Alcohol Dependency Clinical Trial
Official title:
Feasibility and Pilot Testing of SBI to Reduce Alcohol Misuse Among Active Duty Members in a Military ER Setting
An alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) approach will be
adapted for use in a large military hospital setting, and then pilot tested in a military
emergency department (ED) to assess its potential for effectiveness and for further testing
in a large-scale trial. SBIRT is an "opportunistic" approach whereby all adult patients in
the ED are screened by Health Educators for their alcohol use, and then, taking advantage of
a "teachable moment," are delivered a brief, motivational intervention matched to their level
of risk.
The feasibility/formative research activities in the first phase (Phase I) of the study are
not summative research, and therefore, do not lend themselves to testable hypotheses.
Hypotheses with regard to the pilot randomized trial in Phase II are as follows:
1. Participants in the SBIRT intervention will show relatively greater reductions over a
six month period (or less increase) than the brochure/usual care control group in the
prevalence of past-month heavy drinking, frequency of heavy drinking, past week number
of drinks, and the AUDIT-based drinkers' index.
2. Alcohol use-related motivation/readiness to change and controlled drinking self-efficacy
will show greater change in the SBIRT intervention group relative to the brochure/usual
care control group.
In addition, exploratory analyses will examine the following:
3. Sociodemographic/military variables (e.g., age, race/ethnicity, gender, branch of
service, officer/enlisted status, PTS) and social-psychological factors (e.g., baseline
readiness to change, self efficacy) will mediate or moderate changes in alcohol misuse.
Deployment frequency and duration and combat exposure are implicated as risk factors for
alcohol misuse and PTSD among military personnel. During the past 10 years, Department of
Defense healthcare systems have observed steep increases in mental health and substance use
services among personnel demobilizing from these conflicts. Although the alcohol Screening,
Brief Intervention and Referral to Treatment (SBIRT) approach has shown promise as a
low-cost, effective strategy for reducing alcohol use in civilians many of whom are risky
drinkers but not yet dependent, it has not been adapted or tested in military health care
settings for active duty personnel. This 2.5 year civilian-military collaborative study is
highly responsive to exploring solutions to this emerging issue. The specific objectives for
the overall project are given below.
Objective 1: Feasibility and Acceptability
- Determine how the SBIRT intervention can be integrated into standard military emergency
department (ED) operations by conducting record review and observation of the ED.
- Develop and test the acceptability and usability (for both ED staff and potential
participants) of the SBIRT approach by conducting focus groups with active duty
personnel and garnering input from ED staff.
- Develop an implementation/operations protocol for delivering SBIRT in the ED.
Objective 2: Adaptation
- Apply a translational research approach to adapt SBIRT implementation in military
settings and populations by using information from focus groups and input from ED staff.
- Adapt the content of the SBIRT intervention to be relevant for military personnel,
including language and images for counseling and materials using information from focus
groups and input from ED staff.
Objective 3: Pilot Trial
- Using a two group repeated measures design, assess the impact of SBIRT using
standardized alcohol use measures to assess its potential for effectiveness with active
duty military personnel in an ED setting. Specific methodologies include:
- Apply a randomization method in the ED to assign active duty participants to
experimental condition.
- Implement the SBIRT intervention in the ED for those assigned to the intervention arm.
- Implement a process for obtaining follow-up data with this mobile population.
- Assess presumed mediators (e.g., readiness/motivation to change and self-efficacy) and
moderators (e.g., PTSD status, gender) of alcohol misuse change.
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