Health Explorer - Optimizing Alcohol Brief Interventions
Condition: Alcohol Abuse
MeSH terms: Alcoholism
Study type: Interventional

Summary: 
      The aims of the study are to develop and refine tailored motivational brief interventions
      that are parallel in structure but have varied delivery modalities (computer vs. therapist)
      for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled
      trial comparing the efficacy of these BI approaches (CBI, TBI, control) on subsequent alcohol
      consumption and alcohol consequences, including alcohol-related injury, mental and
      physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit.
    

Detailed description: 
      Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or
      problem alcohol use, few are screened and receive services such as brief interventions (BI)
      designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps
      due to feasibility challenges such as training of staff, monitoring fidelity, and maintaining
      a system to ensure longer-term implementation. Alcohol BIs have been found to be efficacious
      and effective in a variety of health care settings. However, the evidence for their use in
      the ED has been mixed. There is a pressing need to develop efficacious strategies to screen
      and optimally deliver alcohol BIs in this fast-paced and widely-used setting. Existing
      clinician-delivered BI strategies need to be modified so that they can be standardized and
      administered with high fidelity and minimal demands on ED staff time and resources.
      Computer-delivered BIs are one method to address the challenges inherent in delivering
      interventions in this and other healthcare settings. The proposed study will use computerized
      screening via touch-screen computer tablets with audio to recruit inner-city ED patients
      screening positive for at-risk or problem alcohol use. Participants age 21-65 will be
      randomized to one of three conditions: 1) Computer-delivered brief intervention (CBI); 2)
      Therapist-delivered brief intervention (TBI); or 3) Enhanced usual care (EUC). All
      participants will receive written information regarding community resources; individuals who
      meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals.
      Stratified random assignment [by gender; meeting criteria for an alcohol use disorder] will
      take place at baseline for all conditions. The rigorous examination of the efficacy of
      therapist- vs. computer-delivered BIs, including potential moderators and mediators, will
      address the key limitations raised by previous trials and will determine the optimal modality
      for wide implementation of brief alcohol interventions in this venue. Because the ED is such
      an important portal for entry into the medical care system, particularly for inner-city
      patients, the delivery of efficacious alcohol BIs that emphasize key motivational
      interviewing components and minimize staff resources could have a major public health impact.
    

Intervention name(s): CBI; TBI
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The multimedia, interactive Computer Brief Intervention (CBI) condition will be delivered using tablet computers. The content and format will be easily negotiated by participants. The 30-minute interventions are designed to address the primary target behavior of alcohol use, and will include a tailored review of participants' goals/values, feedback regarding their present alcohol use patterns and consequences (either actual experiences or potential based on risk behaviors), developing a discrepancy between their alcohol use and ability to meet goals and values through a decisional balance exercise, and formulation of a "change plan" tailored for each participant.; Participants receive a 30-minute intervention session with a Master's-level clinician. The interventions are designed to address the primary target behavior of alcohol use, and will include a tailored review of participants' goals/values, feedback regarding their present alcohol use patterns and consequences (either actual experiences or potential based on risk behaviors), developing a discrepancy between their alcohol use and ability to meet goals and values through a decisional balance exercise, and formulation of a "change plan" tailored for each participant.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research