Kathy Bradley, MD, MPH, is a senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) and a general internal medicine physician with Washington Permanente Medical Group. Dr. Bradley focuses on identifying and addressing unhealthy alcohol and other substance use in primary care. Her research is having a lasting impact on how behavioral health is integrated into primary care—and how patients with alcohol use disorders are cared for—at Kaiser Permanente Washington, Veterans Affairs (VA), and beyond.
I entered my primary care residency at the University of California, San Francisco, in 1989 with a passion for teaching and primary care. One day a patient asked me, “My girlfriend says I drink too much; how much is too much?” I said, “I don’t know, but I’ll get back to you.” I consulted our faculty and library and was shocked to find no evidence-based advice on the topic. The assumption was if you were not a so-called “alcoholic,” you could drink as much as you wanted—which was ludicrous!
Then in my third year of residency we began offering liver transplants for cirrhosis due to drinking. It seemed so backwards to be spending huge resources on a few patients’ end-stage alcohol-related disease while ignoring prevention and treatment for so many people with alcohol use disorders.
But I learned we knew very little about how to prevent and treat problems due to alcohol use in medical settings. So I decided to try research, and guided by my first mentor—Eric Larson—discovered that I loved research! My first research article was a systematic literature review titled “How much is too much?”
My goal is to find the best ways to provide high-quality patient-centered care for a whole spectrum of substance use issues—ranging from risky use to severe addiction. And I want to help make that kind of care part of mainstream medical practice. Here at Kaiser Permanente, we have the capacity to innovate. And I have outstanding collaborators in our delivery system—Ryan Caldeiro and Rebecca Parrish—who partner on our research. Together we can test approaches to improving care for alcohol and other substance use disorders in real-world medical settings. Also in 2015 Kaiser Permanente became part of the Health Systems Node of the National Institute on Drug Abuse's Clinical Trials Network, led by Connie Weisner and Cynthia Campbell at Kaiser Permanente Division of Research in Northern California, and me.
Kathy Bradley and her husband Dan Lessler hiking in California’s High Sierra.
Awareness is growing that there’s a broad spectrum of unhealthy alcohol use. Generally, the more you drink, the greater the risks. Moreover, anyone can develop problems due to drinking.
So Kaiser Permanente Washington’s program supports primary care teams in educating patients about risks and recommended drinking limits, and
also starting conversations about whether they want to make a change.
We are excited that our patient decision aid, “Options for People Who Are Thinking about Their Drinking,” will be available in a few weeks. Too many people assume that there is only one option for treating alcohol use disorders: 12-step based rehab programs. The decision aid supports patients in considering whether they want to make a change—and if so, provides information on five general evidence-based options.
Our research supported implementation of Integrated Mental Health and Wellness, which is improving alcohol-related care at Kaiser Permanente Washington by providing a systematic way to address depression and alcohol and other substance use in all primary care clinics. As part of this program, we developed a YouTube video and an innovative handout—both using non-judgmental, plain language—that we hope can help people assess their drinking and whether they want to make a change.
I’m also now co-leading a study that addresses the current opioid epidemic. It’s an innovative trial testing a practical approach to increasing evidence-based treatment of opioid use disorder in real world primary care settings.
I am lucky that my research career has allowed me to continue my original passion: teaching. Now, half of my time is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism for mentoring the next generation of researchers. We’re building a whole team of researchers committed to improving substance use care in medical settings—Joe Glass, Gwen Lapham, David Carrell, and Clarissa Hsu, here at KPWHRI, and others at the University of Washington and beyond.
Outside work, my husband and I have two grown sons, and our vacations are usually spent hiking. I visit my 91-year-old mother in California often. To keep me going day to day, I try to meditate and exercise. Currently, do Pilates and work on a treadmill for a few hours a day whenever possible. Reading and writing while walking on a treadmill feels so much better than sitting!
Sharing CHOICE trial results, KPWHRI takes next steps to advance research on alcohol-related care at Kaiser Permanente Washington and beyond.