Need: Excess alcohol use and tobacco use are two of the top three risk factors for cancer incidence and mortality. Both excess alcohol use and tobacco lead to increased incidence of multiple types of cancers, and in some cases, their combined effects are synergistic, particularly for head and neck cancers. In Travis County, approximately 25% of adults reported binge drinking in the previous month, and 9% of adults have alcohol use disorder. Additionally, about 10% of adults in Travis County still smoke, despite recent decreases. Rates of unhealthy alcohol and tobacco use are even higher in hospitalized patients, many of whom are admitted to treat the consequences of these risky behaviors. ...

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Need: Excess alcohol use and tobacco use are two of the top three risk factors for cancer incidence and mortality. Both excess alcohol use and tobacco lead to increased incidence of multiple types of cancers, and in some cases, their combined effects are synergistic, particularly for head and neck cancers. In Travis County, approximately 25% of adults reported binge drinking in the previous month, and 9% of adults have alcohol use disorder. Additionally, about 10% of adults in Travis County still smoke, despite recent decreases. Rates of unhealthy alcohol and tobacco use are even higher in hospitalized patients, many of whom are admitted to treat the consequences of these risky behaviors. Screening hospitalized patients for alcohol and tobacco use and offering subsequent treatment can improve these unhealthy behaviors and reduce cancer risk. Three primary components of addressing alcohol and/or tobacco use disorder in an inpatient setting are screening, treatment, and resource linkage. The US Preventive Services Task Force recommends screening of unhealthy alcohol and tobacco use and initiation of behavioral and pharmacological therapies. Despite these recommendations, screening and treatment for excess alcohol and tobacco use is limited, particularly in inpatient settings for both behavioral and pharmacological interventions. Barriers to screening for alcohol use include time, patients' varying engagement in the healthcare system, and provider beliefs that answers will be inaccurate. Screening for tobacco use is typically less time consuming and more widely supported, although some barriers do exist, including the belief that tobacco use is a means of harm reduction from other substance use, provider lack of expertise in tobacco treatments and programs, and socioeconomic hurdles impeding access to care. These challenges may be especially prevalent in underserved patient populations, who often do not have opportunities to engage in consistent primary care, lack resources for outpatient care, have limited funding for treatment centers or recovery programs, and are left to navigate a fractured health care system. Our proposal aims to address these barriers through educational initiatives for providers, implementation of systematic screening and brief intervention, and by providing connection to outpatient services to improve continuity of care for alcohol and/or tobacco use disorder. Overall Project Strategy: This project aims to utilize an evidence-based strategy in an inpatient setting to identify patients with unhealthy alcohol use and/or tobacco use, provide behavioral intervention, offer medication-assisted treatment if appropriate, and develop an outpatient plan to continue treatment. Our proposal builds on the extensive experience of team members to develop this type of program in a novel setting, as well as the resources established through the existing CPRIT-supported outpatient programs for alcohol and tobacco screening and treatment. Specific Goals: 1. Increase prevalence and fidelity of universal screening for unhealthy alcohol use and current tobacco use for admitted patients. 2. Deliver a brief behavioral intervention to admitted patients identified as having unhealthy alcohol use and assess eligibility for naltrexone. 3. Deliver a brief intervention and offer NRT to admitted patients who screen positive for current tobacco use 4. Of patients who engage in treatment for unhealthy alcohol use, AUDIT scores will decrease at 4-6 week follow-up. 5. Of patients who engage in treatment for current tobacco use, tobacco use will decrease at 4-6 week follow-up. Significance and Impact: To our knowledge, this proposal would be only the second CPRIT-funded program to include screening and treatment for unhealthy alcohol use as a risk factor for cancer. Implementing the proposed interventions in this particular inpatient setting takes advantage of an episode where patients may be particularly motivated to make behavioral change and provides an opportunity to reach patients who may not be engaged in outpatient care. Additionally, the screening, treatment, and referral services would be integrated into a hospital that does not currently have an addiction consult service. This project hopes to tackle alcohol and tobacco use disorders by utilizing multiple modalities to reduce the morbidity and mortality of alcohol- and tobacco-related diseases, particularly cancers linked to these risky behaviors.

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