Impact

Ongoing Projects

Comparing scalable technology-driven brief intervention packages for youth alcohol use (PIs: Walton and Bonar, 2022-2027, NCT05988931). We are leading a comparative efficacy trial to address prevention of alcohol use among teens. We are working with teens, caregivers/parents, and providers to inform this trial of digital interventions.

Leveraging virtual care strategies to improve access and treatment for individuals with alcohol use disorders (PIs: Bonar and Lin, 2022-2027, R01-AA029808). Care for AUD has typically focused on referrals to specialty addiction treatment programs, which have barriers to accessibility and are stigmatized. To address this gap, this project will use a sequential, multiple assignment randomized trial (SMART) design to examine a novel virtually-delivered engagement and treatment delivery model that can be integrated in healthcare systems to outcomes and reduce disparities in alcohol use disorder care.

Preferences and predictors driving opioid-involved polysubstance use profiles and trajectories: Implications for improving care (PIs: Coughlin and Lin, 2022-2025, R01-DA057591). The overdose epidemic has shifted dramatically to focus on people who use multiple substances (e.g., fentanyl and methamphetamine). This study will collect innovative data and provide new insights on motives and behaviors driving the riskiest patterns of substance use and understand barriers to treatment, through use of new behavioral economics measures to inform actionable strategies that can be implemented across diverse populations.

Harnessing telemedicine to improve alcohol use disorder outcomes in primary care patients (PIs: Lin and Bonar, 2021-2026, R01-AA029400). Less than 10% of patients with alcohol use disorder currently receive treatment. Primary care is a critical setting for identifying patients who need care, but many barriers prevent patients from engaging and receiving effective treatments. This project aims to fill this tremendous treatment gap, by outreaching to the 90% not engaged in care and testing the impact of a new model of telehealth-delivered treatment to better identify, engage and treat patients with alcohol use disorder.

Developing a telehealth model to improve treatment access for rural Veterans with substance use disorders (PI: Dr. Lin, 2021-2024). The vast majority of patients with substance use disorders do not receive treatment. The goal of this project is to develop and pilot innovative new models of telehealth-delivered care to better identify, engage and treat rural Veterans with untreated substance use disorders and inform how to implement these new models in the VA to reach more Veterans.

Optimized interventions to prevent Opioid Use Disorder among adolescents and young adults in the Emergency Department (PIs: Bonar and Walton, 2019-2024). We have a current study under way to evaluate opioid misuse and opioid use disorder prevention interventions among adolescents and young adults who receive care in an Emergency Department. They also have received supplemental funding to enhance representation of Black and/or African American individuals with qualitative interviews to inform improvements to the interventions and their implementation.

Enhancing the impact of behavioral pain management on MAT outcomes (PIs: Ilgen and Lin, 2019-2023, R01-AT010797). We are testing a new intervention to improve outcomes for patients with chronic pain and opioid use disorder to help increase buprenorphine retention and improve pain and substance use outcomes.

Informing Ways to Increase Contingency Management for Veterans with stimulant and other substance use disorders (PIs: Lin and Coughlin, 2024-2026). Contingency management (CM) is one of the most effective treatments for substance use disorders (SUDs), including stimulant use disorder (StUD), yet currently almost no patients have access to CM. The VA led the largest implementation of CM in the US. The goal of this project is to evaluate real-world CM use in Veterans and examine association with outcomes including overdose deaths, to inform future efforts to implement and disseminate CM.

Publications

Dr. Fernandez co-authored a publication on Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement. Few studies have evaluated whether treatment of alcohol use disorders will reduce progression of liver disease and improve liver-related outcomes. In November 2021, the National Institute of Alcohol Abuse and Alcoholism commissioned a task force that included hepatologists, addiction medicine specialists, statisticians, clinical trialists and members of regulatory agencies to develop recommendations for the design and conduct of clinical trials to evaluate the effect of alcohol use, particularly treatment to reduce or eliminate alcohol use in patients with ALD. Dr. Fernandez, was an expert panelist at this in-person meeting. The recommendations from the meeting and task force, were refined and discussed over the next 16 months to develop the final recommendations.

Cannabis use is legal for recreational use in more states each year, with a rapidly growing landscape of cannabis products (vapes, flower, edibles) available. Our team developed a novel tool to look at different policy environments, such as increasing tax rates, capping THC potency of products, to understand prospectively the impact of legal cannabis policies on consumer purchase and use behaviors.

Less than 5% of people with a cannabis use disorder receive any treatment. Our team developed a telehealth-delivered intervention that is aiming to engage and provide care to those who are not currently receiving any cannabis use disorder care. This new treatment focuses on promoting wellness by increasing cannabis-free activities based on each person’s own preferences and goals.

Dr. Walton published a protocol paper describing a study testing digital health interventions to prevent involvement with risky drinking and violence. The study uses an innovative design called a sequential, multiple assignment, randomized trial (SMART), which using a precision health lens, adjusts intervention dose and content based on response. Specifically, youth (ages 14-20) in the emergency department who self-report recent risky drinking and violent behaviors will be randomly assigned to a telehealth session called SafERteens, with 4-weeks of boosters: 1) Text Messaging (TM), or 2) Remote Health Coach calls (HC). After 4 weeks, intervention response/non-response is determined (e.g., binge drinking or violent behaviors). Responders are re-randomized to continued intervention condition (e.g., maintenance) or minimized condition (e.g., stepped down). Non-responders are re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes are measured at 4 and 8 months. Data analyses are ongoing, with findings informing the content and timing booster interventions to alter risk behavior trajectories and improve health.

Stimulant-involved overdose deaths are increasing in the US. At the same time, stimulant use disorder treatment was increasing prior to the pandemic, but precipitously dropped off at the start of the pandemic. Concerningly, stimulant use disorder treatment has not returned to pre-pandemic levels, pointing to a need to targeted efforts to bring stimulant use disorder treatment to people who could benefit from care.

Preoperative risky alcohol use is one of the most common surgical risk factors. Accurate and early identification of risky alcohol use could enhance surgical safety. Artificial Intelligence-based approaches, such as natural language processing (NLP), provide an innovative method to identify alcohol-related risks from patients' electronic health records (EHR) before surgery.

Drs. Lin and Bonar along with their team have published a new paper in Contemporary Clinical Trials describing the innovative protocol for an ongoing randomized controlled trial. Taking a patient-first approach, the team uses electronic health record data and proactive outreach approaches to engage primary care patients living with alcohol use disorders into telehealth treatment.

Presentations & Posters

2024

October 2024: Dr. Lara Coughlin presented a talk titled "Contingency Management for Substance Use Disorders" at Opioid Research Institute Coffee Connections.

October 2024: Dr. Walton presented a poster at the Addiction Health Services Research (AHSR) Conference in San Francisco based on collaborative work with Dr. Coughlin, et al., focusing on Piloting a Mobile Health Intervention for Emerging Adults with Regular Cannabis Use: A Micro-Randomized Trial. The trial involved randomizing emerging adults (ages 18-25), with regular cannabis use and motivation to change, to be sent an intervention message (or not) twice daily, based on a reinforcement learning algorithm. Over 30 days, MiWaves, a just-in-time adaptive intervention powered by AI to reduce cannabis use among emerging adults, included twice-daily check-ins; feedback graphs; and, intervention messages (e.g., future goals, alternative activities, affect management), varied by length and interaction type. Assessments occurred weekly, post-intervention, and at 2-month follow-up. Initial findings highlighted challenges, lessons learned, and opportunities for refinement to enhance engagement and efficacy of this AI-powered digital intervention to reduce cannabis use and inform the next generation of optimized interventions for substance use.

September 2024: Dr. Walton presented a poster at the annual Healthy Flint Research Coordinating Center (HFRCC) Research Symposium - From Research to Action focusing on Digital Health Interventions to Reduce Binge Drinking and Aggression Among Youth in the Emergency Department: Preliminary Findings. This intervention enrolled 400 youth in emergency departments who self-reported binge drinking and aggression. All participants received a telehealth session with a health coach and 4 weeks of boosters: text messages or telehealth calls. Participants were classified as responders or non-responders (binge drinking or aggression) and re-randomized. Responders received 4 weeks of the same condition or a resource brochure; non-responders received either 4 weeks of the same condition or an intensified condition. Participants completed follow-up assessments at 4 and 8 months. Preliminary findings implicate that among youth receiving digital health interventions, involvement with alcohol use and aggression decreased over time. Additional analyses will seek to inform future implementation of adaptive interventions to enhance health among youth.

September 2024: Dr. Erin Bonar presented a talk titled "Cannabis interventions to reduce consumption and risk among young adults" at the Addictions, Drug & Alcohol (ADAI) Symposium in Seattle, WA.

June 2024: Dr. Allison Lin presented a talk titled “Contingency management for substance use disorder treatment in the Veterans Health Administration” at the College on Problems of Drug Dependence (CPDD) Conference in Montreal, Canada.

June 2024: Drs. Walton & Bonar presented their poster titled "Exploring Individual Factors Associated with Risk Levels for Opioid Misuse and Opioid Use Disorder Among Adolescents and Young Adults in the Emergency Department" at the College on Problems of Drug Dependence (CPDD) Conference in Montreal, Canada.

June 2024: Dr. Lara Coughlin presented as part of a symposium on “Innovations in digital interventions for substance use” at the College on Problems of Drug Dependence (CCPD) Conference in Montreal, Canada.

June 2024: Dr. Anne Fernandez presented “Strategies for treatment of alcohol use disorder in patients with alcohol-associated liver disease” as part of a roundtable discussion at the Research Society on Alcohol Conference in Minneapolis, MN.

May 2024: Dr. Lara Coughlin facilitated a workshop, "The Tobacco Endgame: What does this mean for peers?" at the Michigan Peers Conference in Novi, MI.

May 2024: Dr. Allison Lin was an invited faculty presenter at the MGH/McLean 2024 Addictions Conference in Boston, MA.

May 2024: Dr. Erin Bonar presented a talk "Cannabis: Understanding the green wave in today's landscape" at the Spring Forum 2024: Substance Use and Addiction. Register here to attend (virtual or in-person).

May 2024: Dr. Allison Lin was a featured panelist for the discussion "Addiction 101: Basics, Stigma, and Education" for the Washtenaw chapter of Families Against Narcotics.

May 2024: Dr. Lara Coughlin presented her talk "Rural Substance Use and Stigma" to Newaygo Community Mental Health.

May 2024: Dr. Lara Coughlin gave a talk to the U-M Psychiatry Addiction fellows titled "Stigma in SUD Treatment."

May 2024: Dr. Lara Coughlin was featured in the latest episode of the Tobacco Cessation Podcast by the American Lung Association "Using SPAs and 1115 Waivers to Improve Cessation Coverage" in which she spoke about policy opportunities to improve tobacco cessation services in Michigan.

April 2024: Dr. Anne Fernandez presented “Heavy Drinking: An overlooked surgical risk factor” for the Department of Anesthesia Grand Rounds at the University of Nebraska Medical Center.

April 2024: Dr. Erin Bonar presented to the Michigan Medicine Virtual Care Team on "Virtual behavioral health strategies for preventing and treating substance use disorders." This talk is part of a series of sharing digital health research with clinician leads and project managers that work to improve the delivery of virtual care at Michigan Medicine.

April 2024: Dr. Anne Fernandez presented on “Brief Interventions in Different settings – Including Patients with ALD” at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Workshop on Reducing Alcohol-associated Liver Disease (ALD) Burden through Early Screening and Management in the General Population.

April 2024: Drs. Coughlin and Fernandez presented their talk, "Empowering change: Diverse digital solutions for addressing substance use across the lifespan," at the Collaborative Perspectives on Addiction Conference in Denver, CO.

April 2024: Dr. Erin Bonar spoke on behalf of the study team, including MPI Maureen Walton, at the Heal Prevention Cooperative Meeting 2024 on the Future of Opioid Prevention.

March 2024: Dr. Erin Bonar presented a DEA training on cannabis use in adolescents titled, "New Highs: Understanding Cannabis Use in Today’s Youth and Young Adults" organized by the Michigan Opioid Collaborative.

February 2024: Dr. Erin Bonar presented a talk “Virtual behavioral health strategies for preventing and treating substance use disorders” to the Virtual Care Team and Michigan Medicine.

April 2024: Drs. Coughlin (far left) and Fernandez (second from left) with team members in front of their poster at the Collaborative Perspectives on Addiction Conference.

2023

December 2023: Dr. Erin Bonar gave the presentation “A Growing Problem: The Green Wave of Cannabis in Michigan & Beyond” at the Michigan Prevention Association Burning Issues Conference.

November 2023: Dr. Allison Lin spoke at the Western Michigan University DEA/MATE Training: A Practical Approach to Addiction in our Community.

November 2023: MI-ACRE and the Michigan Society of Addiction Medicine hosted the first “Advancing Addiction Care in Michigan Conference.” Speakers included Dr. Yngvild Olsen, the Director of addiction treatment at SAMHSA, Dr. Ellen Edens from Yale, and Dr. Nate Menke, director of the UM Addiction Consult Treatment service. We also welcomed special guests, Congresswoman Debbie Dingell and State Senator Sue Shink.

Nov. 11, 2023: Dr. Nate Menke presenting "Management of Polysubstance Withdrawal" at the Advancing Addiction Care in Michigan Conference.

October 2023: Dr. Anne Fernandez presented a webinar on "Alcohol Use Disorders: Epidemiology and Clinical Best Practices" for the Michigan Opioid Collaborative.

October 2023: Dr. Maureen Walton presented a poster as the Addiction Health Services Research Conference in New York which focused on collaborative work with Drs. Coughlin (PI) and Bonar, as well as Dr. Nahum-Shani affiliated with the Data-science for Dynamic Decision Making (d3C) at ISR, and colleagues from Harvard such as Dr. Murphy. The focus on the poster was describing a newly developed mobile health intervention, which is focused on reducing cannabis use and improving health among emerging adults who are regularly using cannabis.

October 2023: Drs. Bonar and Lin presented their poster titled "Identifying, reaching, and engaging primary care patients in need of alcohol use disorder treatment: Early data from a remote randomized controlled trial" at the Addiction Health Services Research (AHSR) conference.

September 2023: Dr. Erin Bonar presented at the St. Clair County Recovery Summit about cannabis use and cannabis use disorder.

September 2023: Dr. Lara Coughlin presented “Sleep, Stress, and Substance Use – Where Do They Meet?” for Well Aware with Michigan Medicine.