Alcohol Screening, Brief Intervention, and Referral to Treatment in a Military Treatment Facility

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.