Alcohol Use Disorder Treatment Simulation: Modeling treatment impacts on alcohol-related disparities - Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable death in the US. Relatively few people with alcohol use disorder (AUD) receive appropriate services, and there are wide subgroup differences in access to alcohol health services. The proposed study will answer pressing questions about how to improve access, using simulation modeling to examine whether universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and referral to treatment (SBIRT) or medication-assisted treatment are sufficient, or whether more targeted efforts also are needed to reach certain population subgroups. Simulation models are well-suited for identifying unintended consequences of interventions implemented in complex systems, as well as outcomes that may occur years after implementation. By projecting intervention effects across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol health services interventions to increase access to care. Although simulation methods are being used to address the opioid crisis, to date there is no published simulation model comprehensively describing the continuum of alcohol health services in relation to AUD. The proposed study fills this gap by simulating effects of increased access to alcohol health services across the continuum of care from SBIRT, to specialty care (including AUD medications) and informal treatment (including 12-step groups like Alcoholics Anonymous). First, we will build and calibrate a microsimulation model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual model that includes factors that impact access to treatment at the individual, organizational, community, and policy levels. Next, we will use a geographically situated simulated population representing the large, demographically, and geographically varied states of California and Texas to make long-term projections for AUD severity and recovery for key population subgroups over time. Finally, informed by theories of healthcare access and utilization, we will project changes in AUD treatment receipt under several enhanced conditions to identify the mix and distribution of services that would best increase access to care, and we estimate costs and benefits of improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and acceptability of alcohol health services, and to (3) estimate cost and cost-effectiveness of these changes. Results will provide detailed information to inform service planning by states, counties, and communities to improve health services, including projections for how and where to intervene in a cost-effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.
