Ultra-brief intervention for problem drinkers: research protocol

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.This study is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Grant #R01 AA015680-01A2

What Triggers The Resolution of Alcohol Problems Without Treatment?

This study investigated natural recoveries (self-change) from alcohol problems, and overcame several methodological problems that affected the few previous studies of this phenomenon. Three groups of individuals who had resolved an alcohol problem without treatment were interviewed about their drinking history, life events that occurred during the year prior to their resolution, and factors that helped maintain their resolution. As a control for prevalence of life events, a control group of nonresolved, nontreated alcohol abusers were interviewed about events in a randomly selected year. Collaterals were interviewed for all subjects. No life event or constellation of events was differentially associated with the resolutions across the three resolved groups or differentiated the resolved and nonresolved groups. Interviews with resolved subjects were qualitatively analyzed-the majority (57%) of recoveries were characterized as involving a cognitive evaluation or appraisal of the pros and cons of drinking. Spousal support was reported by the greatest number of resolved subjects as having helped them maintain their resolution. Findings from this study may provide direction for developing new treatment strategies and for accelerating self-change among problem drinkers in the community. The study also demonstrates the importance of using a control group, without which very different conclusions might have been drawn

The Phenomenon of Self-Change: Overview and Key Issues

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