Cognitive Behavioral Treatment by Phone to Promote Use of Alcohol Related Care and Reduce Drinking
Phase: NA
Conditions: Alcohol Use Disorder, Alcohol Abuse
Sponsor: University of Rochester

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ClinicalTrials.gov Cover Page - Protocol 
 
Title: Talk Therapy by Phone to Promote Treatment for Alcohol Problems 
NCT number: NCT03758274 
Date (of revised protocol): March 10, 2022 
 

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Kenneth R. Conner, PsyD, MPH (Principal Investigator) 
Department of Emergency Medicine and Psychiatry 
University of Rochester Medical Center 
 
1. STUDY OVERVIEW – PURPOSE AND BACKGROUND 
Alcohol use disorder (AUD) is a prevalent and consequential condition (Grant et al., 2015; Hasin 
& Grant, 2015). Unfortunately, even though obtaining alcohol-related care is associated with both 
improved drinking outcomes and recovery for those with AUD (Cunningham, 2005; Trim, Schuckit, & 
Smith, 2013), those with the disorder who end up getting help average going 18 – 20 years before doing 
so (Blanco et al., 2015). In fact, one of the strongest predictive factors for individuals to seek treatment 
is whether they have previously sought treatment (Blanco et al., 2015), making that first step all the 
more crucial to their lifetime prognosis. A recent treatment development study (R21 AA07143) adapted 
a novel and comparatively brief intervention based on Cognitive Behavioral Therapy delivered over 
the telephone, and found that it led to significantly increased use of alcohol-related treatment (Stecker, 
McGovern, & Herr, 2012). 
 
The current study is a phase-II RCT using a two-group parallel design to further and more 
extensively test the efficacy of this intervention (CBT-TE) to promote use of alcohol-related care and 
improve drinking outcomes. Participants (n=450) will be recruited through advertisements, screened 
for eligibility by telephone, and those who are interested in participating and eligible will be consented, 
followed by administration of part one of a baseline assessment. Next, participants will be randomized 
to an intervention condition (45-60 minute CBT-TE intervention) or a control condition (being read a 
NIAAA brochure on AUD treatment). Participants are administered one of these interventions 
immediately following completion of part two of the baseline assessment which is to be completed 
within 21 days of part one of the baseline assessment. Follow-up assessments of alcohol-related 
treatment use and alcohol consumption will be conducted at 1,3, and 6 months  after the administration 
of part one of the baseline assessment, with the assessors blinded to study condition. Prior to June 1, 
2022, 9-month and 12-month follow-up assessments will also be conducted. On June 1, 2022 and after, 
follow-up assessments will be limited to 1, 3, and 6 month follow-ups.   
 
2. CHARACTERISTICS OF THE RESEARCH POPULATION 
 
2.1. Subject Characteristics 
Participants will be adult residents of The Greater Rochester, Buffalo, and Syracuse Area with 
most likely being from Rochester and Buffalo specifically. 
 
a) Number of Subjects:  Approximately 450 participants will be recruited into the study. 
a. What is the total (maximum) number of subjects to be enrolled (or their 
records/specimens accessed) at the University of Rochester (and other institutions if 
applicable to a multi-center study)? The total should include the number of evaluable 
subjects (i.e., those who meet eligibility criteria), as well as the number of 
anticipated screen failures necessary to obtain the enrollment goal. A subject is 
considered in the total count once informed consent has been obtained (as 
applicable). If evaluable subjects who withdraw from the study will be replaced to 
meet the enrollment goal, this should also be stated here.   
 
b) Gender and Age of Subjects:  Participants will be age 18 and older and based on prior 
experience of the study team (Stecker et al., 2012), we further expect that 56% of participants 
will be male, 44% will be female, and the mean age will be 40 years old. 
 
c) Racial and Ethnic Origin:  Based on the demographics of Monroe County, it is expected 
that the racial composition will be approximately 65% while, 32% black, 3% Asian, and <1% 
American Indian/Alaskan Native. Ethnic composition is expected to be approximately 13% 

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Hispanic or Latino and 87% non-Hispanic. 
 
2.2. Inclusion and Exclusion Criteria 
 
a) Inclusion Criteria:  1) age 18-plus; 2) score ≥ 16 on AUDIT; 3) within the past 30 days, 
exceeding the limits for low-risk drinking adopted by NIAAA: >3 standard drinks on any 
occasion or >7 drinks per week (women); >4 drinks on any occasion or >14 drinks per week 
(men).  
b) Exclusion Criteria: 1) unable to communicate with the researcher in English; 2) unable to 
comprehend the nature of the study; 3) history of alcohol-related care; 4) alcohol withdrawal 
necessitating medical evaluation; 5) residency outside of The Greater Rochester, Buffalo, 
and Syracuse Area; 6) Providing false information such as false name, contact information, 
or study responses.  
 
3. SUBJECT IDENTIFICATION, RECRUITMENT, WITHDRAWAL AND CONSENT 
 
3.1. Method of Subject Identification and Recruitment 
Study participants for the proposed project will be recruited within the Greater Rochester, 
Buffalo and Syracuse Area. The Greater Rochester, Buffalo, and Syracuse area can be defined as 
the 17 surrounding counties:  Orleans, Genesee, Wyoming, Monroe, Livingston, Ontario, Yates, 
Wayne, Seneca, Steuben, Niagara, Erie, Cortland, Madison, Oneida, Onondaga, and Oswego. 
Moreover, study participants for the proposed project will be recruited through a varied of online 
advertisements (e.g., Facebook, Instagram, Digital Banners, Craigslist, Reddit, Paid Search Ads, 
etc.) and local television, Print, and radio advertisements. Any use of digital advertisements will 
direct potential participants to a landing page where they can get in contact with the study team. 
IRB approved documents may also be used (e.g. flyers, billboards, digital signage, banners, etc.) 
in select targeted locations such as local bars, University affiliated healthcare clinics and 
hospitals, supermarkets, and other relevant locations. Advertisements will consist of an 
appropriately brief study description (based on the advertisement method) and contact 
information for interested persons to privately reach out for further information.  
Recruitment for the study will also include the use of ResearchMatch, a national health 
volunteer registry that was created by several academic Institutions and supported by the U.S. 
National institutes of health as part of the Clinical Translational Science Award (CTSA) 
programs. ResearchMatch has a large population of volunteers who have consented to be 
contacted by researchers about health studies for which they may be eligible. Review and 
approval for this study and all procedures was obtained from the IRB. 
 
Individuals inquiring about the study will be provided a brief overview and, if interested, 
screened using the 10-item AUDIT, 4-items from the National Survey of Drug Use and Health 
(NSDUH; Center for Behavioral Health Statistics and Quality, 2015) to determine if alcohol use 
within the past 30 days exceeds the limits for low-risk drinking adopted by NIAAA, and 
screening items on the Alcohol Use Disorders and Associated Disabilities Interview (AUDADIS; 
Grant et al., 2011) to determine if there is any history of professional alcohol-related treatment. 
 
3.2. Circumstances for Withdrawal 
Participants may be withdrawn from the study if they cannot keep appointments for study 
visits, if they cannot complete study activities, if study funding has been terminated, if alcohol 
withdrawal necessitating medical is required, or if subjects provide false information (false name, 
contact information, study responses etc.). 
If a subject is withdrawn early, they will be notified of the following: No further information 
from them is required, they are being discontinued from the study, and that no further research 
session will be scheduled or take place. In addition, if the study subject is withdrawn before 

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treatment (a one-time phone intervention meeting), then treatment will not be provided. However, 
if it is discovered that the subject should be withdrawn after the treatment was provided, then the 
delivery of the treatment would not be affected but any subsequent follow-up assessments would 
be discontinued. Furthermore, no follow-up data will be continued to be collected and the 
information that they provided may not be used in study analysis and will be protected (see 
confidentiality of data and information storage). Lastly, these subjects will be replaced.  
 
3.3. Process of Consent 
Research staff will thoroughly go over the consent form with the participant by phone while 
clarifying any points as needed and answering all questions the subject may have. The informed 
consent will also be done with the aid of an interpreter for deaf/hard of hearing 
individuals as needed. 
The informed consent form will contain a detailed description of the study procedures, 
along with statements regarding participants’ rights to withdraw from the procedure at any time 
without consequences. It will be explained to participants in easy-to-understand language. The 
limits of confidentiality will also be explained, including the potential to break confidentiality in 
the acute risk of suicidal behavior or violence, or disclosures of unreported physical or sexual 
abuse of a child. This will occur prior to any data collection and the consent form will include 
text regarding the retention and use of that data. 
Research staff will sign their name at the bottom of the form to show that they have 
explained the research, answered all questions to the subject’s satisfaction, that the subject has 
demonstrated comprehension of the information, and provided oral consent to participate.  
 
4. METHODS AND STUDY PROCEDURES 
4.1. Study Procedures and Assessments 
4.1a. Assessments: Nineteen relatively structured assessments will be used, which are 
described along with the schedule of administration in the table below. Each measure 
has been included in the online IRB application as appropriate. Supervision of the phone 
assessments for quality assurance (QA) will come in three forms:  
1. The PI meets monthly with the IRB approved assessors to avoid drift in 
interviews, discuss any difficulties that arise, and answer any questions regarding 
the phone assessments.     
2. The PI at the University of Rochester Medical Center or a Co-I at Syracuse 
University will act as a supervisor during select phone assessments. The 
purpose of this is to effectively complete a “check-in” to ensure that drift is not 
occurring and to provide feedback that might arise pertaining to assessment style 
and technique. The supervisor would be an IRB-approved Co-I or PI on the study 
team. The supervision of the phone assessment will occur by means of a three-
way call, and when a supervisor does observes an assessment, the subject will 
be notified by the assessor at the start of the phone assessment (e.g. “my 
supervisor will be monitoring this phone call for quality assurance purposes”). At 
this point, the supervisor may also introduce himself/herself. Moreover, we will 
record in REDCap that instance for which live supervision was provided for a 
given follow-up assessment including the subject number, date of the follow-up 
assessment, the study assessor performing the assessment, and the investigator 
providing supervision (The co-I at Syracuse will not be receiving data, as his role 
pertains to provide QA). After the completion of the phone assessment (at this 
time the subject would have disconnected), the supervisor and the assessor 
would stay on the call and verbally go over the quality of the assessment (if time 
allows) or schedule a time to go over the feedback. The feedback to the assessor 
would address the following topics:  

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a. Opening the interview:  
b. Establishing rapport:   
c. Neutrality:  
d. Listening:  
 
e. Reading items verbatim:  
f. Voice clarity:  
g. Information recorded accurately and completely:  
h. Probes used as needed:  
i. 
Closing the interview:  
j. 
Safety/human subjects’ issues:  
3.  Lastly, Dr. Conner provides ongoing oversight of supervision through a weekly 
study conference call that he chairs and that includes all sub-investigators 
including sub-investigators from collaborating institutions.. During this call, the 
results of any supervisory observations will be discussed and any challenges that 
arose addressed. If there are instances that warrant further discussion, for 
example because an interview was problematic or an assessor requires further 
training, then Dr. Conner and the Co-I providing the supervision will schedule a 
time to talk 1:1 to make a plan for providing further training and supervision to the 
assessor. More specifically, Dr. Conner and Stephen Maisto, Co-I and Professor 
at Syracuse University, will be provide the supervision to the study assessors. 
Drs. Conner and Maisto are on the weekly study conference calls as a matter of 
course, facilitating such coordination and oversight.  
 
Measure 
Screen 
Baseline 
Follow-Ups 
Purpose 
Preliminary Demographics 
✓ 
 
 
Basic Information 
NSDUH 
✓ 
 
✓ 
Eligibility in Terms of 
AUG (Short-Term) 
Lifetime Treatment Use 
✓ 
 
 
Eligibility in Terms of 
Services 
Substance-related sleep 
problems (SUSS) 
✓ 
 
✓ 
Sleep QOL 
Assessment 
AUDIT 
✓ 
 
 
Eligibility in Terms of 
AUD (Long-Term) 
Supplemental Demographics 
 
✓ 
 
Describe Sample 
TLFB 
 
✓ 
✓ 
Substance Use 

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AUDADIS-V 
 
✓ 
 
AUD Symptoms 
ASSIST 
 
✓ 
✓ 
Substance abuse in 
the past 30 days 
DMQ-R 
 
✓ 
✓ 
To assess the impacts 
of COVID-19 on 
drinking to cope with 
difficulties and 
emotion 
INDUC 
 
✓ 
✓ 
Substance Use 
PHQ-2 and Standardized 
PHQ-4 Screener 
 
✓ 
✓ 
Assess COVID-19 on 
sad mood & suicide 
risk screening 
triggered by PHQ-2 
Treatment Use Update 
 
 
✓ 
Utilization of AUD-
Related Services 
ATOS COVID-19 
 
✓ 
✓ 
Assessing the impact 
of COVID-19 on a 
subject’s lifestyle 
Theory of planned Behavior 
(TPB) 
 
✓ 
✓ 
Assessing the impact 
of COVID-19 related 
to telehealth 
IMPASS* 
 
✓ 
✓ 
Guides Therapy 
Session and Examine 
Change in Beliefs 
WHOQOL – BREF 
 
✓ 
✓ 
QOL Assessment 
Insomnia Sleep Index 
 
✓ 
✓ 
Sleep QOL 
Assessment 
Debriefing Questions  
 
 
✓ 
Understanding a 
Subject’s experience 
*Administered immediately prior to delivery of the intervention condition or the control 
condition.  
 
 
4.1b. Intervention Condition: Cognitive Behavioral Therapy for Treatment Engagement 
(CBT-TE) is a brief, tailored on-on-one session delivered by telephone lasting 45-60 minutes 
(Stecker, 2010). The intervention targets a change in the beliefs that influence whether or not 
someone initiates behavioral health treatment. During the session, participants are given a brief 
introduction to CBT and informed that it is based on the theory that cognitions, feelings, and 
behaviors all interact with each other. Therefore, since thoughts are modifiable, changing 
thoughts may lead to change in behavior. Based on a 3-step process, participants will be asked to 

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dispute beliefs about Alcohol Use Disorder (AUD) treatment elicited by the 39-item Identifying 
Modifiable Perceptions of Services Scale (IMPASS; Stecker, Fortney, Hamilton, & Azjen, 2007). 
A maximum of three beliefs will be discussed during the session and the participant and the 
interventionist will mutually agree upon beliefs to be discussed. All individuals assigned to the 
treatment condition will be administered the same structured intervention; however, content 
discussed within the session will differ for each participant based on their responses and thoughts 
surrounding the beliefs discussed within the session. Therefore, the intervention is structured but 
is not scripted. 
 
4.1c. Control Condition: Control participants will be sent a NIAAA brochure on AUD 
treatment, either electronically or through regular mail. They will then be read the brochure over 
the phone by a study staff member, which is designed to offset effects that are attributable to 
attention. This brochure, titled “Treatment for Alcohol Problems: Finding and Getting Help” is 
included in the online IRB application. 
 
4.2. Payment for Participation 
Participants will be paid $60 following completion of the two-part baseline assessment and 
will be paid additional $20 if part-two of the baseline assessment is completed within 7 days of 
part-one. Participants will also be paid $40 following the completion of each follow-up 
assessment and will be paid an additional $40 following the completion of the last follow-up 
assessment (whether the last follow-up occurs at 6 months, 9 months, or 12 months following the 
baseline assessment) if all prior follow-ups are completed. This would provide a maximum total 
compensation of $320 for individuals completing 1, 3, 6, 9, and 12 month follow-ups; it would 
provide a maximum total compensation of $280 for individuals completing 1, 3, 6, and 9 month 
follow-ups; and a maximum total compensation of $240 for individuals completing 1, 3, and 6 
month follow-up assessments Payments will be made securely by check, gift card, cash, or 
electronically (Department payment cards will be used as the mechanism for purchasing e-gift 
cards from Amazon).  
 
5. REPORTABLE EVENTS   
5.1 Adverse Events 
All adverse events will be identified and reported to Dr. Conner, who will be responsible for the 
timely reporting of adverse events to the required oversight entities. Such events will be 
documented in the adverse event log maintained by the study team. All adverse events will also be 
communicated to the IRB in the form of continuing reviews, and an annual report will be submitted 
to the NIAAA project officer summarizing adverse events. Adverse events that are determined to 
be unanticipated, study-related, and serious will be reported by Dr. Conner to the IRB, and the 
NIAAA Project Officer within 48 hours of discovery. All adverse events will be followed up by 
Dr. Conner in a timely way as to prevent any risks to participants, in coordination with the IRB. 
 
5.2 Suicidality 
The PHQ-2 and Standardized P4 Screener measure may result in the discovery of suicidal thoughts 
or behavior . Specifically, if depressed mood or lack of interest or pleasure is identified on the 
PHQ-2, it triggers administration of PHQ-9 item #9. If the subject endorses thoughts of self-harm 
on item #9, then the standardized P4 screener is administered which categorizes individuals into 
“minimal risk”, “lower risk”, and “higher risk.” If a subject is determined to be at “lower risk” or 
“higher risk” on the P-4, following the call, the assessor conducting the assessment will contact the 
PI (Dr. Conner) or another qualified investigator on the research team who will review the 
assessment and determine if a follow-up call with the subject may be beneficial to promote safety. 
If this is the case, Dr. Conner or another qualified investigator will seek to follow-up with the 
subject as needed by telephone to obtain further assessment and assist them as necessary. Typically, 
subjects deemed at “higher risk” would warrant such a follow-up call, unless there are mitigating 

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circumstances to suggest it is not clinically indicated, whereas subjects deemed at “lower risk” 
would be less likely to require follow-up. There are a broad range of potential responses to address 
risk including further assessment by phone, making a plan to reach out for additional support or 
formal treatment, and, in rare circumstances, initiating an emergency intervention (e.g., calling 
911).  
 
6. RISK/BENEFIT ASSESSMENT 
6.1. Risks to Subjects 
Risks include that the subjects will be identified as participants in an alcohol treatment 
study, inadvertent breach of confidentiality concerning drinking behavior, or that assessments, 
the CBT-TE, or the control intervention may temporarily adversely affect an individual’s well-
being (e.g., experience discomfort while discussing the consequences of alcohol use). 
 
6.2. Benefits to Subjects 
Benefits to participants include the possibility of receiving an intervention, at no cost, with 
preliminary evidence of efficacy to promote entry into alcohol-related care. 
 
6.3. Alternatives to Participation 
The alternative to participation is not to participate. 
 
7. CONFIDENTIALIATY OF DATA AND INFORMATION STORAGE  
With respect to confidential data collection, all project data will be collected by trained research 
interviewers using IRB approved data collection instruments. In addition, research interviewers and 
interventionists will receive on-going supervision through the course of the project. All data will be 
stored in locked file cabinets and password protected databases and will be accessible only by 
appropriate research personnel. All subject data will be identified by a unique number. Subject 
identifiers (e.g., name, address, telephone number) will be stored separately from research data and 
linkable through a unique identification number. The control and treatment interventions to be used in 
the project have been implemented in prior research without causing serious harm (Stecker et al., 2012). 
All study personnel will receive mandatory education in human subjects’ protection. All data will be 
used for research purposes only, and will not be revealed without the participants’ written consent 
unless to protect individuals immediate safety. All paper data will be kept in locked files in a locked 
study office. Computerized data will be stored in databases on a secure, password protected server that 
is regularly backed up. As an added protection, NIH funded studies are covered by a Federal Certificate 
of Confidentiality.   
 
We will share data with other researchers and use widely used measures that will facilitate 
harmonization with other research. However, the data sharing agreement involves sharing only de-
identified data with other investigators and the use of data-sharing agreements that provide for: (1) a 
commitment to using the data only for research purposes and not to identify any individual participant; 
(2) a commitment to securing the data using appropriate computer technology; and (3) a commitment 
to destroying or returning the data after analyses are completed. 
 
All research and clinical information obtained is kept confidential unless the subject is an 
immediate danger to him/herself or to others. Subject well-being will be monitored throughout the 
study. If the clinical information obtained in the course of research assessments pertains to patient safety 
(e.g., intent to harm one's self or others) then, to promote safety, confidentiality will not be maintained, 
and appropriate treating professionals will be informed. During crisis situations, this clinical 
information may be provided to other clinicians (or family members) in order to facilitate appropriate 
treatment and minimize the risks of self-harm or harm to others. This information may include the 
subject's medical history, financial and social resources, and history of suicidal behavior, if known. 
Confidentiality is the ethical and/or legal right that information, such as research data, will be held 
secret and safeguarded from disclosure unless consent is provided permitting disclosure.   

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8. DATA ANALYSIS AND DATA MONITORING 
 
8.1. Planned Statistical Analysis 
What are the statistical/analytical methods to be used for the collected research data and to meet 
the goals of any specific endpoints that will be analyzed? 
 
8.2. Data and Safety Monitoring 
1.  The DSM plan must designate an experienced, qualified professional (usually the PI) who 
can distinguish a serious adverse event (SAE) from a non-serious adverse event (AE). 
 
PI Response:  Dr. Kenneth R. Conner, contact PI of this study, will review all adverse 
events, and decide if they are serious or non-serious adverse events. As needed, he will 
consult with multi-PI Dr. Tracy Stecker on these determinations. Dr. Conner has the 
expertise to make these judgments and will be available to make any necessary decisions 
within the reporting timeframe.  
 
2.  
The DSM plan must indicate that serious adverse events will be reported to the local IRB 
and to the NIAAA project officer within 48 hours. 
PI Response: Any reportable serious adverse events experienced in this study (i.e., those 
that are serious, unanticipated, and study related) will be reported to the University of 
Rochester Medical Center (URMC) IRB, and to the NIAAA project officer (Dr. Roach) 
within 48 hours of the event. 
3.  
The DSM plan must indicate that an annual report will be submitted to the NIAAA Project 
Officer summarizing all adverse events.  
PI Response: An annual report will be submitted to the NIAAA Project Officer 
summarizing all adverse events. 
4.  
The DSM plan must specify that female subjects who are pregnant, nursing, or not using 
effective methods of birth control will be excluded from studies involving the 
administration of alcohol and/or drugs. 
PI Response: N/A 
5.   
The DSM plan must indicate that trained personnel will be present or on call when human 
laboratory studies of alcohol or other drug intake are conducted.  
PI Response: N/A 
6.   
For studies in which alcohol is administered, the DSM plan must indicate that NIAAA 
guidelines for the administration of alcohol will be followed. These guidelines can be found 
at the following web address: http://www.niaaa.nih.gov/extramural/job22.htm 
PI Response: N/A 
7.   
If the study has a follow-up phase, there must be a specific plan for referral to treatment 
during follow-up of any respondent requiring additional intervention due to significantly 
increased alcohol consumption or serious psychiatric/medical symptoms.  
PI Response: This study will follow participants for 12 months. Any information that we 

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collect at any point in the study that suggests that a participant may require or could be 
helped by it will be referred to treatment as indicated.    
8.   
The DSM plan must indicate that all adverse events during follow-up will be reported 
(SAEs within 48 hours) to the IRB and NIAAA. 
PI Response: All adverse events during follow-up will be reported to the URMC IRB, and 
to NIAAA. 
9.   
The DSM plan must briefly describe the procedures for data quality assurance and 
confidentiality. 
PI Response: Procedures will be in place to assure data quality and participant 
confidentiality. The procedures for data quality are: a) Adhere to CONSORT guidelines 
for conducting and reporting two-group parallel RCT’s (Begg et al., 1996; Moher et al., 
2001; Schulz et al., 2011). b) Regular meetings of the multi-PIs and the project staff to 
review any concerns regarding participant data.  c) All data will be entered by trained 
project staff and will be double checked for accuracy.  d) Assessment data will be entered 
into REDCap (Research Electronic Data Capture), a widely software toolset and workflow 
methodology that was created specifically around HIPAA-Security guidelines.  The 
procedures for confidentiality are: a) Respondent records [questionnaires, computer data] 
will be labeled by code number only.  b) All research personnel will be trained in 
procedures in assuring confidentiality, and only trained personnel will have access to 
subject records.   c) Individual data will never be presented. The data will be analyzed and 
reported only in terms of group outcomes. d) The project will be covered by a Federal 
Certificate of Confidentiality. 
10.   Phase III clinical trials must have an independent data and safety monitoring board. 
PI Response: N/A 
. 
 
9. REFERENCES 
9.1. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. (2015). Epidemiology of 
DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and 
Related Conditions III. JAMA Psychiatry, 72, 757–766. 
9.2. Hasin DS, Grant BF (2015). The National Epidemiologic Survey on Alcohol and Related 
Conditions (NESARC) Waves 1 and 2: Review and summary of findings. Social Psychiatry and 
Psychiatric Epidemiology, 50, 1609–1640. 
9.3. Cunningham J (2005). Short-term recovery from alcohol abuse or dependence: Any evidence of a 
relationship with treatment use in a general population sample? Alcohol and Alcoholism, 40, 419–
421. 
9.4. Trim RS, Schuckit MA, Smith TL (2013). Predictors of initial and sustained remission from 
alcohol use disorders: Findings from the 30-year follow-up of the San Diego Prospective Study. 
Alcoholism: Clinical and Experimental Research, 37, 1424–1431 
9.5. Blanco C, Iza M, Rodriguez-Fernandez JM, Baca-Garcia E, Wang S, Olfson M. (2015). 
Probability and predictors of treatment-seeking for substance use disorders in the U.S. Drug and 
Alcohol Dependence, 149, 136-144. 

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9.6. Stecker T, McGovern M, Herr B (2012). An intervention to increase alcohol treatment 
engagement: A pilot trial. Journal of Substance Abuse Treatment, 43, 161-167. 
9.7. Center for Behavioral Health Statistics and Quality. National survey on drug use and health 
(NSDUH): Summary of methodological studies, 1971–2014.  Retrieved May 15, 2015. 
9.8. Grant BF, Goldstein RB, Chou SP, et al. (2011). The Alcohol Use Disorder and Associated 
Disabilities Interview Schedule–Diagnostic and Statistical Manual of Mental Disorders, Fifth 
Edition Version (AUDADIS-5). Rockville, MD: National Institute on Alcohol Abuse and 
Alcoholism. 
9.9. Stecker T, Fortney J, Hamilton F, Sherbourne C, Ajzen I (2010). Engagement in mental health 
treatment among veterans returning from Iraq. Patient Preferences and Adherence, 4, 45-49. 
9.10. Stecker T, Fortney JC, Hamilton F, Azjen I (2007). An assessment of beliefs about mental health 
care among veterans who served in Iraq. Psychiatric Services, 58, 1358-1361