2019 HSR&D/QUERI National Conference

4015 — A Multi-Site Randomized Controlled Trial of a Computer-Delivered Brief Alcohol Intervention in Veterans Affairs (VA) Liver Clinics

Lead/Presenter: Keith Humphreys,  COIN - Palo Alto
All Authors: Humphreys K (Palo Alto VA Health Care System), Combs A (Palo Alto VA Health Care System), Joshi G (Palo Alto VA Health Care System) Han X (Central Arkansas VA Health Care System) Cucciare M (Central Arkansas VA Health Care System)

Hazardous drinking occurs at high rates among persons with liver disease and contributes to significant morbidity/mortality. Identifying interventions that reduce alcohol use in this population is critical. Brief alcohol interventions are effective at reducing alcohol use but are difficult to implement in medical settings because of constraints on provider time for training and delivery. Computer-delivered BAIs (cBAIs) have proven effective at reducing alcohol use in some studies but have never been evaluated with Veterans who have liver disease.

We conducted a randomized controlled trial comparing a cBAI to standard care in Veterans (N = 138) with liver disease at two VA medical facilities. Primary hypotheses were that patients assigned to the cBAI condition, relative to standard care, would report fewer drinking days and days engaging in unhealthy drinking. Secondary outcomes were reduction in drinks per drinking day and psychological distress, and, improvements in health.

Relative to controls, participants in the cBAI condition reported fewer past month days (4.79 vs. 9.03) with any alcohol use at 6-month follow-up. Veterans in the cBAI condition, relative to controls, also reported fewer days in the past month (1.90 vs. 4.11) engaging in unhealthy drinking at 3-month follow-up. These results were significant at the p < .05 level. No intervention effects were observed for the secondary outcomes.

Our cBAIs was effective at reducing alcohol use in our sample. Although effect sizes for the primary outcomes were in the small-moderate range, cBAIs are relatively easy to "scale up" and with low cost. The potential health benefits of using a cBAI for Veterans with liver disease coupled with their relative feasibility to implement in VA liver clinics could justify their expense, which our team plans to assess.

We recently shared these findings with our operation partners (VHA Office of Specialty Care Services and VHA Office of Clinical Public Health) who are interested in scaling up this intervention system-wide.