Addictions

Research overview

Kaiser Permanente Washington researchers are exploring how to improve prevention and treatment of health issues due to alcohol and other drug use. The addictions research group conducts innovative research to help patients and their providers prevent and treat problems caused by tobacco, alcohol, cannabis, opioids, and other drugs in health settings.

A major focus of the addictions research group is how to integrate patient-centered care for alcohol and other drug use into medical settings. Over the past three decades, their work has focused on the need for health systems to routinely measure and address alcohol and other drug use as part of whole-person health, in nonjudgmental, patient-centered ways.

"Our alcohol-related research has built tools—such as a brief video, handout, and a patient decision aid—that help overcome stigma so that patients and families can find the help they want and need," says Katharine A. Bradley, MD, MPH, a senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) and internal medicine physician with Washington Permanente Medical Group.

The addictions research group is conducting a variety of studies. "We are working to find ways to easily document the extent of cannabis exposure for both medical and nonmedical use in electronic health records," says Gwen Lapham, PhD, MSW, a KPWHRI assistant investigator. "We are also testing how to get proven online treatments for addiction into the hands of patients who could benefit," says Joseph E. Glass, PhD, MSW, a KPWHRI associate investigator. These are among the group’s current studies:

• PRimary Care Opioid Use Disorders (PROUD) is an implementation trial testing collaborative care for opioid use disorders.
• Digital Treatments for Substance Use Disorder (DIGITS) is a trial of strategies to implement online substance use disorder treatments into primary care.
• The Medical Cannabis study uses electronic health record (EHR) and survey data to study patterns of medical cannabis use among primary care patients.
• Medication Use, Safety, and Evidence (MUSE) is a multisite observational study on the incidence of and risk factors for opioid misuse, abuse, and addiction.
• Dr. Glass has an early-career award to study the effectiveness of treatments for alcohol use disorders in primary care.
• As a K12 CATALyST Learning Health Systems scholar, Dr. Lapham is partnering with Kaiser Permanente Washington Mental Health and Wellness leaders to integrate evidence-based care for substance use into adolescent primary care.
• Dr. Bradley’s mid-career award supports research innovation and mentoring early-career addictions researchers.

"We partnered with mental health and primary care leaders at Kaiser Permanente Washington to implement a program that addresses addictions and other common mental health concerns as part of routine primary care," says Amy K. Lee, MPH, a KPWHRI research associate. These are among the studies that the addictions research group has completed:

• In collaboration with Emily Williams, PhD, MPH, a KPWHRI affiliate investigator at Veterans Affairs Puget Sound Health Care System, they found that patients with unhealthy alcohol use who had HIV were less likely to receive evidence-based alcohol-related care than those without HIV.
• The Choosing Healthier Drinking Options in Primary Care (CHOICE) trial found that, with nurse care management, collaborative care for patients with high-risk drinking raised their engagement in alcohol-related care—but did not decrease heavy drinking or related problems. But usual care may have had benefits for patients without high-risk drinking.
• The Options study developed a patient-centered decision aid for thinking about drinking and learning about options for making changes in drinking.
• Integrated Mental Health was implemented and evaluated in Kaiser Permanente Washington.
• The Sustained Patient-centered Alcohol-related Care (SPARC) trial found that implementing integrated mental health in primary care improved sustained implementation of evidence-based alcohol-related care.
• The impact of poverty on alcohol use was stronger among black people—men and women alike—than in people in other racial/ethnic groups.

Affiliate researcher in addictions 

Emily Williams, PhD, MPH
Investigator
Health Services Research & Development
VA Puget Sound Health Care System