# Adaptive Interventions to Improve Alcohol Treatment Engagement among Alcohol-related Liver Disease Patients

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $645,878

## Abstract

Project Summary
Alcohol-related liver disease (ALD) rates have risen 40% in recent years with mortality rising 3.4% per year
over the last 15 years. Alcohol treatment, even just one session, improves liver disease mortality and liver
function, but only 10-15% of ALD patients engage in treatment after their diagnosis. To date, no interventions
to improve alcohol treatment engagement in ALD patients have been developed. To address this gap, we will
perform a sequential, multiple-assignment, randomized trial (SMART) to evaluate an adaptive intervention
strategy to increase alcohol treatment engagement. Adaptive interventions use specific decision rules tailored
to relevant clinical timepoints in the care of ALD patients to identify early non-responders to the initial
intervention and offer additional interventions to those who need them in order to improve clinical outcomes.
Our specific aims are: 1) To test the efficacy of an adaptive intervention which begins with the Michigan
Alcohol Improvement Network –Alcohol Reduction and Treatment (MAIN-ART) app versus Enhanced Usual
Care on alcohol treatment engagement (primary outcome) and alcohol reduction and liver health (secondary
outcomes); 2) To test the efficacy of the addition of a treatment facilitation bundle for increasing alcohol
treatment engagement among non-responders. Patients (n=268) enrolled in hepatology clinics with all stages
of ALD, past 6-month drinking and no past-month alcohol treatment will be randomized to either the MAIN-ART
app or Enhanced Usual Care. Intervention response at 3 months will be assessed and those who have not
engaged in alcohol treatment in either arm (“non-responders”) will be re-randomized to a second intervention,
the Treatment Facilitation bundle. The Treatment Facilitation bundle will be composed of two parts: 1) an
online barriers elicitation survey to determine patient-specific personal or structural barriers to alcohol
treatment, and 2) a virtual coaching session with an addiction social worker offered after completion of the
barriers survey to help facilitate alcohol treatment engagement by overcoming identified barriers. Outcomes
will be assessed at 3-, 6- and 12-month follow-ups. Exploratory aims are a) to determine the best adaptive
strategy to increase alcohol treatment engagement and b) to evaluate mediators and moderators of
intervention efficacy. The proposed work is innovative, timely, and directly responsive to NIAAA priorities to
improve access to alcohol treatment through barrier reduction and through extension of interventions into
novel, non-addiction clinic settings, such as hepatology clinics (NOT PAR-22-156). Using a novel SMART trial
design, the adaptive interventions developed and tested in this study will leverage the hepatology clinic
environment in an innovative way to increase alcohol treatment engagement for ALD patients and improve
clinical outcomes.

## Key facts

- **NIH application ID:** 10875382
- **Project number:** 5R01AA030748-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Jessica Leigh Mellinger
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $645,878
- **Award type:** 5
- **Project period:** 2023-07-01 → 2024-07-02

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10875382

## Citation

> US National Institutes of Health, RePORTER application 10875382, Adaptive Interventions to Improve Alcohol Treatment Engagement among Alcohol-related Liver Disease Patients (5R01AA030748-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10875382. Licensed CC0.

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