Ultra-brief intervention for problem drinkers: research protocol

John A Cunningham, Clayton Neighbors, Cameron Wild, Keith Humphreys, John A Cunningham, Clayton Neighbors, Cameron Wild, Keith Humphreys

Abstract

Background: Helping the large number of problem drinkers who will never seek treatment is a challenging issue. Public health initiatives employing educational materials or mass media campaigns have met with mixed success. However, clinical research has developed effective brief interventions to help problem drinkers. This project will employ an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as a public health intervention. The major objective of this study is to conduct a randomized controlled trial to establish the effectiveness of an ultra-brief, personalized feedback intervention for problem drinkers.

Methods/design: Problem drinkers recruited on a baseline population telephone survey conducted in a major metropolitan city in Canada will be randomized to one of three conditions - a personalized feedback pamphlet condition, a control pamphlet condition, or a no intervention control condition. In the week after the baseline survey, households in the two pamphlet conditions will be sent their respective pamphlets. Changes in drinking will be assessed post intervention at three-month and six-month follow-ups. Drinking outcomes will be compared between experimental conditions using Structural Equation Modeling. The primary hypothesis is that problem drinkers from households who receive the personalized feedback pamphlet intervention will display significantly improved drinking outcomes at three and six-month follow-ups as compared to problem drinkers from households in the no intervention control condition. Secondary hypotheses will test the impact of the intervention on help seeking, and explore the mediating or moderating role of perceived drinking norms, perceived alcohol risks and the problem drinker's social reasons for drinking.

Discussion: This trial will provide information on the effectiveness of a pamphlet-based personalized feedback intervention for problem drinkers in a community setting.

Trial registration: ClinicalTrials.gov registration #NCT00688584.

References

    1. Institute of Medicine . Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press; 1990.
    1. Cahalan D. Studying drinking problems rather than alcoholism. In: Galanter M, editor. Recent developments in alcoholism. Vol. 5. New York: Plenum; 1987. pp. 363–372.
    1. Room R, Bondy S, Ferris J. The risk of harm to oneself from drinking, Canada 1989. Addiction. 1995;90:499–513. doi: 10.1111/j.1360-0443.1995.tb02185.x.
    1. Roizen R, Cahalan D, Shanks P. "Spontaneous remission" among untreated problem drinkers. In: Kandel DB, editor. Longitudinal research on drug use: Empirical findings and methodological issues. Washington, DC: Hemisphere; 1978. pp. 197–221.
    1. Sobell LC, Sobell MB, Toneatto T. Recovery from alcohol problems without treatment. In: Heather N, Miller WR, Greeley J, editor. Self-control and the addictive behaviours. New York, NY: Maxwell MacMillan; 1992. pp. 198–242.
    1. Hasin DS. Treatment/self-help for alcohol-related problems: Relationship to social pressure and alcohol dependence. J Stud Alcohol. 1994;55:660–666.
    1. Burton TL, Williamson DL. Harmful effects of drinking and the use and perceived effectiveness of treatment. J Stud Alcohol. 1995;56:611–615.
    1. Cunningham JA, Breslin FC. Only one in three people with alcohol abuse or dependence ever seek treatment. Addict Behav. 2004;29:221–223. doi: 10.1016/S0306-4603(03)00077-7.
    1. Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction. 2005;100:281–292. doi: 10.1111/j.1360-0443.2004.00964.x.
    1. Cunningham JA, Sobell LC, Sobell MB, Agrawal S, Toneatto T. Barriers to treatment: Why alcohol and drug abusers delay or never seek treatment. Addict Behav. 1993;18:347–353. doi: 10.1016/0306-4603(93)90036-9.
    1. Roizen R. Barriers to alcoholism treatment. Berkeley, CA: Alcohol Research Group; 1977.
    1. Tuchfeld BS. Changes in patterns of alcohol use without the aid of formal treatment: An exploratory study of former problem drinkers. Research Triangle Park, NC: Research Triangle Institute; 1976.
    1. Grant BF. Barriers to alcoholism treatment: Reasons for not seeking treatment in a general population sample. J Stud Alcohol. 1997;58:365–371.
    1. Breslin FC, Sobell MB, Sobell LC, Buchan G, Cunningham JA. Toward a stepped care approach to treating problem drinkers: The predictive utility of within treatment variables and therapist prognostic ratings. Addiction. 1997;92:1479–1489. doi: 10.1111/j.1360-0443.1997.tb02869.x.
    1. Sobell MB, Sobell LC. Treatment for problem drinkers: A public health priority. In: Baer JS, Marlatt GA, McMahon RJ, editor. Addictive Behaviors Across the Life Span. Newbury Park, NJ: Sage Publications; 1993. pp. 138–157.
    1. Abrams DB, Orleans CT, Niaura RS, Goldstein MG, Prochaska JO, Velicer W. Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped care and matching model. Ann Behav Med. 1996;18:290–304. doi: 10.1007/BF02895291.
    1. Abrams DB, Clayton R. Transdisciplinary research to improve brief interventions for addictive behaviors. In: Monti PM, Colby TA, O'Leary TA, editor. Adolescents, alcohol, and substance abuse. New York: Guilford; 2001. pp. 321–341.
    1. World Health Organization . World Health Report 2002: Reducing risks, promoting health life. Geneva: World Health Organization; 2002.
    1. Babor TF, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, Grube JW, Gruenwald P, Hill P, Holder H, et al. Alcohol: No Ordinary Commodity – Research and Public Policy. Oxford and London: Oxford University Press; 2003.
    1. Stockwell T, Gruenwald P, Toumbourou JW, Loxley W, (Eds) Preventing harmful substance use: The evidence base for policy and practise. Toronto: John Wiley and Sons; 2005.
    1. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: A review. Addiction. 1993;88:315–336. doi: 10.1111/j.1360-0443.1993.tb00820.x.
    1. Miller WR. Rediscovering fire: Small interventions, large effects. Psychol Addict Behav. 2000;14:6–18. doi: 10.1037/0893-164X.14.1.6.
    1. Walters ST, Neighbors C. Feedback interventions for college alcohol misuse: what, why and for whom? Addict Behav. 2005;30:1168–1182. doi: 10.1016/j.addbeh.2004.12.005.
    1. Room R, Babor T, Rehm J. Alcohol and public health. Lancet. 2005;365:519–530.
    1. National Institute on Alcohol Abuse and Alcoholism . Helping patients who drink too much: A clinician's guide. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 2005.
    1. Denny CH, Serdula MK, Holtzman D, Nelson DE. Physician advice about smoking and drinking: are U.S. adults being informed? Am J Prev Med. 2003;24:71–74. doi: 10.1016/S0749-3797(02)00568-8.
    1. Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15:84–91. doi: 10.1046/j.1525-1497.2000.03379.x.
    1. Cunningham JA, Humpheys K, Kypri K, van Mierlo T. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. J Med Internet Res. 2006;8:e5. doi: 10.2196/jmir.8.2.e5.
    1. Cunningham JA, Selby PL, Kypri K, Humphreys KN. Access to the Internet among drinkers, smokers and illicit drug users: Is it a barrier to the provision of interventions on the World Wide Web? Med Inform Internet Med. 2006;31:53–58. doi: 10.1080/14639230600562816.
    1. Horrigan J, Raine L. When facing a tough decision, 60 million Americans now seek the Internet's help – the Internet's growing role in life's major moments. Pew Internet & American Life Project. 2006.
    1. Fox S. Health Information Online: Eight in ten Internet users have looked for health information online. Pew Internet and American Life Project. 2005.
    1. Agostinelli G, Brown JM, Miller WR. Effects of normative feedback on consumption among heavy drinking college students. J Drug Educ. 1995;25:31–41.
    1. Sobell LC, Cunningham JA, Sobell MB, Agrawal S, Gavin DR, Leo GI, Singh KN. Fostering self-change among problem drinkers: A proactive community intervention. Addict Behav. 1996;21:817–833. doi: 10.1016/0306-4603(96)00039-1.
    1. Agostinelli G, Miller WR. Drinking and thinking: How does personal drinking affect judgments of prevalence and risk. J Stud Alcohol. 1994;55:327–337.
    1. Neighbors C, Lewis MA, Bergstrom RL, Larimer ME. Being controlled by normative influences: self-determination as a moderator of a normative feedback alcohol intervention. Health Psychol. 2006;25:571–579. doi: 10.1037/0278-6133.25.5.571.
    1. Lewis MA, Neighbors C. Optimizing personalized normative feedback: the use of gender-specific referents. J Stud Alcohol Drugs. 2007;68:228–237.
    1. Larimer ME, Lee CM, Kilmer JR, Fabiano PM, Stark CB, Geisner IM, Mallett KA, Lostutter TW, Cronce JM, Feeney M, et al. Personalized mailed feedback for college drinking prevention: a randomized clinical trial. J Consult Clin Psychol. 2007;75:285–293. doi: 10.1037/0022-006X.75.2.285.
    1. Wild TC, Cunningham JA, Roberts AB. Controlled study of brief personalized assessment-feedback for drinkers interested in self-help. Addiction. 2007;102:241–250. doi: 10.1111/j.1360-0443.2006.01682.x.
    1. Cunningham JA, Wild TC, Bondy SJ, Lin E. Impact of normative feedback on problem drinkers: A small-area population study. J Stud Alcohol. 2001;62:228–233.
    1. Miller WR, Sovereign RG, Krege B. Motivational interviewing with problem drinkers: II. The Drinker's Check-up as a preventive intervention. Behavioural Psychotherapy. 1988;16:251–268.
    1. Borsari B, Carey KB. Effects of a brief motivational intervention with college student drinkers. J Consult Clin Psychol. 2000;68:728–733. doi: 10.1037/0022-006X.68.4.728.
    1. Murphy JG, Duchnick JJ, Vuchinich RE, Davison JW, Karg RS, Olson AM, Smith AF, Coffey TT. Relative efficacy of a brief motivational intervention for college student drinkers. Psychol Addict Behav. 2001;15:373–379. doi: 10.1037/0893-164X.15.4.373.
    1. Baer JS, Kivlahan DR, Blume AW, McKnight P, Marlatt GA. Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Am J Public Health. 2001;91:1310–1316.
    1. Neighbors C, Larimer ME, Lewis MA. Targeting misperceptions of descriptive drinking norms: efficacy of a computer-delivered personalized normative feedback intervention. J Consult Clin Psychol. 2004;72:434–447. doi: 10.1037/0022-006X.72.3.434.
    1. Collins SE, Carey KB, Sliwinski MJ. Mailed personalized normative feedback as a brief intervention for at-risk college drinkers. J Stud Alcohol. 2002;63:559–567.
    1. Lewis MA, Neighbors C. Social norms approaches using descriptive drinking norms education: a review of the research on personalized normative feedback. J Am Coll Health. 2006;54:213–218. doi: 10.3200/JACH.54.4.213-218.
    1. Walters ST, Bennet ME, Miller JH. Reducing alcohol use in college students: A controlled trial of two brief interventions. J Drug Educ. 2000;30:361–372. doi: 10.2190/JHML-0JPD-YE7L-14CT.
    1. Geisner IM, Neighbors C, Larimer ME. A randomized clinical trial of a brief, mailed intervention for symptoms of depression. J Consult Clin Psychol. 2006;74:393–399. doi: 10.1037/0022-006X.74.2.393.
    1. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav. 2007;32:2469–2494. doi: 10.1016/j.addbeh.2007.05.004.
    1. Kanfer FH. Implications of a self-regulation model of therapy for treatment of addictive behaviors. In: Miller WR, Heather N, editor. Treating addictive behaviors: Processes of change. New York: Plenum; 1986.
    1. Agostinelli G, Floyd TE, Grube JW, Woodall G, Miller JH. Alcohol problem recognition as a function of own and others' perceived drinking. Addict Behav. 2004;29:143–157. doi: 10.1016/S0306-4603(03)00078-9.
    1. Neal DJ, Carey KB. Developing discrepancy within self-regulation theory: use of personalized normative feedback and personal strivings with heavy-drinking college students. Addict Behav. 2004;29:281–297. doi: 10.1016/j.addbeh.2003.08.004.
    1. Borsari B, Carey KB. Peer influences on college drinking: a review of the research. J Subst Abuse. 2001;13:391–424. doi: 10.1016/S0899-3289(01)00098-0.
    1. Neighbors C, Dillard AJ, Lewis MA, Bergstrom RL, Neil TA. Normative misperceptions and temporal precedence of perceived norms and drinking. J Stud Alcohol. 2006;67:290–299.
    1. Becker MH, Rosenstock IM. Comparing social learning theory and the health belief model. In: Ward WB, editor. Advances in health education and promotion. Vol. 2. Greenwich, CT: JAI Press; 1987. pp. 245–249.
    1. Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In: Cacioppo J, Petty R, editor. Social Psychophysiology. New York: Guilford; 1983. pp. 153–176.
    1. Ajzen I, Fishbein M. Understanding attitudes and predicting behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.
    1. Ronis DL. Conditional health threats: Health beliefs, decisions, and behaviors among adults. Health Psychol. 1992;11:127–134. doi: 10.1037/0278-6133.11.2.127.
    1. Weinstein ND. Testing four competing hypotheses of health-protective behavior. Health Psychol. 1993;12:235–245. doi: 10.1037/0278-6133.12.3.235.
    1. Wild TC, Cunningham JA. Psychosocial determinants of perceived vulnerability to harm among adult drinkers. J Stud Alcohol. 2001;62:105–113.
    1. Leigh BC. In search of the seven dwarves: Issues of measurement and meaning in alcohol expectancy research. Psychol Bull. 1989;105:361–373. doi: 10.1037/0033-2909.105.3.361.
    1. Stacy AW, Widaman KF, Marlatt GA. Expectancy models of alcohol use. J Pers Soc Psychol. 1990;58:918–928. doi: 10.1037/0022-3514.58.5.918.
    1. Cooper ML. Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychol Assess. 1994;6:117–128. doi: 10.1037/1040-3590.6.2.117.
    1. Babor TF, De La Fuente MF, Saunders JB, Grant M. AUDIT – The alcohol use disorders identification test: Guidelines for use in primary health care. Geneva, Switzerland: World Health Organization; 1989.
    1. Saunders JB, Conigrave KM. Early identification of alcohol problems. Cmaj. 1990;143:1060–1069.
    1. Brown JM, Miller WR. Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychol Addict Behav. 1993;7:211–218. doi: 10.1037/0893-164X.7.4.211.
    1. Adlaf EM, Ialomiteanu A, Paglia A. CAMH Monitor 1999: Technical Guide. Toronto: Centre for Addiction and Mental Health; 1999.
    1. Statistics Canada . Microdata User's Guide: Canada's Alcohol and Other Drugs Survey. Ottawa, Canada: Statistics Canada, Special Surveys Division; 1994.
    1. Baer JS, Stacy A, Larimer M. Biases in the perception of drinking norms among college students. J Stud Alcohol. 1991;52:580–586.
    1. Wild TC, Cunningham JA. Alcohol-related risk perceptions: A multimethod study. Kettil Bruun Society for Social and Epidemiological Research on Alcohol: June, 2008; Victoria, Canada. 2008.
    1. Fromme K, Stroot E, Kaplan D. Comprehensive effects of alcohol: Development and psychometric assessment of a new expectancy questionnaire. Psychol Assess. 1993;5:19–26. doi: 10.1037/1040-3590.5.1.19.
    1. Grant BF, Peterson A, Dawson DS, Chou SP. Source and accuracy statement for the National Longitudinal Alcohol Epidemiologic Survey. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1994.
    1. Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. 2. Hillsdale, NJ: Erlbaum; 1983.
    1. Borenstein M, Rothstein H, Cohen J. SamplePower. Chicago: SPSS Inc; 1997.
    1. Kline RB. Principles and Practice of Structural Equation Modeling. New York: The Guilford Press; 1998.
    1. Cunningham JA, Koski-Jännes A, Wild TC, Cordingley J. Treating alcohol problems with self-help materials: A population study. J Stud Alcohol. 2002;63:649–654.
    1. Wild TC, Cunningham JA, Adlaf E. Nonresponse in a follow-up to a representative telephone survey of adult drinkers. J Stud Alcohol. 2001;62:257–261.
    1. Russell DW, Kahn JH, Spoth R, Altmaier EM. Analyzing data from experimental studies: A latent variable structural equation modeling approach. J Couns Psychol. 1998;45:18–29. doi: 10.1037/0022-0167.45.1.18.
    1. Rosenthal R, Rosnow RL. Essentials of behavioral research: Methods and data analysis. 2. New York: McGraw Hill; 1991.
    1. Cohen J. A power primer. 1992. pp. 155–159.

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