Randomized controlled trial of two brief alcohol interventions for OEF/OIF veterans.

Substance abuse among military combat veterans has become an issue of increasing interest to researchers and clinicians, and one of considerable public health importance, given that over 2 million American military personnel have served in recent combat theatres (Department of Defense, 2010). Research on veterans of the recent conflicts in Iraq and Afghanistan (abbreviated OEF/OIF/OND for Operations Enduring Freedom, Iraqi Freedom, and New Dawn) has demonstrated rates of alcohol misuse in the range of 25 to 40% (Calhoun et al., 2008; Jacobson et al., 2008). There is, unfortunately, a very low rate of help-seeking for substance abuse and mental health concerns in this population. One study found that only 2.5% of service members who screened positive for alcohol misuse had received any substance abuse treatment services (Burnett-Zeigler et al., 2011). Drinking in this population is further complicated by high rates of posttraumatic stress disorder (PTSD; McDevitt-Murphy et al., 2010), which may contribute to coping-motivated drinking, a particularly hazardous pattern (Kuntsche, Knibbe, Gmel, & Engels, 2005). Thus it seems that brief, opportunistic interventions, offered as part of regular medical care might be warranted for this population. To date, no brief intervention trials using samples of OEF/OIF/OND veterans have been published. Brief alcohol interventions Brief alcohol interventions (BAI) hold promise for reducing substance abuse across an array of populations. BAIs have emerged as the treatment of choice for heavy-drinking college students (Carey, Scott-Sheldon, Carey & DeMartini, 2007) and have become an important clinical tool with adults in medical settings (Ballesteros, Duffy, Querejeta, Arino, & Gonzalez-Pinto, 2004). BAIs used with college students typically include two primary components: detailed personalized feedback (usually several pages of written material that summarize the consequences and risks associated with each individual’s alcohol use), and motivational interviewing (MI), a counseling style characterized by a non-judgmental stance that aims to increase participants’ motivation to make positive changes (Miller & Rollnick, 2012). BAIs in medical settings are typically shorter, and provide less detailed feedback (Ballesteros et al., 2004). Given the high level of alcohol misuse among OEF/OIF/OND veterans and the low rate of help-seeking in this population, BAIs may be a particularly relevant type of intervention to explore. The goal of the present study was to develop and compare two brief alcohol interventions for combat veterans, a group with a high level of PTSD symptoms. The impact of PTSD on BAI efficacy has been explored in one prior study (Monahan, McDevitt-Murphy, Dennhardt, Skidmore, Martens, & Murphy, 2013). That study used a sample of college students and found that students who endorsed symptoms of PTSD were responsive to both clinician-administered (MI) and computer administered brief alcohol interventions, but that they showed a better response to the MI intervention with respect to alcohol-related consequences. It is possible that counselor-delivered interventions might be preferable to no-contact interventions for individuals with PTSD due to the high level of negative affect associated with PTSD and the emphasis on empathy in MI. Therefore, a secondary goal of the present study was to examine the role of PTSD as a moderator of treatment effects. In this study, the interventions included both general and personalized information about PTSD and depression symptoms and the ways that these symptoms might influence drinking, whereas the interventions in the Monahan et al study did not explicitly address these symptoms.