazardous levels will be placed in a track that provides tailored text messages and more frequent telephone calls. These calls provide further prevention/intervention services to help the veteran reduce alcohol use. These services address motivational issues and identify more effective ways to cope with stress and other factors that trigger unsafe alcohol use. Information on the veteran's progress is used to guide the content of subsequent text messages and prevention interventions. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prevention Intervention | Behavioral |
| ||
| Brief Intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Rates of Risky Drinking, Week 13 | The primary outcome measure will be rates of the presence of any risky drinking in each week (i.e., more than 4 drinks per drinking day) as reported on the Time Line Follow Back. | weeks 1 - 13 |
| Rates of Risky Drinking, Week 26 | Rates of the presence of any risky drinking in each week (14 - 26) | weeks 14 - 26 |
| Rates of Risky Drinking, Week 39 | Rates of the presence of any risky drinking in each week (27 - 39) | weeks 27 - 39 |
| Rates of Risky Drinking, Week 52 | Rates of the presence of any risky drinking in each week (40 - 52) | weeks 40 - 52 |
| Rates of Risky Drinking, Week 78 | Rates of the presence of any risky drinking in each week (53 - 78) | weeks 53 - 78 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| James R McKay, PhD | University of Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Philadelphia VA Medical Center | Philadelphia | Pennsylvania | 19104 | United States | ||
| University of Pennsylvania |
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| ID | Title | Description |
|---|---|---|
| FG000 | Standard Care | In this arm, veterans receive the care that they would receive had they not enrolled in the research. No one will receive less than standard care. Brief Intervention |
| FG001 | Prevention Intervention | An adaptive monitoring intervention, delivered through text messages and brief telephone calls, that can provide extended prevention services for veterans engaging in risky alcohol use. After a veteran receives a BI for risky drinking, we will monitor alcohol use for 4 weeks. Veterans who reduce alcohol use to safe levels will be placed in a monitoring track, which consists of tailored text messages and brief monthly telephone contacts. Conversely, veterans who continue to use alcohol at hazardous levels will be placed in a track that provides tailored text messages and more frequent telephone calls. These calls provide further prevention/intervention services to help the veteran reduce alcohol use. These services address motivational issues and identify more effective ways to cope with stress and other factors that trigger unsafe alcohol use. Information on the veteran's progress is used to guide the content of subsequent text messages and prevention interventions. Prevention Intervention Brief Intervention |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Standard Care | In this arm, veterans receive the care that they would receive had they not enrolled in the research. No one will receive less than standard care. Brief Intervention |
| BG001 | Prevention Intervention |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Rates of Risky Drinking, Week 13 | The primary outcome measure will be rates of the presence of any risky drinking in each week (i.e., more than 4 drinks per drinking day) as reported on the Time Line Follow Back. | The analysis only includes participants for whom the data during this time period is complete. In addition, due to our finding that patients were unwilling to initially disclose alcohol use at screening, we enrolled people who were not necessarily drinking but monitored them. Once they began drinking they were received the intervention (or standard care) and were included in the analyses. However, many enrolled participants were not active drinkers and were not included in the analyses. | Posted | Mean | Standard Deviation | risky drinking weeks | weeks 1 - 13 |
|
Adverse event data was collected for 18 months.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Standard Care | In this arm, veterans receive the care that they would receive had they not enrolled in the research. No one will receive less than standard care. Brief Intervention |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalized | Surgical and medical procedures | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| emotional distress | Social circumstances | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| James McKay | University of Pennsylvania | 215-746-7704 | jimrache@upenn.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 8, 2019 | Sep 29, 2021 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D010146 | Pain |
| D000428 | Alcohol Drinking |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D004327 | Drinking Behavior |
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| ID | Term |
|---|---|
| D003419 | Crisis Intervention |
| ID | Term |
|---|---|
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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| FED |
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| Behavioral |
|
| Philadelphia |
| Pennsylvania |
| 19104 |
| United States |
| VA Pittsburgh Health System | Pittsburgh | Pennsylvania | 15261 | United States |
An adaptive monitoring intervention, delivered through text messages and brief telephone calls, that can provide extended prevention services for veterans engaging in risky alcohol use. After a veteran receives a BI for risky drinking, we will monitor alcohol use for 4 weeks. Veterans who reduce alcohol use to safe levels will be placed in a monitoring track, which consists of tailored text messages and brief monthly telephone contacts. Conversely, veterans who continue to use alcohol at hazardous levels will be placed in a track that provides tailored text messages and more frequent telephone calls. These calls provide further prevention/intervention services to help the veteran reduce alcohol use. These services address motivational issues and identify more effective ways to cope with stress and other factors that trigger unsafe alcohol use. Information on the veteran's progress is used to guide the content of subsequent text messages and prevention interventions.
Prevention Intervention
Brief Intervention
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG001 | Prevention Intervention | An adaptive monitoring intervention, delivered through text messages and brief telephone calls, that can provide extended prevention services for veterans engaging in risky alcohol use. After a veteran receives a BI for risky drinking, we will monitor alcohol use for 4 weeks. Veterans who reduce alcohol use to safe levels will be placed in a monitoring track, which consists of tailored text messages and brief monthly telephone contacts. Conversely, veterans who continue to use alcohol at hazardous levels will be placed in a track that provides tailored text messages and more frequent telephone calls. These calls provide further prevention/intervention services to help the veteran reduce alcohol use. These services address motivational issues and identify more effective ways to cope with stress and other factors that trigger unsafe alcohol use. Information on the veteran's progress is used to guide the content of subsequent text messages and prevention interventions. Prevention Intervention Brief Intervention |
|
|
| Primary | Rates of Risky Drinking, Week 26 | Rates of the presence of any risky drinking in each week (14 - 26) | The analysis only includes participants for whom the data during this time period is complete. In addition, due to our finding that patients were unwilling to initially disclose alcohol use at screening, we enrolled people who were not necessarily drinking but monitored them. Once they began drinking they were received the intervention (or standard care) and were included in the analyses. However, many enrolled participants were not active drinkers and were not included in the analyses. | Posted | Mean | Standard Deviation | risky drinking weeks | weeks 14 - 26 |
|
|
|
| Primary | Rates of Risky Drinking, Week 39 | Rates of the presence of any risky drinking in each week (27 - 39) | Posted | Mean | Standard Deviation | risky drinking weeks | weeks 27 - 39 |
|
|
|
| Primary | Rates of Risky Drinking, Week 52 | Rates of the presence of any risky drinking in each week (40 - 52) | The analysis only includes participants for whom the data during this time period is complete. In addition, due to our finding that patients were unwilling to initially disclose alcohol use at screening, we enrolled people who were not necessarily drinking but monitored them. Once they began drinking they were received the intervention (or standard care) and were included in the analyses. However, many enrolled participants were not active drinkers and were not included in the analyses. | Posted | Mean | Standard Deviation | risky drinking weeks | weeks 40 - 52 |
|
|
|
| Primary | Rates of Risky Drinking, Week 78 | Rates of the presence of any risky drinking in each week (53 - 78) | The analysis only includes participants for whom the data during this time period is complete. In addition, due to our finding that patients were unwilling to initially disclose alcohol use at screening, we enrolled people who were not necessarily drinking but monitored them. Once they began drinking they were received the intervention (or standard care) and were included in the analyses. However, many enrolled participants were not active drinkers and were not included in the analyses. | Posted | Mean | Standard Deviation | risky drinking weeks | weeks 53 - 78 |
|
|
|
| 3 |
| 50 |
| 4 |
| 50 |
| 0 |
| 50 |
| EG001 | Prevention Intervention | An adaptive monitoring intervention, delivered through text messages and brief telephone calls, that can provide extended prevention services for veterans engaging in risky alcohol use. After a veteran receives a BI for risky drinking, we will monitor alcohol use for 4 weeks. Veterans who reduce alcohol use to safe levels will be placed in a monitoring track, which consists of tailored text messages and brief monthly telephone contacts. Conversely, veterans who continue to use alcohol at hazardous levels will be placed in a track that provides tailored text messages and more frequent telephone calls. These calls provide further prevention/intervention services to help the veteran reduce alcohol use. These services address motivational issues and identify more effective ways to cope with stress and other factors that trigger unsafe alcohol use. Information on the veteran's progress is used to guide the content of subsequent text messages and prevention interventions. Prevention Intervention Brief Intervention | 0 | 58 | 8 | 58 | 1 | 58 |
| hospitalized | Gastrointestinal disorders | Non-systematic Assessment |
|
| Hospitalized | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| hospitalized | General disorders | Non-systematic Assessment |
|
| ED visit | General disorders | Non-systematic Assessment |
|
| hospitalized | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Non-systematic Assessment |
|
| hospitalized | Injury, poisoning and procedural complications | Non-systematic Assessment |
|
| Hospitalized | Cardiac disorders | Non-systematic Assessment |
|
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| D001519 | Behavior |