Abstract Ria Health is a nationally scaling early-stage telemedicine and technology company that treats alcohol use disorder with a combination of objective measures of drinking (twice daily breathalyzer measures through our app), physician-supervised medications, and group and individual coaching - the Ria Treatment Platform. Ria has enrolled more than 4,500 patients, is available in 45 states, and is covered by major insurers. Ria has accumulated more than 300K breathalyzer measures from enrolled patients that demonstrate a reduction in alcohol use of 50% at 1 month and 75% at 12 months. Mean retention in treatment is 10 months. The incidence and burdens of alcohol-associated liver disease are growing. There are no automated methods that screen specifically for early alcohol-associated liver disease. In this project we will use a large electronic health record system (Epic at Stanford University Health) to identify patients with elevated liver function tests who are at increased risk for occult alcohol use disorder. A feasibility analysis of Epic records at Stanford identified >56,460 adult patients with elevated liver function tests (AST, ALT, GGT) who could be screened for this study. Patients with elevated liver function tests will be invited by an “honest broker” to be screened for alcohol use disorder and, if alcohol use disorder is present, to receive treatment through Ria. We hypothesize that patients with alcohol use disorder and elevated liver function tests who would otherwise not seek treatment will be motivated to engage in treatment. We will conduct a randomized wait-list controlled study in 124 subjects to demonstrate the efficacy of the Ria Treatment Platform. A comprehensive set of outcome measures will be assessed, with percent of subjects without heavy drinking in the final 4 weeks defined as the primary outcome. The project has several innovative features. It is the first to use mass screening of a large electronic health records system to identify potential cases of alcohol use disorder with abnormal liver function tests and to engage them in treatment. Given the morbidity and mortality of alcohol use disorder, new methods to identify and engage these patients earlier are urgently needed. We will also conduct the first randomized controlled trial of the Ria Treatment Platform, providing crucial validation for payers.

PROJECT NARRATIVE The Ria Treatment Platform is an innovative model for personalized alcohol use disorder treatment using telemedicine that includes anti- craving medications that are managed by expert physicians and nurse practitioners with psychosocial treatment delivered by recovery coaches. The RTP technology system collects objective measures of drinking behavior with breathalyzers synced to our smartphone app and integrates group and peer support within a HIPAA-compliant environment. This project will build upon this successful technology by 1) identifying prospective patients by reviewing medical records for evidence of possible liver injury from alcohol and 2) conducting the first randomized clinical trial of the Ria Treatment Platform.