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BACKGROUND Brief interventions for  problem drinking  in medical setting s are effective but rarely conducted , mainly due to insufficient time . A stepped care approach ( starting with a very brief intervention and intensifying efforts in case of no success ) could save re sources and enlarge effectiveness ; however , research is lacking . The present study compares a full care brief intervention for patients with at-risk drinking , alcohol abuse or dependence with a stepped care approach in a r and omized controlled trial . METHODS Participants were proactively recruited from general practice s in two northern German cities . In total , 10,803 screenings were conducted ( refusal rate : 5 % ) . Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview ( M-CIDI ) . Eligible participants were r and omly assigned to one of three conditions : ( 1 ) stepped care ( SC ) : a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention ; ( 2 ) full-care ( FC ) : a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention ; ( 3 ) an untreated control group ( CG ) .  Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up . RESULTS SC participants received roughly half of the amount of intervention in minutes compared to FC participants . Both groups did not differ in drinking outcomes . Compared to CG , intervention showed small to medium effect size for at-risk drinkers . CONCLUSIONS Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking Background In recent years , interventions that deliver online personalized feedback on alcohol use have been developed and appear to be a feasible way to curb heavy drinking . R and omized controlled trials ( RCTs ) among the general adult population , however , are scarce . The present study offers an RCT of Drinktest.nl , an online personalized feedback intervention in the Netherl and s. Objective The aim of this study was to assess the effectiveness of computer-based personalized feedback  on heavy alcohol use in male adults . Methods R and omization stratified by age and educational level was used to assign participants to either the intervention consisting of online personalized feedback or an information-only control condition . Participants were told as a cover story that they would evaluate newly developed health education material s. Participants were males ( n = 450 ) , aged 18 to 65 years , presenting with either heavy alcohol use ( > 20 units of alcohol weekly ) and /or binge drinking ( > 5 units of alcohol at a single occasion at least 1 day per week ) in the past 6 months . They were selected with a screener from a sampling frame of 25,000 households . The primary outcome measure was the percentage of the participants that had successfully reduced their drinking levels to below the Dutch guideline threshold for at-risk drinking . Results Intention-to-treat analysis showed that in the experimental condition , 42 % ( 97/230 ) of the participants were successful in reducing their drinking levels to below the threshold at the 1-month follow-up as compared with 31 % ( 67/220 ) in the control group ( odds ratio [ OR ] = 1.7 , number needed to treat [ NNT ] = 8.6 ) , which was statistically significant ( χ2 1 = 6.67 , P = .01 ) . At the 6-month follow-up , the success rates were 46 % ( 105/230 ) and 37 % ( 82/220 ) in the experimental and control conditions , respectively ( OR = 1.4 , NNT = 11.9 ) , but no longer statistically significant ( χ2 1 = 3.25 , P = .07 ) . Conclusions Personalized online feedback on alcohol consumption appears to be an effective and easy way to change unhealthy drinking patterns in adult men , at least in the short-term . Trial registration International St and ard R and omized Controlled Trial Number : NTR836 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=836 ( Archived by WebCite at http://www.webcitation.org/5ytnEz2vp OBJECTIVES This study evaluates a computerized alcohol intervention implemented in a Swedish emergency department ( ED ) with regard to the effectiveness of two different types of tailored brief feedback on patients ' drinking patterns and the reach of the intervention . METHODS The study was a prospect i ve , r and omized controlled trial of ED patients . The design ated target population was the ED population aged 18 - 69 years who registered at the triage room before receiving care . Patients who were categorized as risky drinkers and completed the computerized test  were r and omized to either a long or a short feedback . The feedback was tailored on the basis of the individual patient 's responses to questions on their drinking patterns . RESULTS The computerized intervention reached 41 % of the target population . Those who completed the computerized test and received the feedback were younger than those who did not receive the intervention . Among those who could be followed up , the feedback was effective in reducing the patient 's weekly alcohol consumption and the number of heavy episodic drinking occasions . The long feedback was slightly more effective than the short feedback , but the differences were not statistically significant Background Hazardous alcohol use is associated with an increased risk for development of a substance use disorder , leading to negative outcomes in psychiatric patients . Aims In order to investigate whether psychiatric out patients ’  hazardous alcohol consumption could be reduced by way of a brief intervention by telephone . Method Non-psychotic psychiatric out patients , n = 1,670 , completed a self-rating form concerning alcohol habits ( AUDIT ) . Participants with scores indicating risk consumption ( n = 344 ) were r and omised to intervention ( immediate advice ) or control ( advice after 6 months ) . Results Hazardous alcohol habits occurred among 19 % of the women and 24 % of the men . In the intervention group , half of the patients reduced their alcohol consumption to non-hazardous levels at 6-month follow-up ( ITT analysis ) . In women , 41.5 % in the intervention group had no hazardous consumption at follow-up compared to 24.7 % in the control group ( P = 0.003 ) , corresponding figure for men was 49.1 and 34.0 % . Conclusion Brief intervention seems to be effective to reduce hazardous alcohol consumption in psychiatric out patients Objective : Alcohol consumption has been a growing concern at U.S. colleges , particularly among first-year students , who are at increased risk for problems . This study tested the efficacy of the “ electronic Check-Up to Go ” ( e-CHUG ) , a commercially-available internet program , at reducing drinking among a group of at-risk college freshman . Method : The design was a r and omized controlled trial : 106 freshmen students who reported heavy episodic drinking were r and omly assigned to receive feedback or to assessment only . Assessment measures were completed at baseline , 8 weeks , and 16 weeks . Results : At 8 weeks , the feedback group showed a significant decrease in drinks per week and peak BAC over control . By 16 weeks , the control group also declined to a point where there were no differences between groups . Changes in normative drinking estimates mediated the effect of the intervention . An additional 245 abstainers and light drinkers who were also r and omized to condition did not show any intervention effect . Conclusions : This study provides preliminary support for the efficacy of this intervention at reducing short-term drinking among at-risk students Background Current insights indicate that Web-based delivery may enhance the implementation of brief alcohol interventions . Previous research showed that electronically delivered brief alcohol interventions decreased alcohol use in college students and adult problem drinkers . To date , no study has investigated the effectiveness of Web-based brief alcohol interventions in reducing alcohol use in younger population s. Objective The present study tested 2 main hypotheses , that is , whether an online multicomponent brief alcohol intervention was effective in reducing alcohol use among 15- to 20-year-old binge drinkers and whether inclusion of normative feedback would increase the effectiveness of this intervention . In additional analyses , we examined possible moderation effects of participant ’s sex , which we had not a priori hypothesized . Method A total of 575 online panel members ( aged 15 to 20 years ) who were screened as binge drinkers were r and omly assigned to ( 1 ) a Web-based brief alcohol intervention without normative feedback , ( 2 ) a Web-based brief alcohol intervention with normative feedback , or ( 3 ) a control group ( no intervention ) .  Alcohol use and moderate drinking were assessed at baseline , 1 month , and 3 months after the intervention . Separate analyses were conducted for participants in the original sample ( n = 575 ) and those who completed both posttests ( n = 278 ) . Missing values in the original sample were imputed by using the multiple imputation procedure of PASW Statistics 18 . Results Main effects of the intervention were found only in the multiple imputed data set for the original sample suggesting that the intervention without normative feedback reduced weekly drinking in the total group both 1 and 3 months after the intervention ( n = 575 , at the 1-month follow-up , beta = -.24 , P = .05 ; at the 3-month follow-up , beta = -.25 , P = .04 ) . Furthermore , the intervention with normative feedback reduced weekly drinking only at 1 month after the intervention ( n=575 , beta = -.24 , P = .008 ) . There was also a marginally significant trend of the intervention without normative feedback on responsible drinking at the 3-month follow-up ( n = 575 , beta = .40 , P = .07 ) implying a small increase in moderate drinking at the 3-month follow-up . Additional analyses on both data sets testing our post hoc hypothesis about a possible differential intervention effect for males and females revealed that this was the case for the impact of the intervention without normative feedback on weekly drinking and moderate drinking at the 1-month follow-up ( weekly drinking for n = 278 , beta = -.80 , P = .01 , and for n = 575 , beta = -.69 , P = .009 ; moderate drinking for n = 278 , odds ratio [ OR ] = 3.76 , confidence interval [ CI ] 1.05 - 13.49 , P = .04 , and for n = 575 , OR = 3.00 , CI = 0.89 - 10.12 , P = .08 ) and at the 3-month follow-up ( weekly drinking for n = 278 , beta = -.58 , P = .05 , and for n = 575 , beta = -.75 , P = .004 ; moderate drinking for n = 278 , OR = 4.34 , CI = 1.18 - 15.95 , P = .04 , and for n = 575 , OR = 3.65 , CI = 1.44 - 9.25 , P = .006 ) . Furthermore , both data sets showed an interaction effect between the intervention with normative feedback and participant ’s sex on weekly alcohol use at the 1-month follow-up ( for n = 278 , beta = -.74 , P = .02 , and for n = 575 , beta = -.64 , P = .01 ) and for moderate drinking at the 3-month follow-up ( for n = 278 , OR = 3.10 , CI = 0.81 - 11.85 , P = .07 , and for n = 575 , OR = 3.00 , CI = 1.23 - 7.27 , P = .01 ) . Post hoc probing indicated that males who received the intervention showed less weekly drinking and were more likely to drink moderately at 1 month and at 3 months following the intervention . For females , the interventions yielded no effects : the intervention without normative feedback even showed a small unfavorable effect at the 1-month follow-up . Conclusion The present study demonstrated that exposure to a Web-based brief alcohol intervention generated a decrease in weekly drinking among 15- to 20-year-old binge drinkers but did not encourage moderate drinking in the total sample . Additional analyses revealed that intervention effects were most prominent in males result ing in less weekly alcohol use and higher levels of moderate drinking among 15- to 20-year-old males over a period of 1 to 3 months . Trial Registration IS RCT N50512934 ; http://www.controlled-trials.com/IS RCT N50512934/ ( Archived by WebCite at http://www.webcitation.org/5usICa3Tx AIMS To test the feasibility of online alcohol screening and brief intervention ( BI ) by comparing ( i ) two approaches to inviting all students to be screened , and ( ii ) a minimal versus a more extensive BI . METHODS Freshmen students at one university were r and omized to receive one of two types of email invitations to an online anonymous : ( i ) general health assessment , or ( ii ) alcohol-specific assessment . All were linked to the same alcohol screening survey . Those with unhealthy alcohol use ( AUDIT > or=8 ) were r and omly assigned to minimal or more extensive online alcohol BI . RESULTS In both invitation groups ( 4008 students ) , 55 % of students completed the online screening .  Overall , 37 % of men and 26 % of women had unhealthy alcohol use .  Compared to minimal BI , more extensive BI was associated with intention to seek help among men and with a greater increase in readiness to change among women . One month after BI , 75 % of students completed another assessment , 33 % of women and 15 % of men with unhealthy alcohol use at baseline no longer had unhealthy alcohol use . There were no significant differences on drinking measures by BI r and omization group . CONCLUSIONS Over half of an entire freshman class of college students were reached by email and completed alcohol screening and brief intervention . Even an alcohol-specific invitation did not deter students . Although brief interventions that differed had some gender specific effects on readiness to change and intention , in general , unhealthy alcohol use decreased after brief intervention . Web screening and brief intervention show promise for addressing unhealthy alcohol use by college students OBJECTIVE To evaluate the effectiveness of a web-based protocol , ModerateDrinking.com ( MD ; www.moderatedrinking.com ) combined with use of the online re sources of Moderation Management ( MM ; www.moderation.org ) as opposed to the use of the online re sources of MM alone . METHOD We r and omly assigned 80 problem drinkers to either the experimental or control group with follow-ups at 3 , 6 , and 12 months . RESULTS Seventy-five participants ( 94 % ) had outcome data at 1 or more follow-up points , and 59 participants ( 73 % ) were assessed at all 3 follow-ups . Comparing baseline measures to the average outcomes at follow-ups indicated a significant overall reduction in both groups in alcohol-related problems and consumption variables . Compared with the control group , the experimental group had better outcomes on percent days abstinent . There was an interaction between intensity of drinking at baseline and treatment in determining outcomes assessing drinking . Less heavy drinkers in the experimental group had better outcomes on log mean blood alcohol content ( BAC ) per drinking day compared with the control group . Heavier drinkers did not differentially benefit from the MD program on this measure . Mixed model analyses in general corroborated these outcomes . CONCLUSION The outcome data provide partial evidence for the effectiveness of the MD web application combined with MM , compared with the effectiveness of the re sources available online at MM by themselves The authors investigated the efficacy of an interactive Web site , MyStudentBody.com : Alcohol ( MSB : Alcohol ) that offers a brief , tailored intervention to help heavy drinking college students reduce their alcohol use . They conducted a r and omized , controlled clinical trial to compare the intervention with an alcohol education Web site at baseline , postintervention , and 3-month follow-up . Students were assessed on various drinking measures and their readiness to change their drinking habits . The intervention was especially effective for women and persistent binge drinkers . Compared with women who used the control Web site , women who used the intervention significantly reduced their peak and total consumption during special occasions and also reported significantly fewer negative consequences related to drinking . In addition , persistent heavy binge drinkers in the experimental group experienced a more rapid decrease in average consumption and peak consumption compared with those in the control group . The authors judged MSB : Alcohol a useful intervention for reaching important subgroups of college binge drinkers Aims : To examine the impact of a web-based personalized feedback intervention , the Check Your Drinking ( CYD ; www.CheckYourDrinking.net ) screener at 12-month follow-up . Methods : Respondents ( N = 185 ) were recruited from a general population telephone survey of Ontario , Canadian adults ( ≥18 years ) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers . Those r and omly assigned to the intervention condition were provided with the web address and a unique password to a study -specific copy of the CYD . Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be . Respondents were followed up at 3 , 6 and 12 months . Results : By the 12-month follow-up , the impact of the intervention previously reported at 3 and 6 months of CYD on problem drinkers ’ alcohol consumption was no longer apparent ( P > 0.05 ) . Conclusions : Recognizing that many people with alcohol concerns will never seek treatment , recent years have seen an increase in efforts to find ways to take treatment to problem drinkers . The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term ( i.e. 6 months ) . Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns . www . Clinical Trials.gov registration # NCT00367575 OBJECTIVE Alcohol misuse amongst University students is a serious concern , and research has started to investigate the feasibility of using e-health interventions . This study aim ed to establish the effectiveness of an electronic web-based personalised feedback intervention through the use of a r and omised control trial ( RCT ) . METHODS 506 participants were stratified by gender , age group , year of study , self-reported weekly consumption of alcohol and r and omly assigned to either a control or intervention condition . Intervention participants received electronic personalised feedback and social norms information on their drinking behaviour which they could access by logging onto the website at any time during the 12-week period . CAGE score , average number of alcoholic drinks consumed per drinking occasion , and alcohol consumption over the last week were collected from participants at pre- and post-survey . RESULTS A significant difference in pre- to post-survey mean difference of alcohol consumed per occasion was found , with those in the intervention condition displaying a larger mean decrease when compared to controls . No intervention effect was found for units of alcohol consumed per week or for CAGE scores . Sixty-three percent of intervention participants agreed that the feedback provided was useful . Those intervention participants who were above the CAGE cut off were more likely to report that the website would make them think more about the amount they drank . CONCLUSIONS Delivering an electronic personalised feedback intervention to students via the World Wide Web is a feasible and potentially effective method of reducing student alcohol intake . Further research is needed to replicate this outcome , evaluate maintenance of any changes , and investigate the process of interaction with web-based interventions OBJECTIVE To evaluate the correspondence among measures of self-reported drinking , st and ard biological indicators and the reports of collateral informants , and to identify patient characteristics associated with observed discrepancies among these three sources of research data . METHOD Using data collected from a large-scale clinical trial of treatment matching with alcoholics ( N = 1,726 ) , these three alternative outcome measures were compared at the time of admission to treatment and at 12 months after the end of treatment . RESULTS Patient self-reports and collateral reports agreed most ( 97.1 % ) at treatment admission when heavy drinking was unlikely to be denied . In contrast , liver function tests were relatively insensitive , with positive serum gamma-glutamyl transpeptidase ( GGTP ) values obtained from only 39.7 % of those who admitted to heavy drinking . At 15-month follow-up the correspondence between client self-report and collateral report decreased to 84.7 % , but agreement with blood chemistry values increased to 51.6 % . When discrepancies occurred , they still indicated that the client ' s self-report is more sensitive to the amount of drinking than the biochemical measures . Patients who presented discrepant results tended to have more severe drinking problems , more previous treatments , higher levels of pretreatment drinking and significantly greater levels of cognitive impairment , all of which could potentially interfere with accurate recall . CONCLUSIONS In clinical trials using self-selected research volunteers , biochemical tests and collateral informant reports do not add sufficiently to self-report measurement accuracy to warrant their routine use . Re sources devoted to collecting these alternative sources of outcome data might be better invested in interview procedures design ed to increase the validity of self-report information IMPORTANCE Unhealthy alcohol use is a leading contributor to the global burden of disease , particularly among young people . Systematic review s suggest efficacy of web-based alcohol screening and brief intervention and call for effectiveness trials in setting s where it could be sustainably delivered . OBJECTIVE To evaluate a national web-based alcohol screening and brief intervention program . DESIGN , SETTING , AND PARTICIPANTS A multisite , double-blind , parallel-group , individually r and omized trial was conducted at 7 New Zeal and universities . In April and May of 2010 , invitations containing hyperlinks to the Alcohol Use Disorders Identification Test-Consumption ( AUDIT-C ) screening test were e-mailed to 14,991 students aged 17 to 24 years . INTERVENTIONS Participants who screened positive ( AUDIT-C score ≥4 ) were r and omized to undergo screening alone or to 10 minutes of assessment and feedback ( including comparisons with medical guidelines and peer norms ) on alcohol expenditure , peak blood alcohol concentration , alcohol dependence , and access to help and information . MAIN OUTCOMES AND MEASURES A fully automated 5-month follow-up assessment was conducted that measured 6 primary outcomes : consumption per typical occasion , drinking frequency , volume of alcohol consumed , an academic problems score , and whether participants exceeded medical guidelines for acute harm ( binge drinking ) and chronic harm ( heavy drinking ) . A Bonferroni-corrected significance threshold of .0083 was used to account for the 6 comparisons and a sensitivity analysis was used to assess possible attrition bias . RESULTS Of 5135 students screened , 3422 scored 4 or greater and were r and omized , and 83 % were followed up . There was a significant effect on 1 of the 6 prespecified outcomes . Relative to control participants , those who received intervention consumed less alcohol per typical drinking occasion ( median 4 drinks [ interquartile range { IQR } , 2 - 8 ] vs 5 drinks [ IQR 2 - 8 ] ; rate ratio [ RR ] , 0.93 [ 99.17 % CI , 0.86 - 1.00 ] ; P = .005 ) but not less often ( RR , 0.95 [ 99.17 % CI , 0.88 - 1.03 ] ; P = .08 ) or less overall ( RR , 0.95 [ 99.17 % CI , 0.81 - 1.10 ] ; P = .33 ) . Academic problem scores were not lower ( RR , 0.91 [ 99.17 % CI , 0.76 - 1.08 ] ; P = .14 ) and effects on the risks of binge drinking ( odds ratio [ OR ] , 0.84 [ 99.17 % CI , 0.67 - 1.05 ] ; P = .04 ) and heavy drinking ( OR , 0.77 [ 99.17 % CI , 0.56 - 1.05 ] ; P = .03 ) were not significantly significant . In a sensitivity analysis accounting for attrition , the effect on alcohol per typical drinking occasion was no longer statistically significant . CONCLUSIONS AND RELEVANCE A national web-based alcohol screening and brief intervention program produced no significant reductions in the frequency or overall volume of drinking or academic problems . There remains a possibility of a small reduction in the amount of alcohol consumed per typical drinking occasion . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12610000279022 AIMS Self-help interventions for adult problem drinkers in the general population have proved effective . The question is whether this also holds for self-help interventions delivered over the internet . DESIGN We conducted a pragmatic r and omized trial with two parallel groups , using block r and omization stratified for gender and with follow-up at 6 months . SETTING The intervention and trial were conducted online in the Netherl and s in 2003 - 2004 . PARTICIPANTS We selected 261 adult problem drinkers from the general population with a weekly alcohol consumption above 210 g of ethanol for men or 140 g for women , or consuming at least 60 g ( men ) or 40 g ( women ) at least 1 day a week over the past 3 months . Participants were r and omized to either the experimental drinking less ( DL ) condition or to the control condition ( PBA ) . INTERVENTION DL is a web-based , multi-component , interactive self-help intervention for problem drinkers without therapist guidance . The recommended treatment period is 6 weeks . The intervention is based on cognitive-behavioural and self-control principles . The control group received access to an online psychoeducational brochure on alcohol use ( PBA ) . OUTCOME MEASURES We assessed the following outcome measures at 6-month follow-up : ( i ) the percentage of participants who had reduced their drinking levels to within the normative limits of the Dutch guideline for low-risk drinking ; and ( ii ) the reduction in mean weekly alcohol consumption . FINDINGS At follow-up , 17.2 % of the intervention group participants had reduced their drinking successfully to within the guideline norms ; in the control group this was 5.4 % [ odds ratio ( OR ) = 3.66 ; 95 % confidence interval ( CI ) 1.3 - 10.8 ; P = 0.006 ; number needed to treat ( NNT ) = 8.5 ] . The intervention subjects decreased their mean weekly alcohol consumption significantly more than control subjects , with a difference of 12.0 st and ardized units ( 95 % CI 5.9 - 18.1 ; P < 0.001 ; st and ardized mean difference 0.40 ) . CONCLUSIONS To our knowledge this is one of the first r and omized controlled trials on a web-based self-help intervention without therapist guidance for self-referred problem drinkers among the adult general population . The intervention showed itself to be effective in reducing problem drinking in the community BACKGROUND There is compelling evidence supporting screening and brief intervention ( SBI ) for hazardous drinking , yet it remains underused in primary health care . Electronic ( computer or Web-based ) SBI ( e-SBI ) offers the prospect s of ease and economy of access . We sought to determine whether e-SBI reduces hazardous drinking . METHODS We conducted a r and omized controlled trial in a university primary health care service . Participants were 975 students ( age range , 17 - 29 years ) screened using the Alcohol Use Disorders Identification Test ( AUDIT ) . Of 599 students who scored in the hazardous or harmful range , 576 ( 300 of whom were women ) consented to the trial and were r and omized to receive an information pamphlet ( control group ) , a Web-based motivational intervention ( single-dose e-SBI group ) , or a Web-based motivational intervention with further interventions 1 and 6 months later ( multidose e-SBI group ) . RESULTS Relative to the control group , the single-dose e-SBI group at 6 months reported a lower frequency of drinking ( rate ratio [ RR ] , 0.79 ; 95 % confidence interval [ CI ] , 0.68 - 0.94 ) , less total consumption ( RR , 0.77 ; 95 % CI , 0.63 - 0.95 ) , and fewer academic problems ( RR , 0.76 ; 95 % CI , 0.64 - 0.91 ) . At 12 months , statistically significant differences in total consumption ( RR , 0.77 ; 95 % CI , 0.63 - 0.95 [ equivalent to 3.5 st and ard drinks per week ] ) and in academic problems ( RR , 0.80 ; 95 % CI , 0.66 - 0.97 ) remained , and the AUDIT scores were 2.17 ( 95 % CI , -1.10 to -3.24 ) points lower . Relative to the control group , the multidose e-SBI group at 6 months reported a lower frequency of drinking ( RR , 0.85 ; 95 % CI , 0.73 - 0.98 ) , less total consumption ( RR , 0.79 ; 95 % CI , 0.64 - 0.97 [ equivalent to 3.0 st and ard drinks per week ] ) , reduced episodic heavy drinking ( RR , 0.65 ; 95 % CI , 0.45 - 0.93 ) , and fewer academic problems ( RR , 0.78 ; 95 % CI , 0.65 - 0.93 ) . At 12 months , statistically significant differences in academic problems remained ( RR , 0.75 ; 95 % CI , 0.62 - 0.90 ) , while the AUDIT scores were 2.02 ( 95 % CI , -0.97 to -3.10 ) points lower . CONCLUSIONS Single-dose e-SBI reduces hazardous drinking , and the effect lasts 12 months . Additional sessions seem not to enhance the effect . Trial Registration www.anzctr.org.au Identifier : ACTRN012607000103460 BACKGROUND University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels . We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program . METHODS A r and omized controlled trial was conducted at an Australian university in 2007 . Invitations were sent to 13 000 undergraduates ( age range , 17 - 24 years ) to complete a Web-based Alcohol Use Disorders Identification Test . Of 7237 students who responded , 2435 scored in the hazardous/harmful range ( > or = 8) and were r and omized , and 2050 ( 84 % ) completed at least 1 follow-up assessment . Intervention was 10 minutes of Web-based motivational assessment and personalized feedback . Controls received only screening . Follow-up assessment s were conducted at 1 and 6 months with observers and participants blinded to allocation . Outcome measures were drinking frequency , typical occasion quantity , overall volume , number of personal problems , an academic problems score , prevalence of binge drinking , and prevalence of heavy drinking . RESULTS Mean ( SD ) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 ( 5.1 ) and 14.2 ( 5.1 ) , respectively . After 1 month , participants receiving intervention drank less often ( rate ratio [ RR ] , 0.89 ; 95 % confidence interval [ CI ] , 0.83 - 0.94 ) , smaller quantities per occasion ( RR , 0.93 ; 95 % CI , 0.88 - 0.98 ) , and less alcohol overall ( RR , 0.83 ; 95 % CI , 0.78 - 0.90 ) than did controls . Differences in alcohol-related harms were nonsignificant . At 6 months , intervention effects persisted for drinking frequency ( RR , 0.91 ; 95 % CI , 0.85 - 0.97 ) and overall volume ( RR , 0.89 ; 95 % CI , 0.82 - 0.96 ) but not for other variables . CONCLUSION Proactive Web-based screening and intervention reduces drinking in undergraduates , and such a program could be implemented widely AIMS To determine the acceptability to university students of practitioner-delivered screening and brief intervention ( SBI ) versus a novel approach-web-based SBI ( e-SBI ) . METHODS A r and om sample of 1910 university students was invited to indicate their preferences for various brief intervention approaches in an internet survey . RESULTS e-SBI was the most popular intervention . It was favoured by 81 % of all students and 82 % of hazardous drinkers . CONCLUSIONS e-SBI is a promising approach for the reduction of hazardous drinking among young people An interactive web-site-based intervention for reducing alcohol consumption was pilot tested . Participants were 145 employees of a work site in the Silicon Valley region of California , categorized as low or moderate risk for alcohol problems . All participants were given access to a web site that provided feedback on their levels of stress and use of coping strategies . Participants r and omized to the full individualized feedback condition also received individualized feedback about their risk for alcohol-related problems . Some evidence was found for greater alcohol reduction among participants who received full individualized feedback , although due to difficulties in recruiting participants , the sample size was inadequate for evaluating treatment effects on drinking . The results provide preliminary support for using an interactive web site to provide individualized feedback for persons at risk for alcohol problems . However , the low participation rate ( 2.7 % ) suggests that such an intervention must address the challenges of recruiting employees through their work site College athletes are an at-risk population for excessive alcohol use and subsequent alcohol-related harms . The purpose of this study was to test the efficacy of an electronically delivered personalized drinking feedback ( PDF ) intervention targeted specifically to college athletes , both in comparison with a st and ard ( i.e. , nontargeted ) PDF intervention and an education-only ( EO ) condition that also included targeted information . Data were collected on 263 intercollegiate athletes from three colleges ( 76 % women , 86 % White ) who were r and omly assigned to one of the conditions . Results provided partial support for the efficacy of the targeted PDF intervention . Students in the targeted PDF condition reported a lower peak blood alcohol concentration ( BAC ) at the 6-month follow-up than those in the other conditions . Heavy drinking students in the targeted PDF condition reported a lower peak BAC than those in the other conditions at the 1-month follow-up and a lower peak BAC than those in the EO condition at the 6-month follow-up . Finally , in-season athletes in the targeted PDF condition reported fewer drinks per week than those in the PDF-st and ard condition at the 1-month follow-up . These findings provide preliminary support for the use of targeted PDF interventions with at-risk alcohol users , such as college athletes Sixty-one problem drinkers were r and omly assigned to either immediate treatment or a 4-week wait-list control group . Treatment consisted of a computer-based brief motivational intervention , the Drinker 's Check-up ( DCU ) . Outcomes strongly support the experimental hypotheses and long-term effectiveness of the treatment . Overall , participants reduced the quantity and frequency of drinking by 50 % , and had similar reductions in alcohol-related problems that were sustained through 12-month follow-up . The DCU seems to be effective in enhancing problem drinkers ' motivation for change Motivational interviewing ( MI ) is a counseling style that has been shown to reduce heavy drinking among college students . To date , all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style . This study was a dismantling trial of MI and feedback among heavy-drinking college students . After an initial screen , 279 heavy-drinking students were r and omized to ( a ) Web feedback only , ( b ) a single MI session without feedback , ( c ) a single MI session with feedback , or ( d ) assessment only . At 6 months , MI with feedback  significantly reduced drinking , as compared with assessment only ( effect size = .54 ) , MI without feedback ( effect size = .63 ) , and feedback alone ( effect size = .48 ) . Neither MI alone nor feedback alone differed from  assessment  only . Neither sex , race or ethnicity , nor baseline severity of drinking moderated the effect of the intervention . Norm perceptions mediated the effect of the intervention on drinking . MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions BACKGROUND Strong evidence exists for the efficacy of screening and brief intervention for reducing  hazardous drinking .  However , problems have been highlighted with respect to its implementation in health-care systems , not least of which is a reluctance of some doctors to discuss alcohol proactively with their patients . AIMS To determine the efficacy of a novel web-based screening and brief intervention ( e-SBI ) to reduce hazardous drinking . DESIGN A double-blind r and omized controlled trial . SETTING A university student health service . PARTICIPANTS A total of 167 students ( 17 - 26 years ) were recruited in the reception area and completed a 3-minute web-based screen including the Alcohol Use Disorder Identification Test ( AUDIT ) question naire . Of these , 112 tested positive , and 104 ( 52 females ) who consented to follow-up were included in the trial . MEASUREMENTS Drinking frequency , typical occasion quantity , total volume , heavy episode frequency ( females > 80 g ethanol , males > 120 g ethanol ) , number of personal problems , an academic problems score . INTERVENTION Participants were r and omized to 10 - 15 minutes of web-based assessment and personalized feedback on their drinking ( intervention , n = 51 ) or to a leaflet-only control group ( n = 53 ) . FINDINGS Mean baseline AUDIT scores for control and intervention groups were 16.6 ( SD = 6.0 ) and 16.6 ( SD = 5.7 ) . At 6 weeks , participants receiving e-SBI reported significantly lower total consumption ( geometric mean ratio = 0.74 ; 95 % confidence interval : 0.56 - 0.96 ) , lower heavy episode frequency ( 0.63 ; 0.42 - 0.92 ) and fewer personal problems ( 0.70 ; 0.54 - 0.91 ) . At 6 months personal problems remained lower ( 0.76 ; 0.60 - 0.97 ) , although consumption did not differ significantly . At 6 months , academic problems were lower in the intervention group relative to controls ( 0.72 ; 0.51 - 1.02 ) . CONCLUSIONS e-SBI reduced  hazardous drinking among university students , to an extent similar to that found for practitioner-delivered brief interventions in the general population . e-SBI offers promise as a strategy to reduce alcohol-related harm in a way that is non-intrusive , appealing to the target group , and capable of being incorporated into primary care . Research is required to replicate the findings , to determine the duration of intervention effects , and to investigate the mechanisms by which the intervention operates Background Excessive alcohol consumption is most widespread among young adults . Practice guidelines recommend screening and physician advice , which could help address this common cause of injury and premature death . Objective To assess the proportion of persons ages 18–39 who , in the past year , saw a physician  and were asked about their drinking and advised what drinking levels pose health risk , and whether this differed by age or whether respondents exceeded low-risk drinking guidelines [ daily ( > 4 drinks for men/>3 for women ) or weekly ( > 14 for men/>7 for women ) ] . Design Survey of young adults selected from a national internet panel established using r and om digit dial telephone techniques . Participants Adults age 18–39 who ever drank alcohol , n = 3,409 from the internet panel and n = 612 non-panel telephone respondents . Main Measures Respondents were asked whether they saw a doctor in the past year ; those who did see a doctor were asked whether a doctor asked about their drinking , advised about safe drinking levels , or counseled to reduce drinking . Key Results Of respondents , 67 % saw a physician in the past year , but only 14 % of those exceeding guidelines were asked and advised about risky drinking patterns . Persons 18–25 were the most likely to exceed guidelines ( 68 % vs. 56 % , p < 0.001 ) but were least often asked about drinking ( 34 % vs. 54 % , p < 0.001 ) . Conclusions Despite practice guidelines , few young adults are asked and advised by physicians about excessive alcohol consumption . Physicians should routinely ask all adults about their drinking and offer advice about levels that pose health risk , particularly to young adults Forty nonalcoholic heavy drinkers were r and omly assigned to receive a computer-based version of behavioral self-control training either immediately after pretreatment assessment or after a 10-week waiting period . Results at each of 3 follow-ups strongly support the study hypotheses . Participants in the immediate treatment group significantly reduced their drinking relative to their pretreatment levels and relative to those in the delayed treatment condition at the initial follow-up , 10 weeks after the pretreatment assessment . The delayed group did not change their drinking behaviors during this period of time . However , they significantly reduced their drinking by the second follow-up conducted after they received training . At the 12-month follow-up , participants maintained the gains they had achieved during treatment . There were no interactions involving participant ethnicity or gender . Although use of other drugs was not specifically addressed , such use did not increase , and there was some evidence of a decline OBJECTIVE The purpose of this trial was to investigate the feasibility and short-term outcomes of a tailored intervention , delivered via text messages to wireless h and held computers , to reduce alcohol-related consequences among college students . METHOD Forty college students were r and omly assigned to one of two study groups . In the control group , participants used h and held computers to complete daily surveys about their drinking behavior and related variables . In the treatment group , participants used the h and held computers to complete daily surveys and to receive individually tailored messages on the units . The tailored messages addressed consequences of alcohol use and were tailored to respondents ' reported behavior , self-efficacy , and outcome expectancies regarding alcohol-related consequences . RESULTS All treatment group participants reported receiving messages on their h and held computers ; most students were sent messages on 12 - 14 days . Controlling for baseline differences , participants in the treatment group reported drinking significantly fewer drinks per drinking day than participants in the control group during the study period . At follow-up , participants in the treatment group had lower expectancies that they would get in trouble as a result of alcohol consumption than did control group participants . Participants provided both positive and negative feedback about the messages . CONCLUSIONS This study demonstrated the feasibility of delivering tailored messages via wireless h and held computers . Tailored messages about avoiding negative consequences of alcohol use delivered via h and held computers had small but positive effects on alcohol-related attitudes and behaviors . Future research should replicate these findings with a larger , more diverse sample , during a longer period , and with other audiences BACKGROUND Brief interventions have the potential to reduce heavy drinking  in young adults who present to the emergency department ( ED ) , but require time and re sources rarely available . Text-messaging ( TM ) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change . The feasibility of screening young adults in the ED , recruiting them for a TM-based interventional trial , collecting weekly drinking data through TM , and the variance in drinking outcomes remains unknown . METHODS Young adults in 3 urban EDs ( n = 45 ; aged 18 to 24 years , 54 % women ) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were r and omly assigned to weekly TM-based feedback with goal setting ( Intervention ) , weekly TM-based drinking assessment s without feedback ( Assessment ) , or control . Participants in the Intervention group who reported ≥5 ( for men ) and ≥4 ( for women ) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week . We describe the interaction with TM and goal setting . We also describe the heavy drinking days ( HDDs ) , drinks per drinking day ( DPDD ) using timeline follow-back procedure at baseline and 3 months . RESULTS We screened 109 young adults over 157 hours across 24 unique days and 52 ( 48 % ; 95 % CI 38 to 50 ) screened positive for hazardous drinking . Of these , 45 ( 87 % ; 95 % CI 74 to 94 ) met inclusion criteria , were enrolled and r and omized , and 6 ( 13 % ; 95 % CI 5 to 27 ) did not complete 3-month web-based follow-up ; 88 % ( 95 % CI 84 to 91 ) of weekly TM-based drinking assessment s were answered , with 77 % ( 95 % CI 58 to 90 ) of participants responding to all 12 weeks . Agreeing to set a goal was associated with a repeat HDD 36 % ( 95 % CI 17 to 55 ) of the time compared with 63 % ( 95 % CI 44 to 81 ) when not willing to set a goal . At 3 months , participants that were exposed to the TM-based intervention had 3.4 ( SD 5.4 ) fewer HDDs in the last month and 2.1 ( SD 1.5 ) fewer DPDD when compared to baseline . CONCLUSIONS TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED . TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy OBJECTIVE To assess the effect of mode of administration in alcohol surveys ( telephone vs face-to-face interviews ) , prevalence rates of self-reported harms due to alcohol were compared for two data sets with equivalent measures . METHOD Two national alcohol surveys were used : the 1990 Warning Labels Survey , in which r and om digit dialing was used to generate a sample of 2,000 adults interviewed by telephone , and the 1990 National Alcohol Survey ( face-to-face interviews ) , a probability sample of U.S. adults living in households ( N = 2,058 ) . Both surveys included identical items on five areas of alcohol-related harm , yielding one composite index of any harm reported in the last 12 months that was compared between the two surveys for current drinkers . RESULTS After controlling for demographic characteristics and alcohol use , the telephone survey yielded significantly higher rates of alcohol-related health harm , work harm and " any harm " as compared to the in-person survey . The interaction between heavier drinking ( five or more drinks during 1 day , weekly or more often ) and method of data collection was significant for health harm and any harm . Respondents in the telephone survey who drank 5 + less than weekly were more likely than those interviewed in person to report health harm due to alcohol use ; those in the telephone survey who drank 5 + weekly or more often were more likely to report any harm . CONCLUSIONS Possible explanations for differences between the surveys include anonymity and fewer social desirability issues associated with telephone surveys , as well as potentially differing cognitive requirements in telephone versus face-to-face interviews Background Web-based interventions for problem drinking are effective but characterized by high rates of attrition . There is a need to better underst and attrition rates in order to improve the completion rates and the success of Web-based treatment programs . Objective The objectives of our study were to ( 1 ) examine attrition prevalence and pretreatment predictors of attrition in a sample of open-access users of a Web-based program for problem drinkers , and ( 2 ) to further explore attrition data from our r and omized controlled trial ( RCT ) of the Web-based program . Methods Attrition data from two groups of Dutch-speaking problem drinkers were collected : ( 1 ) open-access participants enrolled in the program in 2009 ( n = 885 ) , and ( 2 ) RCT participants ( n = 156 ) . Participants were classified as noncompleters if they did not complete all 12 treatment sessions ( 9 assignments and 3 assessment s ) . In both sample s we assessed prevalence of attrition and pretreatment predictors of treatment completion . Logistic regression  analysis was used to explore predictors of treatment completion . In the RCT sample , we additionally measured reasons for noncompletion and participants ’ suggestions to enhance treatment adherence . The qualitative data were analyzed using thematic analysis . Results The open-access and RCT group differed significantly in the percentage of treatment completers ( 273/780 , 35.0 % vs 65/144 , 45 % , χ2 1 = 5.4 , P = .02 ) . Logistic regression analysis revealed a significant contribution of treatment readiness , gender , education level , age , baseline alcohol consumption , and readiness to change to predict treatment completion . The key reasons for noncompletion were personal reasons , dissatisfaction with the intervention , and satisfaction with their own improvement . The main suggestions for boosting strategies involved email notification and more flexibility in the intervention . Conclusions The challenge of Web-based alcohol treatment programs no longer seems to be their effectiveness but keeping participants involved until the end of the treatment program . Further research should investigate whether the suggested strategies to improve adherence decrease attrition rates in Web-based interventions . If we can succeed in improving attrition rates , the success of Web-based alcohol interventions will also improve and , as a consequence , their public health impact will increase . Trial International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 39104853 ; http://www.controlled-trials.com/IS RCT N39104853 ( Archived by WebCite at http://www.webcitation.org/63IKDul1 T AIMS Assess long-term trends of the correlation between alcohol sales data and survey data . DESIGN Analyses of state alcohol consumption data from the US Alcohol Epidemiologic Data System based on sales , tax receipts or alcohol shipments . Cross-sectional , state annual estimates of alcohol-related measures for adults from the US Behavioral Risk Factor Surveillance System using telephone surveys . SETTING United States . Participants State alcohol tax authorities , alcohol vendors , alcohol industry ( sales data ) and r and omly selected adults aged > or = 18 years 1993 - 2006 ( survey data ) . MEASUREMENTS State-level per capita annual alcohol consumption estimates from sales data . Self-reported alcohol consumption , current drinking , heavy drinking , binge drinking and alcohol-impaired driving from surveys . Correlation coefficients were calculated using linear regression models . FINDINGS State survey estimates of consumption accounted for a median of 22 % to 32 % of state sales data across years . Nevertheless , state consumption estimates from both sources were strongly correlated with annual r-values ranging from 0.55 - 0.71 . State sales data had moderate-to-strong correlations with survey estimates of current drinking , heavy drinking and binge drinking ( range of r-values across years : 0.57 - 0.65 ; 0.33 - 0.70 and 0.45 - 0.61 , respectively ) , but a weaker correlation with alcohol-impaired driving ( range of r-values : 0.24 - 0.56 ) . There were no trends in the magnitude of correlation coefficients . CONCLUSIONS Although state surveys substantially underestimated alcohol consumption , the consistency of the strength of the association between sales consumption and survey data for most alcohol measures suggest both data sources continue to provide valuable information . These findings support and extend the distribution of consumption model and single distribution theory , suggesting that both sales and survey data are useful for monitoring population changes in alcohol use Background Unhealthy alcohol use among university students is cause for concern , yet the level of help seeking behavior for alcohol use is low within the student population . Electronic brief interventions delivered via the Internet present an alternative to traditional treatments and could enable the delivery of interventions on a population basis . Further evidence is needed of the effectiveness of Internet-delivered interventions and of their generalizability across educational institutions . Objective Our objective was to evaluate the effectiveness across 4 UK universities of a Web-based intervention for student alcohol use . Methods In total , 1112 participants took part . Participants were stratified by educational institution , gender , age group , year of study , and self-reported weekly consumption of alcohol and r and omly assigned to either the control arm or to the immediate or delayed intervention arms . Intervention participants gained access to the intervention between weeks 1 to 7 or weeks 8 to 15 , respectively . The intervention provided electronic personalized feedback and social norms information on drinking behavior accessed by logging on to a website . Participants registered interest by completing a brief screening question naire and were then asked to complete 4 further assessment s across the 24 weeks of the study . Assessment s included a retrospective weekly drinking diary , the Alcohol Use Disorders Identification Test ( AUDIT ) , and a readiness-to-change algorithm . The outcome variable was the number of units of alcohol consumed in the last week . The effect of treatment arm and time on units consumed last week and average units consumed per drinking occasion were investigated using repeated measures multivariate analysis of covariance ( MANCOVA ) . In addition , the data were modeled using a longitudinal regression with time points clustered within students . Results MANCOVA revealed a main effect of time on units of alcohol consumed over the last week . A longitudinal regression model showed an effect of assessment across time predicting that participants who completed at least 2 assessment s reduced their drinking . The model predicted an additional effect of being assigned to an intervention arm , an effect that increased across time . Regression analysis predicted that being male or being assigned to an intervention arm increased the odds of not completing all assessment s. The number of units of alcohol consumed over the last week at registration , age , university educational institution , and readiness to change were not predictive of completion . Conclusions Delivering an electronic personalized feedback intervention to students via the Internet can be effective in reducing weekly alcohol consumption . The effect does not appear to differ by educational institution . Our model suggested that monitoring alone is likely to reduce weekly consumption over 24 weeks but that consumption could be further reduced by providing access to a Web-based intervention . Further research is needed to underst and the apparent therapeutic effect of monitoring and how this can be utilized to enhance the effectiveness of brief Web-based interventions BACKGROUND The wide accessibility of computer-based technologies like the Internet and Interactive Voice Response ( IVR ) systems raises the question of whether population survey data could be collected more easily and cheaply compared to using paper question naires . In the area of possibly stigmatized behaviors such as problematic alcohol and drug use , the question extends to whether the prevalence of such behaviors in the general population could be surveyed without compromising the quality of the data . AIMS This study compares Internet and IVR versions of the AUDIT and DUDIT with respect to : ( 1 ) response rate , ( 2 ) problematic alcohol and drug use and ( 3 ) reliability . METHOD 5000 individuals , r and omly selected from the Swedish general population , were contacted via postal mail and invited to complete the AUDIT and DUDIT question naires via Internet or IVR . In total , 1861 ( 37.8 % ) participated in the study , 1089 via Internet and 772 via IVR .  RESULTS The Internet administration mode yielded a higher response rate ( 38.1 % ) compared to the IVR mode ( 33.9 % ) . When respondents were given a choice between Internet and IVR , a higher response rate result ed ( 43.2 - 46.6 % ) . Problematic alcohol and drug use occurred among 21.1 % and 2.8 % of the sample , respectively , with no significant differences by administration mode . Both the AUDIT and DUDIT exhibited satisfactory reliability across administration modes , Cronbach 's α 0.76/0.86 . CONCLUSIONS Data quality does not deteriorate with computerized administration methods for the AUDIT and DUDIT in population studies but paper question naires should also be made available to respondents in order to maximize response rates The association between self-reported  alcohol intake  and the risk of future liver disease  was studied in a large population -based prospect i ve cohort with 12-year follow-up . Alcohol intake was assessed in 13,285 men and women aged 30 to 79 years by a  self-administered question naire .  Diagnoses indicating alcohol-induced liver disease ( n = 261 ) or alcohol-induced cirrhosis ( n = 124 ) were obtained from death certificates and the hospital discharge register , and data were analyzed by multiplicative Poisson regression models . The total cumulated observation time was 130,558 person-years . The overall incidence rates of alcohol-induced cirrhosis were 0.2 % per year in men and 0.03 % per year in women . The nadir of the estimated relative risk of developing liver disease was observed at an alcohol intake of 1 to 6 beverages per week , and above this level a steep increase in relative risk was observed . The risk function was independent of age and stable over time . The level of alcohol intake above which the relative risk was significantly greater than 1 was observed at 7 to 13 beverages per week for women and 14 to 27 beverages per week for men . Women had a significantly higher relative risk of developing alcohol-related liver disease than men for any given level of alcohol intake . We observed a dose-dependent increase in relative risk of developing alcohol-induced liver disease for both men and women , with the steepest increase among women . In the general population , self-reported current alcohol intake is a good predictor of the future risk of alcohol-induced liver disease OBJECTIVE Interactive voice response ( IVR ) , a computer-based interviewing technique in which respondents interact directly with a computerized system , can increase a sense of privacy and potentially a willingness to report putatively sensitive attitudes and behaviors more accurately . The purpose of this study was to compare the prevalence rates obtained by IVR with  computer-assisted telephone interviewing ( CATI )  for alcohol-related problems , physical and sexual abuse , and sexual orientation . METHOD As part of the data collection effort for the 2005 National Alcohol Survey , sub sample s of respondents were r and omly assigned to three groups : two IVR groups , each receiving an IVR module on either alcohol-related problems ( n = 562 ) or on physical/sexual abuse and sexual orientation ( n = 563 ) , and control groups that did not receive IVR ( n = 559 ) . RESULTS Analyses indicate no significant differences between IVR and the control groups on alcohol-related problems . A significantly higher proportion of reports of homosexual and bisexual sexual identity was found in the  IVR group for respondents 40 years and older . The IVR group also reported higher rates of condom use for respondents 18 - 39 years old . CONCLUSIONS These findings suggest that alcohol-related problems may no longer be considered sensitive items in the general adult population . However , reports of nonheterosexual sexual orientation identity remain sensitive for older respondents . Embedding IVR within a telephone interview may provide an effective way of helping assure valid responses to sensitive item content BACKGROUND One-third of injured patients treated in the emergency department ( ED ) have an alcohol use disorder ( AUD ) . Few are screened and receive counseling because ED staff have little time for additional tasks . We hypothesized that computer technology can screen and provide an intervention that reduces at-risk drinking ( British Medical Association criteria ) in injured ED patients . METHODS In all , 3,026 subcritically injured patients admitted to an ED were screened for an AUD using a laptop computer that administered the  AUD Identification Test ( AUDIT ) and assessed motivation to reduce drinking .  Patients with a positive AUDIT ( n = 1,139 ) were r and omized to an intervention ( n = 563 ) or control ( n = 576 ) condition . The computer generated a customized printout based on the patient 's own alcohol use pattern , level of motivation , and personal factors , which was provided in the form of feedback and advice . RESULTS Most patients ( 85 % ) used the computer with minimal assistance . At study entry , a similar proportion in each group met criteria for at-risk drinking ( 49.6 % versus 46.8 % , p = 0.355 ) . At 6 months , 21.7 % of intervention and 30.4 % of control patients met criteria for at-risk drinking ( p = 0.008 ) . Intervention patients also had a 35.7 % decrease in alcohol intake , compared with a 20.5 % decrease in controls ( p = 0.006 ) . At 12 months , alcohol intake decreased by 22.8 % in the intervention group versus 10.9 % in controls ( p = 0.023 ) , but the proportion of at-risk drinkers did not significantly differ ( 37.3 % versus 42.6 % , p = 0.168 ) . CONCLUSIONS The computer-generated intervention was associated with a significant decrease in alcohol use and at-risk drinking . Research is needed to further evaluate and adapt information technology to provide preventive clinical services in the ED CONTEXT Emergency department ( ED ) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury . OBJECTIVE To determine the efficacy of brief interventions addressing violence and alcohol use among adolescents presenting to an urban ED . DESIGN , SETTING , AND PARTICIPANTS Between September 2006 and September 2009 , 3338 patients aged 14 to 18 years presenting to a level I ED in Flint , Michigan , between 12 pm and 11 pm 7 days a week completed a computerized survey ( 43.5 % male ; 55.9 % African American ) . Adolescents reporting past-year alcohol use and aggression were enrolled in a r and omized controlled trial ( SafERteens ) . INTERVENTION All patients underwent a computerized baseline assessment and were r and omized to a control group that received a brochure ( n = 235 ) or a 35-minute brief intervention delivered by either a computer ( n = 237 ) or therapist ( n = 254 ) in the ED , with follow-up assessment s at 3 and 6 months . Combining motivational interviewing with skills training , the brief intervention for violence and alcohol included review of goals , tailored feedback , decisional balance exercise , role plays , and referrals . MAIN OUTCOME MEASURES Self-report measures included peer aggression and violence , violence consequences , alcohol use , binge drinking , and alcohol consequences . RESULTS About 25 % ( n = 829 ) of screened patients had positive results for both alcohol and violence ; 726 were r and omized . Compared with controls , participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression ( therapist , -34.3 % ; control , -16.4 % ; relative risk [ RR ] , 0.74 ; 95 % confidence interval [ CI ] , 0.61 - 0.90 ) , experience of peer violence ( therapist , -10.4 % ; control , + 4.7 % ; RR , 0.70 ; 95 % CI , 0.52 - 0.95 ) , and violence consequences ( therapist , -30.4 % ; control , -13.0 % ; RR , 0.76 ; 95 % CI , 0.64 - 0.90 ) at 3 months . At 6 months , participants in the therapist intervention showed self-reported reductions in alcohol consequences ( therapist , -32.2 % ; control , -17.7 % ; odds ratio , 0.56 ; 95 % CI , 0.34 - 0.91 ) compared with controls ; participants in the computer intervention also showed self-reported reductions in alcohol consequences ( computer , -29.1 % ; control , -17.7 % ; odds ratio , 0.57 ; 95 % CI , 0.34 - 0.95 ) . CONCLUSION Among adolescents identified in the ED with self-reported alcohol use and aggression , a brief intervention result ed in a decrease in the prevalence of self-reported aggression and alcohol consequences . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00251212 BACKGROUND The limited number of electronic screening and brief intervention ( e-SBI ) projects taking place in young adult student population s has left knowledge gaps about the specific methods needed to motivate reduced drinking . The aim of the present study was to compare differences in alcohol consumption over time after a series of e-SBIs was conducted with two groups of young adult students who were considered risky drinkers . The intervention group ( IG ) ( n=80 ) received extensive normative feedback ; the control group ( CG ) ( n=78 ) received very brief feedback consisting of only three statements . METHOD An e-SBI project was conducted in naturalistic setting s among young adult students at a Swedish university . This study used a r and omized controlled trial design , with respondents having an equal chance of being assigned to either the IG or the CG . The study assessed changes comparing the IG with the CG on four alcohol-related measurements : proportion with risky alcohol consumption , average weekly alcohol consumption , frequency of heavy episodic drinking ( HED ) and peak blood alcohol concentration ( BAC ) . Follow-up was performed at 3 and 6 months after baseline . RESULTS The study documented a significant decrease in the average weekly consumption for the IG over time but not for the CG , although the differences between the groups were non-significant . The study also found that there were significant decreases in HED over time within both groups ; the differences were about equal in both groups at the 6-month follow-up . The proportion of risky drinkers decreased by about a third in both the CG and IG at the 3- and 6-month follow-ups . CONCLUSIONS As the differences between the groups at 6 months for all alcohol-related outcome variables were not significant , the shorter , generic brief intervention appears to be as effective as the longer one including normative feedback . However , further studies in similar naturalistic setting s are warranted with delayed assessment groups as controls in order to increase our underst and ing of reactivity assessment in email-based interventions among students Background Decreasing Injuries from ALcohol ( DIAL ) is a r and omised control trial of a telephone brief intervention ( BI ) with injured emergency department ( ED ) patients with high-risk alcohol use . Here the authors examine 12-month outcomes of the intervention 's effect on alcohol use , alcohol-related injuries and alcohol-related negative consequences . Methods ED research assistants recruited adult injured patients who screened positive for high-risk alcohol use and were to be discharged home . After discharge , all participants received by telephone an assessment of their alcohol use , alcohol-related injuries , and alcohol-related negative consequences and then were r and omised to treatment or st and ard care . Treatment consisted of two telephone sessions of BI focusing on risky alcohol use . Both groups were reassessed after 12 months . Results At 12 months , 249 ( 89 % ) participants completed follow-up assessment s. After using a log transformation , the difference in alcohol-related injuries between baseline and 12-month follow-up was greater in the BI group than the st and ard care group ( p=0.04 ) ; this is an effect size of Cohen 's d=0.21 . No difference between groups was found when comparing change in alcohol consumption and other alcohol-related negative consequences at 12 months . Conclusions These findings suggest that a telephone BI with injured ED patients may decrease alcohol-related injuries . Identifying patients with risky alcohol use in the ED and then subsequently delivering the intervention by telephone after discharge has promise as a model for BI and deserves further study
CONTEXT Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually .
Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults .
Electronic screening and brief intervention ( e-SBI ) uses electronic devices to deliver key elements of alcohol screening and brief intervention , with the potential to exp and population reach .