Professional Abstract

Objective

To assess the feasibility and acceptability of using a shared decision making training curriculum and graphic novels to reduce substance use and increase medication-assisted treatment (MAT) uptake in patients with alcohol use disorder

Study Design

Design Element	Description
Design	Feasibility study
Population	37 patients with alcohol use disorder
Interventions/ Comparators	Health Education Toolkit Usual care
Outcomes	Shared decision making conversation rate, session satisfaction and acceptability, substance use, MAT initiation
Timeframe	12-week follow-up for study outcomes

This exploratory study examined the use of a Health Education Toolkit to train counselors of patients with alcohol use disorder to conduct shared decision making conversations to reduce substance use and increase MAT uptake. The Toolkit included a set of four graphic novels, which used stories about patients at a drug and alcohol treatment facility to describe what to expect during treatment; model shared decision making conversations about medication; and offer educational resources about recovery, treatment, and medication choices.

The research team randomly assigned counselors to lead sessions using the Toolkit or to provide usual care. In the Toolkit group, counselors received a brief training on using the Toolkit and then led a structured, four-session series on the graphic novel topics with patients over four to six weeks. In the usual care group, counselors received training on topic areas comparable to the Toolkit and led a four-session series with patients over four to six weeks, with flexibility to decide which topics to emphasize and when to present them.

The study included 37 patients with alcohol use disorder who received treatment at a medical center in Philadelphia. Of these, 70% were African American, 14% were white, and 16% were other races. The average age was 43, and 65% were male.

Patients completed measures of shared decision making, session satisfaction and acceptability, substance use, and MAT initiation before the study and 6 and 12 weeks later. The research team conducted focus groups with counselors after the six-week follow-up and with patients after the 12-week follow-up about their experiences using the Toolkit.

Addiction treatment professionals, patients with substance use disorder, and patient advocates helped design the graphic novels and provided input throughout the study.

Results

The study did not have a large enough sample to detect differences between the groups; therefore, results are preliminary and inconclusive. Patients who attended sessions in which counselors used the Toolkit and patients who received usual care did not differ significantly in measures of shared decision making, session satisfaction and acceptability, or substance use. In the usual care group, 33% of patients reported following up on a MAT evaluation or referral compared with 6% in the Toolkit group.

In the focus groups, counselors and patients who used the Toolkit generally had neutral or positive views on the quality of the graphic novels. In addition, counselors and patients gave positive feedback on the usefulness of the graphic novels in creating a dialogue between counselors and patients.

Limitations

The study took place in one medical center. Findings may differ in other settings or locations.

Conclusions and Relevance

The study could not draw conclusions about the usefulness of the Health Education Toolkit in reducing substance use or increasing MAT uptake among patients with alcohol use disorder. Focus group findings indicate that counselors and patients found the Toolkit to be useful.

Future Research Needs

Future research could test the Health Education Toolkit with samples large enough to detect statistically significant differences.