A Critical Illness Recovery Navigator for Alcohol (CIRNA)

Excessive alcohol consumption is common in patients admitted to the intensive care unit (ICU). Among patients who survive an ICU admission, excessive alcohol consumption is associated with a higher risk of being admitted the hospital. In this study, the Investigators will compare an intervention designed to address excessive drinking in ICU survivors to usual care. This intervention combines motivational interviewing (MI) and shared decision making (SDM). MI and SDM share several core components including the development of a therapeutic alliance and promotion of autonomy. MI can be employed in the context of motivating a patient to change their drinking. Once this decision has been made, SDM can be employed to help a patient decide amongst multiple reasonable treatment options. The Investigators long-term goal is to test whether MI-SDM is better than usual care and whether multiple sessions of MI-SDM are better than a single session. This pilot clinical trial will demonstrate the feasibility of conducting a larger efficacy study to test these hypotheses.

This group will undergo contact with Recovery Navigator on an "as needed basis" up to 6 months.They will then have a 3 month and 6 month follow up visit with the PI. There is no drug or treatment administered to the subject. The intervention is the conversation/contact with the Recovery Navigator, in this arm, it is continued throughout the study. Note: The first 10 subjects will not be randomized and will be assigned to this Arm. The purpose of this is to ensure the fidelity of the intervention. The remaining 60 subjects will be randomized equally among the three Arms. Data from the first 10 subjects will not be considered for the outcome measures.

This group will undergo one interaction with the Recovery Navigator prior to the hospital discharge. They will then have a 3 month and 6 month follow up visit with the PI. There is no drug or treatment administered to the subject.The intervention is the conversation/contact with the Recovery Navigator, in this arm, it is conducted once.

This group will not have any interaction with the Recovery Navigator. They will then have a 3 month and 6 month follow up visit. There is no drug or treatment administered to the subject.

This group will undergo contact with Recovery Navigator on an "as needed basis" up to 6 months and then have a 3 month and 6 month follow-up visit.

This group will undergo one interaction with Recovery Navigator prior to hospital discharge and then have a 3 month and 6 month follow-up visit.

This group will not have any interaction with Recovery Navigator. They will have a 3 month and 6 month follow-up visit.

Client satisfaction questionnaire (CSQ-8), with revisions to make it specific to the objectives of this study.

The following will be collected to determine the feasibility and design of a larger effectiveness study: recruitment rates calculated as the number of patients recruited per month per hospital.

The number of patients who refuse study participation due to refusal to undergo randomization. This will be collected to inform the feasibility and design of a larger effectiveness study.

The amount of time per subject visit to determine feasibility of the intervention for a larger study.

Initiation of treatment by attendance at one treatment session within 14 days as efficacy measure for larger trial.

Initiation of treatment by attendance at one treatment session within 6 months as efficacy measure for larger trial

2 or more inpatient admissions, outpatient visits, intensive outpatient encounters or partial hospitalizations as efficacy measure for larger trial

Phosphatidylethanol (PEth) level at 6 months compared against subject's self-reported alcohol consumption and measured by United States Drug Testing laboratory

alcohol related problems assessed by administering the Short Inventory of Problems 2, revised (SIP-2R).

Inclusion Criteria: Admission to the intensive care unit; Age 18 years or older; Resolution of critical illness, defined as the intention of the treating team to discharge the patient or downgrade their admission level from the ICU to a progressive care unit or the floor; Resolution of delirium, defined by: a Riker Agitation Sedation Scale score of 0, a negative CAM ICU, and confirmation from the treating team (nurse, physicians) that the patient is not delirious. AUDIT-C score of 3 or greater for women and 4 or greater for men. Exclusion Criteria: Prisoner; Pregnant; Unable to speak or write in English; Unable to provide informed consent; Unable to provide a home or cell phone number plus at least one additional way to be contacted (mail, email, friend or family); Expected survival less than 6 months.