Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: a randomized controlled trial. Evaluation of an electronic clinical reminder to facilitate brief alcohol-counseling interventions in primary care. Do Health Educator Telephone Calls Reduce At-risk Drinking Among Older Adults in Primary Care? Use of a Website to Accomplish Health Behavior Change: If You Build It, Will They Come? And Will It Work If They Do? Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study Web-Delivered CBT Reduces Heavy Drinking in OEF-OIF Veterans in Primary Care With Symptomatic Substance Use and PTSD. Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients A Randomized Controlled Trial of Brief Intervention by Interactive Voice Response Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders. Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. A randomized controlled trial testing the efficacy of a brief cannabis universal prevention program among adolescents in primary care. Cognitive-Behavioral Therapy in Depressed Primary Care Patients with Co-Occurring Problematic Alcohol Use: Effect of Telephone-Administered vs. Face-to-Face Treatment—A Secondary Analysis Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial The community health educator referral liaison (CHERL): a primary care practice role for promoting healthy behaviors. Cluster-randomized controlled trial of dissemination strategies of an online quality improvement programme for alcohol-related disorders. Disease Management for Depression and At-Risk Drinking Via Telephone in an Older Population of Veterans Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Changes in Specific Substance Involvement Scores among SBIRT recipients in an HIV primary care setting Randomized-controlled trial of a telephone and mail intervention for alcohol use disorders: three-month drinking outcomes. A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes. Computerized versus in-person brief intervention for drug misuse: a randomized clinical trial. A randomized controlled trial of a web-delivered brief alcohol intervention in Veterans Affairs primary care. The effect of telephone-based intervention (TBI) in alcohol abusers: a pilot study. Using interactive voice response to enhance brief alcohol intervention in primary care settings. Integration and sustainability of alcohol screening, brief intervention, and pharmacotherapy in primary care settings. Computer‐generated written behavioral contracts with problem drinkers in primary medical care Examining the Impact of Separate Components of a Multicomponent Intervention Designed to Reduce At-Risk Drinking Among Older Adults: The Project SHARE Study. Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement. Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs. A randomized trial of computerized vs. in-person brief intervention for illicit drug use in primary care: outcomes through 12 months. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. Telephone-based psychiatric referral-care management intervention health outcomes.
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 OBJECTIVE Brief intervention for patients with unhealthy alcohol use  is a prevention priority in the United States , but most eligible patients do not receive it . This study evaluated an electronic alcohol-counseling clinical reminder at a single Veterans Affairs general medicine clinic . METHOD The systems-level intervention evaluated in this study consisted of making the clinical reminder , which facilitated medical record documentation of brief intervention among patients who screened positive for unhealthy alcohol use , available to providers on one ( of two ) r and omly selected hallways . Secondary electronic data were extracted for all patients who visited the clinic ( October 1 , 2002 , to September 30 , 2005 ) . The proportion of patients with clinical -reminder use was evaluated among patients who screened positive for unhealthy drinking and were assigned to intervention hallway providers ( " descriptive cohort " ) . Adjusted logistic regression evaluated the association between the intervention and resolution of unhealthy drinking at follow-up among all screen-positive patients who completed a second Alcohol Use Disorders Identification Test Consumption question naire 18 months or longer after the first ( " outcomes cohort " ) . RESULTS Eligible patients ( N= 22,863 ) included 10,392 controls and 12,471 in the intervention group . Fifteen percent ( 398 of 2,640 ) of descriptive cohort patients with unhealthy drinking had clinical -reminder use , which varied by severity ( 14 % [ n = 302 of 2,165 ] with mild/moderate and 20 % [ n = 96 of 475 ] with severe unhealthy drinking , p = .001 ) . Only 39 % ( 156 of 398 ) of patients with clinical -reminder use had documented brief intervention ; advice to abstain was most common . Access to the clinical reminder was not significantly associated with resolution of unhealthy drinking in 1,358 patients in the outcomes cohort . CONCLUSIONS Availability of a clinical reminder to facilitate brief intervention did not , alone , result in substantial use of the clinical reminder . More active implementation efforts may be needed to get brief interventions onto the agenda of busy primary care providers Background Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare . Objective To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing  at-risk drinking among older adults in primary care setting s. Design Secondary analyses of data from a r and omized controlled trial . Participants Subjects r and omized to the intervention arm of the trial ( n = 310 ) . Interventions Personalized risk reports , advice from physicians , booklet about alcohol and aging , and up to three telephone calls from a health educator . All interventions were completed before the three-month follow-up . Measurements Risk outcomes ( at-risk or not at-risk ) at 3 and 12 months after enrollment . Main results In univariate analyses , compared to those who remained at risk , those who achieved not at-risk outcome at 3 months were more likely to be women , Hispanic or non-white , have lower levels of education , consume less alcohol , drink less frequently , and have lower baseline number of risks . In mixed-effects logistic regression models , completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months ( OR 5.31 ; 95 % CI 1.92–14.7 ; p = 0.001 ) , but not at 12 months ( OR 2.01 ; 95 % CI 0.71–5.67 ; p = 0.18 ) . Conclusions Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care setting s ; however , the effect was not sustained at 12 months Purpose : This article describes the development , implementation , and effectiveness of 2 interactive websites design ed to support health behavior change around healthy eating , physical activity , smoking , and use of alcohol for primary care patients . Methods : Patients from 6 primary care practice s were recruited and r and omized to a basic website ( including a health assessment with feedback of the results and educational material s about health behavior change ) or an enhanced website that included the features of the basic site plus an action planning component . Patients were prompted to return for follow-up assessment s at 3 and 6 months after enrollment . Results : Of 7706 participants , 169 ( 2.2 % ) targeted for recruitment actually used the website . Both web-based interventions seemed to assist patients with making positive changes in their behavior , especially activity level and healthful diet . There were no significant differences in the effectiveness of the basic and enhanced websites . Conclusions : Interactive behavior-change technology interventions can assist primary care patients and practice s in health behavior change activities . Difficulties with patient recruitment and the lack of added effectiveness of the enhanced website suggest that such interventions work better if integrated into the interaction between primary care clinicians and patients rather than as a st and alone intervention Objectives To evaluate the 12-month costs and quality -adjusted life years ( QALYs ) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a st and ard face-to-face brief intervention ( BI ) . Design R and omised 1:1 non-inferiority trial . Setting Practice s of 58 general practitioners ( GPs ) in Italy . Participants Of 9080 patients ( > 18 years old ) approached to take part in the trial , 4529 ( 49·9 % ) logged on to the website and 3841 ( 84.8 % ) undertook online screening for hazardous drinking . 822 ( 21.4 % ) screened positive and 763 ( 19.9 % ) were recruited to the trial . Interventions Patients were r and omised to receive either a face-to-face BI or access via a brochure from their GP to an alcohol reduction website ( facilitated access ) . Primary and secondary outcome measures The primary outcome is the cost per QALY gained of facilitated access compared with face-to-face . A secondary analysis includes total costs and benefits per 100 patients , including number of hazardous drinkers prevented at 12 months . Results The average time required for the face-to-face BI was 8 min ( 95 % CI 7.5 min to 8.6 min ) . Given the maximum time taken for facilitated access of 5 min , face-to-face is an additional 3 min : equivalent to having time for another GP appointment for every three patients referred to the website . Complete case analysis adjusting for baseline the difference in QALYs for facilitated access is 0.002 QALYs per patient ( 95 % CI −0.007 to 0.011 ) . Conclusions Facilitated access to a website to reduce hazardous drinking costs less than a face-to-face BI given by a GP with no worse outcomes . The lower cost of facilitated access , particularly in regards to investment of time , may facilitate the increase in provision of BIs for hazardous drinking . Trial registration number NCT01638338 ; Post- results Background Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary -care practice s to integrate treatment for addiction and other behavioral health conditions into their practice s. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these setting s is substantial but largely untested . This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones , called Seva , into primary -care setting s. Seva is an evidence -based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians . Methods / Design Our implementation strategy uses three models of organizational change : the Program Planning Model to promote acceptance and sustainability , the NIATx quality improvement model to create a welcoming environment for change , and Rogers ’s diffusion of innovations research , which facilitates adaptations of innovations to maximize their adoption potential . We will implement Seva and conduct an intensive , mixed- methods assessment at three diverse Federally Qualified Healthcare Centers in the United States . Our non-concurrent multiple-baseline design includes three periods — pretest ( ending in four months of implementation preparation ) , active Seva implementation , and maintenance — with implementation staggered at six-month intervals across sites . The first site will serve as a pilot clinic . We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach , Effectiveness , Adoption , Implementation , and Maintenance framework , including effects on clinicians , patients , and practice s. Our mixed- methods approach will include quantitative ( e.g. , interrupted time-series analysis of treatment attendance , with clinics as the unit of analysis ) and qualitative ( e.g. , staff interviews regarding adaptations to implementation protocol ) methods , and assessment of implementation costs . Discussion If implementation is successful , the field will have a proven technology that helps Federally Qualified Health Centers and affiliated organizations provide addiction treatment and recovery support , as well as a proven strategy for implementing the technology . Seva also has the potential to improve core elements of addiction treatment , such as referral and treatment processes . A mobile technology for addiction treatment and accompanying implementation model could provide a cost-effective means to improve the lives of patients with drug and alcohol problems . Trial registration Clinical Trials.gov ( NCT01963234 ) Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems , including posttraumatic stress disorder ( PTSD ) and hazardous or harmful substance use . Unfortunately , many veterans experience significant barriers to receiving evidence -based treatment , including poor treatment motivation , concerns about stigma , and lack of access to appropriate care . To address this need , the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy ( CBT ) , targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care . Veterans with PTSD/subthreshold PTSD and hazardous substance use were r and omized to  primary care treatment as usual ( TAU ; n = 81 ) or to  TAU plus a web-based CBT intervention called Thinking Forward ( n = 81 ) . Thinking Forward consisted of 24 sections ( approximately 20 minutes each ) , accessible over 12 weeks . Participants completed baseline and 4- , 8- , 12- , 16- , and 24-week follow-up assessment s. Three primary outcomes of PTSD , alcohol and other drug use , and quality of life were examined . Significant treatment effects were found for heavy drinking , but not for PTSD or quality of life . The effect of the intervention on heavy drinking was mediated by intervening increases in coping , social support , self-efficacy , and hope for the future . These results demonstrate the promise of a web-based , self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns Background Computer technologies hold promise for implementing alcohol screening , brief intervention , and referral to treatment ( SBIRT ) . Questions concerning the most effective and appropriate SBIRT model remain . Objective The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant ( HERA ) on risky alcohol use treatment initiation . Methods Alcohol users ( N=319 ) presenting to an emergency department ( ED ) were considered for enrollment . Those enrolled ( n=212 ) were r and omly assigned to the HERA , to complete a patient-administered assessment using a tablet computer , or a minimal-treatment control , and were followed for 3 months . Analyses compared alcohol treatment provider contact , treatment initiation , treatment completion , and alcohol use across condition using univariate comparisons , generalized estimating equations ( GEEs ) , and post hoc chi-square analyses . Results HERA participants ( n=212 ; control=115 ; intervention=97 ) did not differ between conditions on initial contact with an alcohol treatment provider , treatment initiation , treatment completion , or change in risky alcohol use behavior . Subanalyses indicated that HERA participants , who accepted a faxed referral , were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use , but were not more likely to continue engaging in treatment , or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit . Conclusions The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral , but it did not lead to reduced risky alcohol use behavior . Factors which may have limited the HERA ’s impact include lack of support for the intervention by clinical staff , the low intensity of the brief and st and -alone design of the intervention , and barriers related to patient follow-through , ( eg , a lack of transportation or childcare , fees for services , or schedule conflicts ) . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : NCT01153373 ; https:// clinical trials.gov/ct2/show/NCT01153373 ( Archived by WebCite at http://www.webcitation.org/6pHQEpuIF Aims To determine the effect of an Interactive Voice Response ( IVR ) brief intervention ( BI ) to reduce alcohol consumption  among adults seeking primary care . Methods Patients ( N = 1855 ) with unhealthy drinking were recruited from eight academic internal medicine and family medicine clinics and r and omized to IVR-BI ( n = 938 ) versus No IVR-BI control ( n = 917 ) .  Daily alcohol consumption was assessed at baseline , 3- and 6-months using the Timeline Followback . Results The IVR-BI was completed by 95 % of the 938 patients r and omized to that condition , and 62 % of them indicated a willingness to consider a change in their drinking . Participants in both conditions significantly reduced consumption over time , but changes were not different between groups . Regardless of condition , participants with alcohol use disorder ( AUD ) showed significant decreases in drinking outcomes . No significant changes were observed in patients without AUD , regardless of condition . Conclusion Although the IVR intervention was well accepted by patients , there was no evidence that IVR-BI was superior to No IVR-BI for reducing drinking in the subsequent 6 months . Because both the design and the intervention tested were novel , we can not say definitively why this particular eHealth treatment lacked efficacy . It could be useful to evaluate the effect of the pre-r and omization assessment alone on change in drinking . The high treatment engagement rate and successful implementation protocol are strengths , and can be adopted for future trials . Short summary We examined the efficacy of a novel BI for patient self-administration by automated telephone . Alcohol consumption decreased over time but there were no between-group changes in consumption . Regardless of treatment condition , participants with alcohol use disorder ( AUD ) showed significant reduction in drinking but participants without AUD showed no change BACKGROUND We estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System ( A-CHESS ) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking . METHODS We conducted secondary data analyses of the A-CHESS r and omized controlled trial . Recruitment occurred in five residential treatment programs operated by two addiction treatment organizations . Participants were 349 adults with alcohol use disorders recruited two weeks before discharge from residential treatment . We provided intervention arm participants with a smartphone , the A-CHESS application , and an 8-month service plan . Control arm participants received treatment as usual . Telephone interviews at 4 , 8 , and 12-month follow-ups assessed past-month risky drinking days , past-month abstinence , and post-discharge service utilization ( past-month outpatient addiction treatment and past-week mutual help including Alcoholics Anonymous and Narcotics Anonymous ) . Using mixed effects latent variable models , we estimated the indirect effects of A-CHESS on drinking outcomes , as mediated by post-discharge service utilization . RESULTS Approximately 50.5 % of participants reported outpatient addiction  treatment and 75.5 % reported mutual help at any follow-up interview in the year following r and omization . Assignment to the A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups , but not mutual help . This use of outpatient addiction treatment mediated the effect of  A-CHESS on risky drinking days , but not abstinence . The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11 % . CONCLUSIONS The mobile health ( mHealth ) intervention promoted the use of outpatient addiction  treatment , which appeared to contribute to its efficacy in reducing risky drinking . Future research should investigate how mHealth interventions could link patients to needed treatment services and promote the sustained use of these services OBJECTIVE A r and omized trial assessed the effectiveness of a 2-level strategy for implementing evidence -based mental health treatments for delinquent youth . METHOD A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors : ( a ) the r and om assignment of delinquent youth within each county to a multisystemic therapy ( MST ) program or usual services and ( b ) the r and om assignment of counties to the ARC ( for availability , responsiveness , and continuity ) organizational intervention for implementing effective community-based mental health services . The design created 4 treatment conditions ( MST plus ARC , MST only , ARC only , control ) . Outcome measures for 615 youth who were 69 % male , 91 % Caucasian , and aged 9 - 17 years included the Child Behavior Checklist and out-of-home placements .  RESULTS A multilevel , mixed-effects , regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a non clinical level and significantly lower than in other conditions . Total problem behavior was equivalent and at non clinical levels in all conditions by the 18-month follow-up , but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate ( 16 % ) than youth in the control condition ( 34 % ) . CONCLUSIONS Two-level strategies that combine an organizational intervention such as ARC and an evidence -based treatment such as MST are promising approaches to implementing effective community-based mental health services . More research is needed to underst and how such strategies can be used effectively in a variety of organizational context s and with other types of evidence -based treatments AIMS To examine the efficacy of a brief intervention delivered by a therapist ( TBI ) or a computer ( CBI ) in preventing  cannabis use among adolescents in urban primary care clinics . DESIGN A r and omized controlled trial comparing : CBI and TBI versus control . SETTING Urban primary care clinics in the United States . PARTICIPANTS Research staff recruited 714 adolescents ( aged 12 - 18 years ) who reported no life-time cannabis use on a screening survey for this study , which included a baseline survey , r and omization ( stratified by gender and grade ) to conditions ( control ; CBI ; TBI ) and 3- , 6- and 12-month assessment s. MEASUREMENTS Using an intent-to-treat approach , primary outcomes were cannabis use ( any , frequency ) ; secondary outcomes included frequency of other drug use , severity of alcohol use and frequency of delinquency ( among 85 % completing follow-ups ) . FINDINGS Compared with controls , CBI participants had significantly lower rates of any cannabis use over 12 months ( 24.16 % , 16.82 % , respectively , P < 0.05 ) , frequency of cannabis use at 3 and 6 months ( P < 0.05 ) and other drug use at 3 months ( P < 0.01 ) . Compared with controls , TBI participants did not differ in cannabis use or frequency , but had significantly less other drug use at 3 months ( P < 0.05 ) , alcohol use at 6 months ( P < 0.01 ) and delinquency at 3 months ( P < 0.01 ) . CONCLUSIONS Among adolescents in urban primary care in the United States , a computer brief intervention appeared to prevent and reduce cannabis use . Both computer and therapist delivered brief interventions appeared to have small effects in reducing other risk behaviors , but these dissipated over time Abstract This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy ( T-CBT ) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use . To our knowledge , T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients . Participants were r and omized in a 1:1 ratio to face-to-face CBT or T-CBT for depression . Participants receiving T-CBT ( n = 50 ) and face-to-face CBT ( n = 53 ) were compared at baseline , end of treatment ( week 18 ) , and three-month and six-month follow-ups . Face-to-face CBT and T-CBT groups did not significantly differ in age , sex , ethnicity , marital status , educational level , severity of depression , antidepressant use , and total score on the Alcohol Use Disorders Identification Test . Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all time points . T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use . When targeting patients who might have difficulties in accessing care , primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use AIMS To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months . DESIGN R and omized controlled trial . SETTING Three primary care sites in southern California . PARTICIPANTS Six hundred and thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool ( CARET ) were assigned r and omly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report , booklet on alcohol and aging , drinking diary , advice from the primary care provider and telephone counseling from a health educator at 2 , 4 and 8 weeks . MEASUREMENTS The primary outcome was the proportion of participants meeting at-risk criteria , and secondary outcomes were number of drinks in past 7 days , heavy drinking ( four or more drinks in a day ) in the past 7 days and risk score . FINDINGS At 3 months , relative to controls , fewer intervention group participants were at-risk drinkers [ odds ratio ( OR ) 0.41 ; 95 % confidence interval ( CI ) 0.22 - 0.75 ] ; they reported drinking fewer drinks in the past 7 days [ rate ratio ( RR ) 0.79 ; 95 % CI 0.70 - 0.90 ] , less heavy drinking ( OR 0.46 ; 95 % CI 0.22 - 0.99 ) and had lower risk scores ( RR 0.77 95 % CI 0.63 - 0.94 ) . At 12 months , only the difference in number of drinks remained statistically significant ( RR 0.87 ; 95 % CI 0.76 - 0.99 ) . CONCLUSIONS A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers , but does reduce amount of drinking at 12 months Objective To evaluate the effectiveness of different brief intervention strategies at reducing  hazardous or harmful drinking in primary care . The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking . Design Pragmatic cluster r and omised controlled trial . Setting Primary care practice s in the north east and south east of Engl and and in London . Participants 3562 patients aged 18 or more routinely presenting in primary care , of whom 2991 ( 84.0 % ) were eligible to enter the trial : 900 ( 30.1 % ) screened positive for hazardous or harmful drinking and 756 ( 84.0 % ) received a brief  intervention .  The sample was predominantly male ( 62 % ) and white ( 92 % ) , and 34 % were current smokers . Interventions Practice s were r and omised to three interventions , each of which built on the previous one : a patient information leaflet control group , five minutes of structured brief advice , and 20 minutes of brief lifestyle counselling . Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation . Main outcome measures The primary outcome was patients ’ self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test ( AUDIT ) at six months . A negative AUDIT result ( score < 8) indicated non-hazardous or non-harmful drinking . Secondary outcomes were a negative AUDIT result at 12 months , experience of alcohol related problems ( alcohol problems question naire ) , health utility ( EQ-5D ) , service utilisation , and patients ’ motivation to change drinking behaviour ( readiness to change ) as measured by a modified readiness ruler . Results Patient follow-up rates were 83 % at six months ( n=644 ) and 79 % at 12 months ( n=617 ) . At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions . Compared with the patient information leaflet group , the odds ratio of having a negative AUDIT result for brief advice was 0.85 ( 95 % confidence interval 0.52 to 1.39 ) and for brief lifestyle counselling was 0.78 ( 0.48 to 1.25 ) . A per protocol analysis confirmed these findings . Conclusions All patients received simple feedback on their screening outcome . Beyond this input , however , evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking . Trial registration Current Controlled Trials IS RCT N06145674 BACKGROUND Tobacco use , unhealthy diet , physical inactivity , and risky alcohol use are leading causes of preventable death . As there are many barriers that prevent primary care clinicians from effectively assisting patients with these behaviors , connecting patients with health behavior re sources may reduce these unhealthy behaviors . METHODS A new adjunct role in primary care practice , the community health educator referral liaison ( CHERL ) , was tested in 15 practice s in three Michigan communities . All practice s were advised how to access this liaison , and nine practice s were r and omly selected to receive support to develop a systematic referral process . Adult patients needing improvement in at least one of the four unhealthy behaviors were eligible for referral . The CHERL contacted referred patients by telephone ; assessed health risks ; provided health behavior-change counseling , referral to other re sources , or both ; and sent patient progress reports to referring clinicians . Data were collected from February 2006 through July 2007 . RESULTS The CHERLs received 797 referrals over 8 months , a referral rate of 0%-2 % per practice . Among referred patients , 55 % enrolled , and 61 % of those participated in multiple-session telephone counseling ; 85 % were referred to additional re sources . Among patients enrolling , improvements ( p<0.001 ) were reported at 6 months for BMI , dietary patterns , alcohol use , tobacco use , health status , and days of limited activity in the past month . CONCLUSIONS The results of this study suggest that through relationships with practice s , patients , and community re sources , these liaisons successfully facilitated patients ' behavior change . The CHERL role may fill a gap in promoting healthy behaviors in primary care practice s and merits further exploration AIMS This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany . METHODS In a cluster-r and omized controlled trial , 112 general practice s were r and omized into three groups . The first group ( n = 43 ) received access to the online system and a training programme for the general practitioners ( GPs ) . The second group ( n = 42 ) additionally received education for the whole practice team . The third group ( n = 27 ) acted as control and received only access to the online system . RESULTS Two thous and six hundred and forty-seven practitioners were asked to take part in the study , and it was possible to r and omize 112 ( 4 % ) practice s. There were no significant differences concerning the use of the system between the groups : 41.9 % of the GPs in the first group , 42.9 % in the second group and 44.4 % in the control group used the system . In terms of only the system users , 55.6 % of the GPs in the first group , 33.3 % in the second group and 8.3 % in the control group used the system six times or more ( P = 0.019 ) . Diagnostic assessment s made by the GPs in the groups differed substantially : 72.2 % of diagnoses in the first group were correct , while this figure lay at 69.7 % in the second group and 36.4 % in the control group ( P = 0.034 ) . CONCLUSIONS No effect of the additional training on the primary outcome ( acceptance ) was identified , but on two of the secondary outcomes . Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable . The study is registered at Clinical Trials.gov : NCT00314067 . This article conforms to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement ( Moher et al. , 2001 ; Campbell et al. , 2004 ) Objectives The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and /or at-risk drinking . Material s and Methods Veterans ( N = 97 ) with depression and /or at-risk drinking were identified by systematic screening and assessment . Eligible subjects received either telephone disease management ( TDM ) program or usual care based on r and om assignment of their clinician . The TDM program consisted of regular contacts with each subject by a behavioral health specialist ( BHS ) to assist in assessment , education , support , and treatment planning . Symptomatic outcomes were assessed at 4 months . Results Overall response rates favored those assigned to TDM compared with those assigned to usual care ( 39.1 % responded vs. 17.6 % , p = 0.022 ) . Response rates within the separate diagnostic groups also favored TDM , but this was only significant for depressive disorders . Conclusions Although the sample size was modest and the sample was limited to veterans , findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem . Findings also suggest that a health specialist can focus and manage patients with different diagnoses , thus exp and ing the role beyond just depression care . TDM may be a viable , low-cost , model for primary care clinicians to deliver manual guideline -adherent behavioral health care , especially in a VA clinical setting 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 Abstract Background Substance use is common among people living with HIV ( PLHIV ) and is associated with worse outcomes along the HIV care continuum . One potentially effective clinic-based approach to addressing unhealthy substance use is screening , brief intervention , and referral to treatment ( SBIRT ) . Methods We conducted a two-arm r and omized trial to examine the effects of a self-administered , computerized SBIRT intervention compared to a clinician-administered SBIRT intervention in an HIV primary clinic . Patients were surveyed before receiving the intervention and again at 1 , 3 , and 6 months . We administered the WHO Alcohol , Smoking and Substance Involvement Screening Test to determine Specific Substance Involvement Scores ( SSIS ) and to assign participants to categories of lower , moderate , or high risk to health and other problems for each substance . We collapsed moderate or severe risk responses into a single moderate – high risk category . Based on low rates of participation in the computerized arm , we conducted an “ as treated ” analysis to examine 6-month changes in mean SSIS among SBIRT intervention participants . Results For the overall sample ( n = 208 ) , baseline mean SSIS were in the moderate risk category for alcohol , tobacco , cannabis , cocaine , amphetamine , sedatives and opioids . Of those enrolled , 134 ( 64.4 % ) received the intervention , and 109 ( 52.4 % ) completed the 6-month follow up . There was a statistically significant decline in mean SSIS for all substances except tobacco and cannabis among participants who were at moderate – high risk at baseline . We also observed a statistically significant increase in mean SSIS for all substances except amphetamines and sedatives among participants who were at lower risk at baseline . Conclusions Substance use among patients in this urban , safety-net , HIV primary care clinic was near universal , and moderate risk substance use was common . Among participants who received the SBIRT intervention  , mean SSISs decreased among those at moderate – high risk at baseline , but increased among those at lower risk at baseline over the 6-month study period . Additional research should examine the clinical significance of SSIS changes for PLHIV , which SBIRT components drive changes in substance use scores , and what other interventions might support those patients at lower risk to maintain health and engagement along the HIV care continuum . Trial registration Clinical Trials.gov study BACKGROUND Alcohol screening , brief intervention , and referral to specialized treatment ( ASBIR ) reduce drinking and related harms . Unanswered questions are how to manage nondependent patients with poor response to brief interventions , how to manage dependent patients who do not obtain treatment , and how to ensure population -wide delivery of ASBIR . Telephone-administered counseling may provide answers . METHODS We conducted a 12-month r and omized controlled trial of a telephone and mail intervention for non-treatment-seeking primary care patients with alcohol use disorders . We enrolled 897 subjects after systematic screening in 18 primary care clinic waiting rooms in and around Madison and Milwaukee , Wisconsin , and subsequent telephone-administered diagnostic interviews .  Experimental subjects received up to six sessions of protocol -driven telephone counseling based on principles of motivational interviewing and stages of readiness to change . Control subjects received a pamphlet on healthy lifestyles . The paper reports on 3-month drinking outcomes for men and women with alcohol abuse and dependence . RESULTS Male experimental subjects ( N=199 ) manifested a 30.6 % decline in risky drinking days , compared with a 8.3 % decline in controls ( N=201 , p<0.001 ) . The total consumption declined by 17.3 % compared with 12.9 % by controls ( p=0.001 ) . Female experimental subjects ( N=246 ) manifested a 17.2 % decrease in risky drinking days compared with an 11.5 % decrease by controls ( N=251 ; p = NS ) and a 13.9 % decline in total consumption compared with 11.0 % by controls ( p = NS ) . Greater numbers of telephone counseling sessions were associated with greater declines in drinking . CONCLUSION Following systematic screening , a six-session telephone and mail intervention is more effective than a pamphlet in reducing drinking at 3 months for non-treatment-seeking men with alcohol abuse and dependence . An intervention effect of the enrollment procedures may have obscured further intervention effectiveness . Telephone counseling shows promise for non-treatment-seeking primary care patients with alcohol use disorders Objective : This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions  into routine care setting s. Our goal was to characterize the state of the literature and to provide direction for future implementation studies . Method : A literature search was conducted using electronic data bases and a manual search . Results : Eleven studies were identified that tested implementation strategies with a r and omized ( n = 10 ) or controlled clinical trial design ( n = 1 ) . The wide range of clinical interventions , implementation strategies , and outcomes evaluated precluded meta- analysis . However , the majority of studies ( n = 7 ; 64 % ) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome . Conclusion : There is a clear need for more rigorous research on the effectiveness of implementation strategies , and we provide several suggestions that could improve this research area OBJECTIVE : Primary care providers need effective strategies for substance use screening and brief counseling of adolescents . We examined the effects of a new computer-facilitated screening and provider brief advice ( cSBA ) system . METHODS : We used a quasi-experimental , asynchronous study design in which each site served as its own control . From 2005 to 2008 , 12- to 18-year-olds arriving for routine care at 9 medical offices in New Engl and ( n = 2096 , 58 % females ) and 10 in Prague , Czech Republic ( n = 589 , 47 % females ) were recruited . Patients completed measurements only during the initial treatment-as-usual study phase . We then conducted 1-hour provider training , and initiated the cSBA phase . Before seeing the provider , all cSBA participants completed a computerized screen , and then viewed screening results , scientific information , and true-life stories illustrating substance use harms .  Providers received screening results and “ talking points ” design ed to prompt 2 to 3 minutes of brief advice . We examined alcohol and cannabis use , initiation , and cessation rates over the past 90 days at 3-month follow-up , and over the past 12 months at 12-month follow-up . RESULTS : Compared with treatment as usual , cSBA patients reported less alcohol use at follow-up in New Engl and ( 3-month rates 15.5 % vs 22.9 % , adjusted relative risk ratio [ aRRR ] = 0.54 , 95 % confidence interval 0.38–0.77 ; 12-month rates 29.3 % vs 37.5 % , aRRR = 0.73 , 0.57–0.92 ) , and less cannabis use in Prague ( 3-month rates 5.5 % vs 9.8 % , aRRR = 0.37 , 0.17–0.77 ; 12-month rates 17.0 % vs 28.7 % , aRRR = 0.47 , 0.32–0.71 ) . CONCLUSIONS : Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients 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 AIMS This paper describes outcomes from a r and omized controlled trial examining the efficacy of brief interventions delivered by a computer ( CBI ) or therapist ( TBI ) among adolescents in urban primary care clinics . METHODS Patients ( ages 12 - 18 ) self-administered a computer survey .  Adolescents reporting past year cannabis use completed a baseline survey and were r and omized to control , CBI or TBI , with primary ( cannabis use , cannabis related consequences - CC ) and secondary outcomes [ alcohol use , other drug use ( illicit and non-medical prescription drugs ) , and driving under the influence of cannabis ( DUI ) ] assessed at 3 , 6 , and 12 months . RESULTS 1416 adolescents were surveyed ; 328 reported past year cannabis use and were r and omized . Comparisons of the CBI relative to control showed that at 3 months the group by time interaction ( G × T ) was significant for other drug use and CC , but not for cannabis use , alcohol use , or DUI ; at 6 months , the G × T interaction was significant for other drug use but not for cannabis use , alcohol use , or CC . For analyses comparing the TBI to control , at 3 months the G × T interaction was significant for DUI , but not significant for cannabis use , alcohol use , or CC ; at 6 months , the G × T interaction was not significant for any variable . No significant intervention effects were observed at 12 months . CONCLUSION Among adolescent cannabis users presenting to primary care , a CBI  decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term . Additional boosters may be necessary to enhance these reductions over time BACKGROUND AND AIMS Several studies have found that brief interventions ( BIs ) for drug misuse have superior effectiveness to no-treatment controls . However , many health centers do not provide BIs for drug use consistently due to insufficient behavioral health staff capacity . Computerized BIs for drug use are a promising approach , but their effectiveness compared with in-person BIs has not been established . This study compared the effectiveness of a computerized brief intervention ( CBI ) to an in-person brief intervention ( IBI ) delivered by a behavioral health counselor . METHODS Two-arm r and omized clinical trial , conducted in two health centers in New Mexico , United States . Participants were 360 adult primary care patients with moderate-risk drug scores on the Alcohol , Smoking , and Substance Involvement Screening Test ( ASSIST ) who were r and omly assigned on a 1 : 1 basis to a computerized brief intervention ( CBI ) or to an in-person brief intervention ( IBI ) delivered by a behavioral health counselor . Assessment s were conducted at baseline and 3-month follow-up , and included the ASSIST and drug testing on hair sample s. RESULTS The IBI and CBI conditions did not differ at 3 months on global ASSIST drug scores [ b = -1.79 ; 95 % confidence interval ( CI ) = -4.37 , 0.80 ] or drug-positive hair tests [ odds ratio ( OR ) = 0.97 ; 95 % CI = 0.47 , 2.02 ] . There was a statistically significant advantage of CBI over IBI in substance-specific ASSIST scores for marijuana ( b = -1.73 ; 95 % CI = -2.91 , -0.55 ; Cohen 's d = 0.26 ; P = 0.004 ) and cocaine ( b = -4.48 ; 95 % CI = -8.26 , -0.71 ; Cohen 's d = 0.50 ; P = 0.021 ) at 3 months . CONCLUSIONS Computerized brief intervention can be an effective alternative to in-person brief intervention for addressing moderate drug use in primary care OBJECTIVE This study sought to examine whether a web-delivered brief alcohol intervention ( BAI ) is effective for reducing alcohol misuse in U.S. military veterans presenting to primary care . METHOD Veterans ( N = 167 ) screening positive for alcohol misuse during a routine primary care visit were r and omized to receive a BAI plus treatment as usual ( TAU ) or TAU alone . An assessment of alcohol-related outcomes was conducted at baseline and 3 and 6 months after treatment . RESULTS Veterans in both study conditions showed a significant reduction in alcohol quantity and frequency and alcohol-related problems at 6-month follow-up . No differential treatment effects on outcomes were observed between the two treatment groups . CONCLUSIONS This study is the first to explore whether a web-delivered BAI using normative feedback is effective for veterans with alcohol misuse . Our findings suggest that BAIs using normative feedback may not have any additional benefit beyond TAU for older veterans with high rates of comorbid mental health concerns OBJECTIVE The present study was to examine the efficacy of Telephone-based intervention ( TBI ) with alcohol abusers . MATERIAL AND METHOD Sixty individuals suffering from alcohol abuse were r and omly assigned to either the intervention group ( n=30 ) ( in which the TBI was modified based on the combination of motivational interviewing and supportive techniques ) , or the control group ( n=30 ) ( in which the participants received mail concerning health promotion ) . Each participant in the intervention group received individual weekly therapy sessions of 20 to 30 minutes via telephone for six weeks . Simultaneously , the participants in the control group received weekly mails for six weeks . Assessment was done at weeks 0 , 6 , and 18 . The primary outcome was defined as a change in the amount of alcohol consumed and the number o fda ys spent drinking . Anxiety , depression , and self-esteem were also compared between the two groups . All were analyzed by intention-to-treat . RESULTS After 18 weeks , 54 out of the original 60 participants had complete data sets . The mean amount and frequency of alcohol consumption was significantly lower in the intervention group than in the control group ( 4.1 days + /- 2.0 vs. 2.8 days + /- 2.0 , p < 0.01 ) . At the end of week six , 37.3 % of participants in the experiment group ( compared with 11.8 % of the control ) had successfully decreased their alcohol consumption ( f = 16.49 , df = I , p < 0.001 , with an NNT = 1.69 ) . The frequency of drinking , as determined by the number of drinking days per week , was significantly lower in the experiment group from baseline than in the control group at week 6 ( 2 = 18.20 , df= 1 , p < 0.001 , with an NNT = 1.8 ) . There was no difference between week 6 and the end of week 18 regarding amount and frequency of drinking in both groups . There was no difference in depressive , anxiety and self-esteem scores between the two groups over time and these factors were found to have no effect on alcohol consumption in either group . A common problem reported in the telephone group was connection failures . CONCLUSION Telephone motivational interviews showed promise in being effective in reducing the frequency and amount of drinking for non-treatment-seeking primary care patients who abuse alcohol . Moreover , the effect of the intervention lasted for at least three months . Limitations of the present study are discussed OBJECTIVE Self-monitoring is recommended following brief alcohol intervention ( BI ) . We have previously demonstrated that self-monitoring with an automated telephone system ( interactive voice response ; IVR ) is associated with a steady reduction in alcohol consumption in the absence of BI . In this study we explore the feasibility and efficacy of IVR as a possible therapeutic enhancement for BI . METHOD We up date d all providers ( N= 112 ) in 15 primary care clinics about BI and encouraged them to do a BI with their patients whenever appropriate and to invite those patients to participate in the research project . Interested patients ( N = 338 ) were r and omized to one of four study conditions including no IVR and three groups who self-monitored for 6 months using an IVR : no feedback , feedback , and feedback plus a monetary calling incentive . RESULTS The IVR proved to be a feasible method for self-monitoring . Of those invited to use the IVR , 90 % initiated use and made 95 % of the calls while they remained engaged with the system ; more than half continued calling for the entire 6 months . Reported impact of the  IVR  and associated feedback on drinking awareness was high . Therapeutic results were mixed . Overall , the IVR groups reported higher consumption on the Timeline Followback ( TLFB ) at the 3- and 6-month follow-ups than did the no IVR group . However , because of a potential measurement confound , the TLFB may not have operated in an unbiased fashion across the four study conditions . A comparison of the feedback and no feedback IVR groups , which is independent of this confound , shows a significant therapeutic advantage of IVR with feedback . CONCLUSIONS IVR is a feasible technology for behavioral self-monitoring in primary care clinics . IVR with regular feedback may be an effective therapeutic enhancement to BI OBJECTIVE At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and /or hypertension . The purpose of this article is to report the impact of dissemination of a practice -based quality improvement approach ( Practice Partner Research Network-Translating Research into Practice [ PPRNet-TRIP ] ) on alcohol screening , brief intervention for at-risk drinking and alcohol use disorders , and medications for alcohol use disorders in primary care practice s. METHOD Nineteen primary care practice s from 15 states representing 26,005 patients with diabetes and /or hypertension participated in a group-r and omized trial ( early intervention vs. delayed intervention ) . The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for " best practice " dissemination . RESULTS At the end of Phase 1 , eligible patients in early-intervention practice s were significantly more likely than patients in delayed-intervention practice s to have been screened ( odds ratio [ OR ] = 3.30 , 95 % CI [ 1.15 , 9.50 ] ) and more likely to have been provided a brief intervention ( OR = 6.58 , 95 % CI [ 1.69 , 25.7 ] . At the end of Phase 2 , patients in delayed-intervention practice s were more likely than at the end of Phase 1 to have been screened ( OR = 5.18 , 95 % CI [ 4.65 , 5.76 ] ) and provided a brief intervention ( OR = 1.80 , 95 % CI [ 1.31 , 2.47 ] ) . Early-intervention practice s maintained their screening and brief intervention performance during Phase 2 . Medication for alcohol use disorders was prescribed infrequently . CONCLUSIONS PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and /or hypertension in primary care setting Problem drinking is common among patients in primary medical care , but often unrecognized . Brief physician interventions can be helpful , but several barriers hinder their adoption in practice , notably a lack of time . We conducted a r and omized pilot study of written behavioral contracts that patients wrote with help from a computer program .  In eight family medicine practice s , 2684 patients were approached and 2399 screened with the Alcohol Use Disorders Identification Test ( AUDIT ) . Of those , 186 screened positive , 154 were eligible , and 80 enrolled . Follow‐up interviews were completed with 69 ( 86 % ) . At 12 months , the AUDIT and Addiction Severity Index alcohol scores decreased nonsignificantly more in the intervention group than in the controls . The study demonstrated that computer‐based interventions are acceptable to patients and physicians , feasible in busy primary care practice s , and have effect sizes comparable to those of physician‐based interventions . Computer‐based interventions may be an effective and efficient tool to enhance identification of and intervention with problem drinkers in primary care BACKGROUND Health promotion interventions often include multiple components and several patient contacts . The objective of this study was to examine how participation within a multicomponent intervention ( Project SHARE ) is associated with changes in at-risk drinking among older adults . METHODS We analyzed observational data from a cluster-r and omized trial of 31 primary care physicians and their patients aged ≥60 years , at a community-based practice with 7 clinics . Recruitment occurred between 2005 and 2007 . At-risk drinkers in a particular physician 's practice were r and omly assigned as a group to  usual care ( n = 640 patients ) versus intervention ( n = 546 patients ) . The intervention included personalized reports , educational material s , drinking diaries , in-person physician advice , and telephone counseling by health educators ( HEs ) . The primary outcome was at-risk drinking at follow-up , defined by scores on the Comorbidity Alcohol Risk Evaluation Tool ( CARET ) . Predictors included whether a physician-patient alcohol risk discussion occurred , HE call occurred , drinking agreement with the HE was made , and patients self-reported keeping a drinking diary as suggested by the HE . RESULTS At 6 months , there was no association of at-risk drinking with having had a physician-patient discussion . Compared to having had no HE call , the odds of at-risk drinking at 6 months were lower if an agreement was made or patients reported keeping a diary ( odds ratio [ OR ] 0.58 , 95 % confidence interval [ CI ] 0.37 to 0.90 ) , or if an agreement was made and patients reported keeping a diary ( OR 0.52 , CI 0.28 to 0.97 ) . At 12 months , a physician-patient discussion ( OR 0.61 , CI 0.38 to 0.98 ) or an agreement and reported use of a diary ( OR 0.45 , CI 0.25 ) were associated with lower odds of at-risk drinking . CONCLUSIONS Within the Project SHARE intervention , discussing alcohol risk with a physician , making a drinking agreement , and /or self-reporting the use of a drinking diary were associated with lower odds of at-risk drinking at follow-up . Future studies targeting at-risk drinking among older adults should consider incorporating both intervention components AIMS In HIV-infected individuals , heavy drinking compromises survival . In HIV primary care , the efficacy of brief motivational interviewing ( MI ) to reduce drinking is unknown , alcohol-dependent patients may need greater intervention and re sources are limited . Using interactive voice response ( IVR ) technology , HealthCall was design ed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback . We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients . DESIGN Parallel r and om assignment to  control ( n = 88 ) ,  MI-only ( n = 82 ) or MI+HealthCall ( n = 88 ) . Counselors provided advice/education ( control ) or MI ( MI-only or MI+HealthCall ) at baseline . At 30 and 60 days ( end-of-treatment ) , counselors briefly discussed drinking with patients , using HealthCall graphs with MI+HealthCall patients . SETTING Large urban HIV primary care clinic . PARTICIPANTS Patients consuming ≥4 drinks at least once in prior 30 days . MEASUREMENTS Using time-line follow-back , primary outcome was number of drinks per drinking day , last 30 days . FINDINGS End-of-treatment number of drinks per drinking day ( NumDD ) means were 4.75 , 3.94 and 3.58 in control , MI-only and MI+HealthCall , respectively ( overall model χ(2 ) , d.f . = 9.11,2 , P = 0.01 ) . For contrasts of NumDD , P = 0.01 for MI+HealthCall versus control ; P = 0.07 for MI-only versus control ; and P = 0.24 for MI+HealthCall versus MI-only . Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients . However , for contrasts of NumDD among alcohol-dependent patients , P < 0.01 for MI+HealthCall versus control ; P = 0.09 for MI-only versus control ; and P = 0.03 for MI+HealthCall versus MI-only . By 12-month follow-up , although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others , effects were no longer significant . CONCLUSIONS For alcohol-dependent HIV patients , enhancing MI with HealthCall may offer additional benefit , without extensive additional staff involvement This project evaluated a Web-based multimedia training for primary care providers in screening , brief intervention , and referral to treatment ( SBIRT ) for unhealthy use of alcohol , tobacco , and other drugs . Physicians ( n = 37 ) , physician assistants ( n = 35 ) , and nurse practitioners ( n = 20 ) were recruited nationally by email and r and omly assigned to online access to either the multimedia training or comparable reading material s. At baseline , compared to non-physicians , physicians reported lower self-efficacy for counseling patients regarding substance use and doing so less frequently . All provider types in both conditions showed significant increases in SBIRT-related knowledge , self-efficacy , and clinical practice s. Although the multimedia training was not superior to the reading material s with regard to these outcomes , the multimedia training was more likely to be completed and rated more favorably . Findings indicate that SBIRT training does not have to be elaborate to be effective . However , multimedia training may be more appealing to the target audiences This study examined outcomes through 12 months from a r and omized trial comparing computerized brief intervention ( CBI ) vs. in-person brief intervention ( IBI ) delivered by behavioral health counselors for adult community health center patients with moderate-level drug misuse ( N=360 ) . Data were collected at baseline , 3- , 6- , and 12-month follow-up , and included the Alcohol , Smoking , and Substance Involvement Screening Test ( ASSIST ) and laboratory analysis of hair sample s. Repeated measures analyses examined differential change over time . There were no significant differences in drug-positive hair tests over time or by condition . Global ASSIST scores decreased in both conditions ( p<.001 ) , but there were no significant differences between conditions in overall change across 12 months of follow-up ( p=.13 ) . CBI produced greater overall reductions in alcohol ( p=.04 ) and cocaine ( p=.02 ) ASSIST scores than IBI , with initial differences dissipating over time . Computerized brief interventions present a viable alternative to traditional in-person brief interventions OBJECTIVES To evaluate whether providing physicians and older patients with personalized reports of drinking risks and benefits and patient education reduces alcohol-related risks and problems . DESIGN Prospect i ve comparison study . SETTING Community primary care . PARTICIPANTS Twenty-three physicians and 665 patients aged 65 and older . INTERVENTION Combined report , in which six physicians and 198 [ corrected ] patients received reports of patients ' drinking classifications  and patients also received education ; patient report , in which 245 patients received reports and education  , but their five physicians did not receive reports ; and usual care . MEASUREMENTS Assessment s at baseline and 12 months later to determine patients ' nonhazardous ( no known risks ) , hazardous ( risks for problems ) , or harmful ( presence of problems ) classifications using the  Computerized Alcohol-Related Problems Survey ( CARPS ) . The CARPS contains a scanned screening measure and scoring algorithms and automatically produces patient and physician reports and patient education . RESULTS At baseline , 21 % were harmful drinkers , and 26 % were hazardous drinkers . The patient report and combined report interventions were each associated with greater odds of lower-risk drinking at follow-up than usual care ( odds ratio=1.59 and 1.23 , respectively , P<.05 for each ) . The patient report intervention significantly reduced harmful drinking at follow-up from an expected 21 % in usual care to 16 % and increased nonhazardous drinking from 52 % expected in usual care to 58 % . Patients in the combined report intervention experienced a significantly greater average decrease in quantity and frequency . CONCLUSION Older primary care patients can effectively reduce their alcohol consumption and other drinking risks when given personalized information about their drinking and health OBJECTIVE This study examined the effectiveness of a telephone-based referral-care management ( TBR-CM ) intervention on psychiatric health outcomes . MATERIAL S AND METHODS Between September 2005 and May 2006 , primary care patients ( n = 169 ) at the Philadelphia Veterans Affairs Medical Center completed a psychiatric interview over the telephone , of which 113 gave consent and were r and omized into the TBR-CM usual care or intervention groups ( n = 40 [ 39 % ] depression , n = 40 [ 39 % ] substance abuse , and n = 33 [ 22 % ] comorbid condition : depression and substance abuse ) . Usual care consisted of participants receiving a psychiatric appointment , followed up with st and ard institutional reminders . The intervention care group received the same , with the addition of brief motivational telephone sessions . Baseline and 6-month interviews were used to obtain study data . RESULTS Results indicated that there was improvement in mental health functioning ( p < 0.0001 ) , depression ( p < 0.0001 ) , and binge ( p < 0.0332 ) outcomes over the 6-month interview ( 78 % retention ) . However , there was no change observed for physical health functioning and drinks per week outcomes . For mental health functioning , depression , and binge rates there were no r and omization group assignment effects , indicating that the intervention care group did not show better health outcomes despite showing higher levels of psychiatric appointment attendance . CONCLUSIONS Patients who are exposed to the intervention have similar health outcomes as patients in usual care . In conclusion , the TBR-CM intervention does not lead to relatively improved psychiatric health outcomes . Further research is necessary to examine the efforts needed to extend increased treatment engagement into improved health outcomes for intervention recipients
Background Primary care setting s are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions .
Despite emerging effectiveness data , few efforts have been made to summarize the collective findings from these delivery approaches .
Objective The aim of this study was to review recent literature on the use of technology to deliver , enhance , or support the implementation of alcohol-related interventions in primary care .
We focused on addressing questions related to ( 1 ) categorization or target of the intervention , ( 2 ) descriptive characteristics and context of delivery , ( 3 ) reported efficacy , and ( 4 ) factors influencing efficacy .