Project Summary/Abstract The intersection of Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) presents a significant public health challenge, particularly in clinical settings where their co-occurrence complicates treatment outcomes and exacerbates the severity of each disorder. Despite advancements in pharmacotherapy for OUD and AUD independently, the treatment of these co-occurring disorders remains underexplored, especially in large-scale, real-world contexts. Our research aims to address this gap by leveraging the Oracle Cerner EHR Real-World Data (CRWD), a comprehensive national database encompassing over 100 million patients, to conduct an extensive analysis of treatment patterns, outcomes, and predictive factors in patients with co-occurring OUD and AUD. Our study is structured around three specific aims. The first aim is to assess the effectiveness of integrated treatment approaches, including first-line AUD and OUD medications along with glucagon-like peptide-1 receptor agonists (GLP-1 RA), for patients with co-occurring OUD and AUD. We will focus on evaluating the reduction in substance use, improvements in physical health indicators, mental health improvements, and the utilization of detoxification services and drug tests. We hypothesize that patients receiving integrated treatment regimens will exhibit better outcomes, such as lower rates of alcohol intoxication and opioid overdose, improved liver function, reduced hospitalization, and alleviated mental health symptoms. The second aim is to identify demographic, racial, and clinical factors that predict adherence to treatment regimens in patients with co-occurring OUD and AUD. We will examine the consistency of medication orders, the duration and dosage consistency of prescribed treatments, and the alignment of medication orders with clinical appointments. Our hypothesis is that specific demographic and clinical characteristics will significantly influence treatment adherence, with variations observed across different patient groups. The third aim is to investigate the impact of stable and consistent comprehensive treatment engagement on long-term recovery outcomes in individuals with co-occurring OUD and AUD. We will measure relapse rates and durations of abstinence, hypothesizing that patients who demonstrate stable and consistent engagement in their treatment process will exhibit lower relapse rates and longer durations of abstinence. This research is innovative in its approach to leveraging a national database to address the complexities of co-occurring OUD and AUD. It is particularly innovative in exploring GLP-1 RA as a potential therapeutic agent in the treatment of these co-occurring disorders. By integrating this novel approach with traditional pharmacotherapies and evaluating its effectiveness using a large-scale national database, this study aims to contribute significantly to addiction medicine. The findings have the potential to inform clinical practice and public health policy, leading to more effective and personalized treatment strategies for individuals affected by these disorders. Ultimately, this research will provide empirical evidence to guide the development of new clinical guidelines or updates to existing procedures and policies in treating co-occurring OUD and AUD.

Project Narrative Our study addresses the critical intersection of Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) in clinical settings, a significant public health challenge. Leveraging the Oracle Cerner EHR Real-World Data (CRWD) of over 100 million patients, we aim to analyze treatment patterns, outcomes, and predictive factors for patients with co-occurring OUD and AUD. This innovative research, exploring the potential of glucagon-like peptide-1 receptor agonists (GLP-1 RA) alongside traditional pharmacotherapies, seeks to significantly advance addiction medicine and inform effective, personalized treatment strategies.