Technology transfer of behavioral economic tasks for assessing alcohol reinforcer pathology: Development and feasibility of a commercially-available tool for clinical practice

PROJECT SUMMARY Alcohol use disorderAUDcontributes to excessive disabilitymorbidityand mortality in the United StatesAs one of the nation s leading preventable causes of deaththe first line of defense against AUD must be standardized screening provided by the patient s primary care physicianpsychiatristand or counselorStandardized screeninghoweveris simply under performedReform proposals call for improved technology for electronic screening to save time and improve standards of careMoreoverthe National Institute of Mental Health s Research Domain CriteriaRDoCframework prescribes a focus on defining the underlying functional dynamics of AUD instead of using symptom based tools as biomarkers for diseaseThereforethe present proposal aims to develop a validatedtheoretically guided toolwhich provides clinicians with information beyond AUD symptomsReinforcer pathology is a measure of severity derived from the synergy between two distinct decision making processespreference for immediately available small rewardsi eexcessive delay discountingandover valuation of alcohol rewardsi ehigh behavioral economic demandParamount to this proposaldecades of research have concluded that delay discounting and demand are highly correlated with alcohol use severity and important predictors of AUD treatment successIn order to develop a feasible and acceptable reinforcer pathology based mobile tablet applicationBEACONfor use in the clinicthe present proposal aims to recruit clinicians to provide feedback via focus group sessionsAimand integrate the BEACON into their practiceAimaexecuted by BEAM DiagnosticsIncDevelopmentiterationand maintenance of the appincluding the user interface and back endsecure databasescore calculationand associated web portal will be built and maintained by Virginia Tech Carilion Research InstituteAimA total of three tool prototype iterationsbased on clinician focus group feedbackwill be administered to clinic patients throughout the testing period to collect reinforcer pathology scores and patient feedbackAimbBEAM DiagnosticsIncThis reinforcement pathology assessment tool is innovative given its propensity to by pass self report of past drinking behavior AUD symptoms and prospectively predict severity based on a theoretical frameworkmaking this Phase I STTR application both timely and necessary PROJECT NARRATIVE Alcohol misuse and alcohol use disorderAUDare major contributors to disabilitymorbidityand mortalityyet the current standardized screening measures in clinical practice are under performed and test only symptoms of past behaviorInsteadand in response to National Institute of Health s call for increased translation of theoretically based screening tools that examine core functions of AUDthe reinforcer pathology framework examines an individual s decision making processes about alcohol providing the clinician with more information about patient AUD severity and prospective riskThe current proposal seeks to develop and test the feasibility of a reinforcer pathology mobile tablet application to rapidly assess AUD severity and riskproviding improved screening of vulnerable patients