# Implementation Intervention to Improve Care for Unhealthy Alcohol Use

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Background. Alcohol use is a significant risk factor of disability and death for U.S. adults and one out of every
six Veteran seen in primary care (PC) report unhealthy alcohol use. Unhealthy drinking is associated with
increased risk for poor medical outcomes, substantial societal costs, and death, including suicide. Based on
substantial evidence from randomized controlled trials and the U.S. Preventive Services Task Force, VA/DoD
clinical guidelines stipulate that all Veterans screening positive for unhealthy alcohol use should receive
evidence-based alcohol care in PC, including brief counseling interventions (BI) and additional treatment (e.g.,
pharmacotherapy) for those with alcohol use disorders (AUD). The VA was a pioneer in implementing alcohol
screening and BI in PC, yet substantial implementation gaps remain. Approximately 25% of Veterans with
unhealthy alcohol use still do not receive BIs and evidence suggests that the quality of BIs is lacking. For those
with AUD, BI implementation has not appeared to increase access to recommended services (e.g., referrals) nor
reduced barriers to pharmacotherapy. In order to improve the quality and fidelity of alcohol-related care, the
current research proposes to use an evidence-based implementation strategy, practice facilitation, at one VA to
pilot test whether practice facilitation has the potential to improve quality of PC-based alcohol-related care.
Significance/Impact. This research directly addresses one of the largest public health crises of our time, as
alcohol kills more people than opioids and is associated with increased risk of suicide. Thus, this work may have
far-reaching effects on adverse outcomes experienced by Veterans and is aligned with top HSRD and VA
priorities, including increased access to care and suicide prevention. Innovation. The project will use innovative
implementation techniques not previously used to improve VA alcohol-related care. Specific Aims. Aim 1 is a
qualitative study assessing Veteran and PC stakeholders to understand barriers and facilitators to high-quality
alcohol care and use results to refine and hone the practice facilitation intervention. Aim 2 will deliver the practice
facilitation intervention in a small PC sample to examine its acceptability and feasibility. Aim 3 is a pilot test of
the practice facilitation intervention in the full PC clinic to understand whether practice facilitation improves quality
of PC-based alcohol-related care. Methodology. Aim 1 will recruit and interview Veterans with unhealthy alcohol
use (n=20-25) and PC stakeholders (N=10-15) to help refine the practice facilitation. Aim 2 will deliver the
practice facilitation among a small sample of PC providers and staff (n=5-7) to assess acceptability/feasibility. In
Aim 3, PC providers/staff from the full clinic will be invited to participate in the practice facilitation in order to
assess implementation (e.g., reach) and effectiveness (reduced drinking) outcomes. Implementation...

## Key facts

- **NIH application ID:** 10246898
- **Project number:** 5IK2HX003087-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Rachel Lauren Bachrach
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10246898

## Citation

> US National Institutes of Health, RePORTER application 10246898, Implementation Intervention to Improve Care for Unhealthy Alcohol Use (5IK2HX003087-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10246898. Licensed CC0.

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