BACKGROUND/RATIONALE:
Alcohol screening and brief alcohol interventions (SBI) are effective in reducing drinking and are ranked the 3rd highest prevention priority for US adults. However, there are many barriers to providing SBI to all primary care patients, and recent research suggests that efficacious SBI can be offered via the web.

OBJECTIVE(S):
The purpose of this research was to adapt an efficacious, confidential, Australian web-based alcohol screening and brief intervention program (eSBI) for US Veteran outpatients, revise it based on expert review, and pre-test the adapted eSBI program with Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veteran outpatients who frequently drink alcohol. The specific aims were to: (1) estimate US and VA drinking norms to use in eSBI feedback to participants, (2) adapt an efficacious Australian eSBI program for use by VA outpatients, and (3) identify barriers and facilitators to acceptance of an eSBI program by OEF/OIF Veterans.

METHODS:
For Aim 1, national US and VA population-based data were analyzed to develop criterion and normative feedback for the eSBI. For criterion feedback, data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC) were used to identify ranges of alcohol screening scores (AUDIT-C risk zones) indicative of low risk, risky, high risk, and very high risk drinking derived from stratum-specific likelihood ratio methods. For normative feedback, age- and sex-stratified estimates of mean drinking measures for the US population (NESARC) and VA outpatients (Survey of the Healthcare Experiences of Patients) were estimated. For Aim 2, the Australian eSBI program was adapted for US Veteran patients incorporating results from Aim 1. Experts regarding OEF/OIF Veterans and/or alcohol misuse provided feedback on the website via semi-structured interviews, and the website was further adapted and then beta-tested to test all algorithms prior to patient interviews. For Aim 3, the adapted eSBI program was pretested with 9 OEF/OIF patients visiting a Deployment Health Clinic followed by 1-on-1 semi-structured interviews which were analyzed using template analysis to identify emerging themes regarding barriers and facilitators to use and acceptance of the eSBI.

FINDINGS/RESULTS:
The eSBI program was adapted for use by VA outpatients using US and VA estimated drinking norms. Because of problems with the face validity of criterion feedback using AUDIT-C risk zones, eSBI feedback was based on AUDIT-C risk zones as well as patient report of drinking above daily and weekly drinking limits. The eSBI was further adapted after 16 expert interviews and pre-tested with one female and 8 male OEF/OIF Veterans. Analysis of patient interviews identified barriers and facilitators related to the content, design and technical features of both the assessment and feedback sections of the website. In addition, most patients felt that the website provided useful information, some volunteered it would lead them to try to change their drinking, and most felt it should be used as an anonymous resource.

IMPACT:
Because the eSBl program is anonymous, it has the potential to offer alcohol screening and brief alcohol intervention to Veterans or active military who may not accurately report their drinking otherwise. Results of this research will be used to develop a grant to further develop the eSBI based on results of the patient interviews, to test approaches to engaging recently returned Veterans in use of the web-site, and to test its efficacy.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Lapham GT, Hawkins EJ, Chavez LJ, Achtmeyer CE, Williams EC, Thomas RM, Ludman EJ, Kypri K, Hunt SC, Bradley KA. Feedback from recently returned veterans on an anonymous web-based brief alcohol intervention. Addiction science & clinical practice. 2012 Aug 28; 7(1):17. [view]

Conference Presentations

1. Lapham GT, Hawkins EJ, Johnson M, Williams EC, Thomas RM, Achtmeyer C, Kivlahan DR, Hunt S, Kypri K, Bradley KA. Returning Veteran reflections on drinking: Lessons learned about adapting a web-based alcohol screening and brief intervention. Poster session presented at: Addiction Health Services Research Conference; 2010 Oct 26; Lexington, KY. [view]
2. DeBenedetti AF, Maynard CC, Kivlahan DR, Bradley KA. Using the AUDIT-C to Screen for Risk of Alcohol Dependence: A stratum-specific likelihood rations analysis. Presented at: Addiction Health Services Research Conference; 2008 Oct 15; Boston, MA. [view]

DRA: Substance Use Disorders
DRE: none
Keywords: Alcohol, Informatics, Screening
MeSH Terms: none