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Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. As such, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (i.e., detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches, who are individuals with the “lived experience” of recovery who obtain training to be coaches, are increasingly utilized to assist individuals with AUD and may provide a degree of continuity during this transition. We evaluated the feasibility of using an existing care coordination app (“Lifeguard”) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care.
Methods: The study was conducted on an ASAM Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge received daily prompts to complete a modified version of the Brief Addiction Monitor (BAM). The BAM inquired about alcohol use, risky (e.g., craving) and protective (e.g., 12-step attendance) factors. The coach sent daily motivational texts, appointment reminders, and checked-in if BAM responses were concerning. Follow-up continued for 30 days post-discharge. The following feasibility outcomes were evaluated: 1) proportion of participants engaging with the coach before discharge, 2) proportion of participants and the number of days engaging with the coach after discharge, 3) proportion of participants and the number of days responding to BAM prompts, and 4) the proportion of participants successfully linking with addiction treatment by 30-day follow-up.
Results: The 10 participants were all men, averaged 50.5 years old, mostly white (60%), non-Hispanic (90%), and single (80%). Overall, 8 participants (80%) successfully engaged with the coach prior to discharge. Following discharge, 6 participants (60%) continued to engage with the coach, doing so on average 5.3 days (SD 7.3, range 0-20). Five (50%) participants responded to the BAM prompts during the follow-up, doing so on average 4.6 days (SD 6.9, range 0-21). Half (50%) successfully linked with ongoing addiction treatment during the follow-up. Participants who engaged with the coach post-discharge, compared to those who did not, were significantly more likely to link with treatment (83.0% vs 0%, χ2=6.67, P=.01).
Conclusions: The results from this proof-of-concept pilot trial demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving post-discharge outcomes.
Keywords: Alcohol use disorder; inpatient detoxification; peer recovery coach; smartphone app