Brief Alcohol Treatment for Women Veterans in Primary Care

• Brief, Integrated Intervention for Women Veterans with Unhealthy Alcohol Use in Primary Care (Behavioral): The intervention consists of 4-6 30-minute behavioral health appointments with a behavioral health provider in an integrated primary care setting. It includes 4 core alcohol-focused appointments focused on providing information and skills to manage unhealthy alcohol use that have been adapted from existing evidence-based treatments in integrated primary care and specialty care. Participants may elect to attend up to 2 additional optional appointments focused on supplemental strategies to manage alcohol use or to address co-occurring mental and behavioral health concerns, including mood, trauma, sleep, and pain.
• Primary care usual care (Behavioral): Primary care usual care consists of universal annual alcohol screening; those who are identified as at-risk receive a brief advice intervention from their primary care provider and may be offered an integrated primary care referral. The brief advice intervention is standardized and triggered automatically by a positive screen. Integrated primary care consists of brief assessment and intervention with licensed, independent behavioral health providers. Patients may decline integrated primary care referrals, complete several appointments, and/or be referred to specialty treatment

Primary outcomes

• Change in self-reported quality of life from baseline to 6-months post-treatment [From baseline to 6 months post-treatment]: Quality of life will be assessed by the abbreviated World Health Organization Quality of Life Assessment (WHOQOL-BREF), a 26-item self-report measure of QoL in the past 2 weeks in 4 areas (social, physical, psychological, and environment) on a 1-5 scale.
• Change in self-reported alcohol-related problems from baseline to 6 months post-treatment [From baseline to 6 months post-treatment]: Alcohol problems will be assessed by the Short Inventory of Problems-Revised (SIP-R)147, a 17-item self-report measure of frequency of alcohol problems on a 0-3 scale.
• Change in self-reported alcohol-related functional impairment from baseline to 6 months post-treatment [Baseline to 6 months post-treatment]: Alcohol-specific functional impairment will be assessed by the Addiction Severity Index - Lite, a semi-structured interview developed among Veterans in substance use treatment that assesses alcohol and drug use and problems and 5 areas of functioning: medical, legal, psychiatric, employment, and family/social
• Feasibility - average session length [For the duration of the intervention period, 8-12 weeks post-baseline.]: Length of sessions in the experimental condition will be measured to test if the average is within guidelines for integrated primary care treatment (30 minutes maximum).
• Intervention fidelity [For the duration of the intervention period, 8-12 weeks post-baseline.]: An independent rater will listen to session tapes and record if each essential element was delivered on a checklist.
• Self-reported patient acceptability of the experimental intervention [After completing the behavioral health treatment, 8-12 weeks post-baseline.]: Patient acceptability will be assessed with the Client Satisfaction Questionnaire (CSQ), an 8-item self-report measure. Acceptability ratings of at least "moderate" on the majority (5/8) of items on the CSQ will be considered acceptable.

Secondary outcomes

• Self-reported change in alcohol consumption from baseline to 6 months post-treatment [Baseline to 6 months post-treatment]: Alcohol use will be assessed with the Timeline Followback (TLFB), a calendar-based measure that records standard drinks consumed each day in the past month to yield percent of drinking days, average drinks per drinking day, percent of heavy drinking (i.e., ≥4 drinks/occasion) days, and a variable indicating if alcohol use is above NIAAA-recommendations.

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Veteran status
* past-year Syracuse VAMC or community-based outpatient clinic (CBOC) primary care appointment
* identify as woman OR use women's PC services
* unhealthy alcohol use (AUDIT ≥ 7)

Exclusion Criteria:

* current substance use treatment outside PC
* current psychosis, mania, or dementia (>10 on the BOMC)
* need for a higher level of alcohol or substance use care (detoxification, residential treatment) as indicated by a) patient preference b) withdrawal symptoms that indicate a need to monitor (≥23 on the AWSC) or high risk substance use (≥27 on the ASSIST)
* imminent risk of suicide.

• Katherine A Buckheit, PhD, Principal investigator, Veterans Health Research Institute of Central New York, Inc.

NIH grants: K01AA031524