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

• Sponsor: San Diego State University (Other)
• Overall Status: Completed
• CT.gov ID: NCT02228967
• Collaborator: United States Naval Medical Center, San Diego (U.S. Fed)
• Enrollment: 791
• Location: 1
• Arms: 2
• Actual Duration (Months): 36
• Patients Per Site Per Month: 22

Study Details

Study Description

Brief Summary

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:

1. 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.

Condition or Disease	Intervention/Treatment	Phase
Alcohol Dependency	Behavioral: SBIRT	N/A

Detailed Description

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.

Study Design

• Study Type: Interventional
• Actual Enrollment: 791 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Prevention
• Official Title: Feasibility and Pilot Testing of SBI to Reduce Alcohol Misuse Among Active Duty Members in a Military ER Setting
• Actual Study Start Date: Aug 1, 2015
• Actual Primary Completion Date: Oct 1, 2016
• Actual Study Completion Date: Aug 1, 2018

Arms and Interventions

Arm	Intervention/Treatment
No Intervention: Usual Care Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.
Active Comparator: SBIRT Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support.	Behavioral: SBIRT; SBIRT is an "opportunistic" approach whereby patients 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.; Other Names: Screening Brief Intervention Brief Treatment Referral to Treatment Motivational Interviewing

Outcome Measures

Primary Outcome Measures

1. Alcohol Use Disorders Identification Test (AUDIT) Total [Baseline, Follow-up (Up to 7 months)]

   The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.

Secondary Outcome Measures

1. AUDIT-C or Drinkers Index [Baseline, Follow-up (Up to 7 months)]

   The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.

2. Controlled Drinking Self-Efficacy Scale (CDSES) [Baseline, Follow-up (Up to 7 months)]

   The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.

3. Readiness to Change Scale [Baseline, Follow-up (Up to 7 months)]

   A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• 18 or Older

• Active Duty

• Off Duty

• Telephone Number for Follow-up

• Healthy Enough to Participate

• Positive Screen for Risky Drinking

Exclusion Criteria:

• Under 18

• Non-Military

• On Duty

• Low Level Drinking

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Naval Medical Center San Diego	San Diego	California	United States	92134

Sponsors and Collaborators

• San Diego State University
• United States Naval Medical Center, San Diego

Investigators

• Principal Investigator: Mark Reed, PhD, SDSURF - Center for Alcohol & Drug Studies & Services
• Principal Investigator: Gerard DeMers, DO, United States Naval Medical Center, San Diego

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Mark Reed, PhD, Director, San Diego State University
• ClinicalTrials.gov Identifier: NCT02228967
• Other Study ID Numbers: W81XWH-14-2-0014; 12019006
• First Posted: Aug 29, 2014
• Last Update Posted: Sep 9, 2020
• Last Verified: Aug 1, 2020

• Keywords provided by Mark Reed, PhD, Director, San Diego State University: Alcohol Use; SBIRT; Military; Health Behavior; Emergency Room; Health Promotion; Formative Research; Randomized Trial
• Additional relevant MeSH terms: Alcoholism

Study Results

Participant Flow

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Period Title: Overall Study
STARTED	403	388
COMPLETED	244	228
NOT COMPLETED	159	160

Baseline Characteristics

Arm/Group Title	Usual Care	SBIRT	Total
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.	Total of all reporting groups
Overall Participants	403	388	791
Age (Years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [Years]	26.4 (6)	26.3 (5.7)	26.3 (5.9)
Sex: Female, Male (Count of Participants)
Female	103 25.6%	108 27.8%	211 26.7%
Male	300 74.4%	280 72.2%	580 73.3%
Race/Ethnicity, Customized (Count of Participants)
Hispanic/Latino	85 21.1%	64 16.5%	149 18.8%
African-American	74 18.4%	71 18.3%	145 18.3%
White	215 53.3%	214 55.2%	429 54.2%
Asian/Hawaiian/Pacific Islander	10 2.5%	15 3.9%	25 3.2%
American Indian/Alaskan Native	4 1%	2 0.5%	6 0.8%
Other	15 3.7%	22 5.7%	37 4.7%
Region of Enrollment (participants) [Number]
United States	403 100%	388 100%	791 100%
Self-Reported PTSD Diagnosis (Count of Participants)
Yes	16 4%	21 5.4%	37 4.7%
No	387 96%	367 94.6%	754 95.3%
Marital Status (Count of Participants)
Single	203 50.4%	185 47.7%	388 49.1%
Married/Co-habitating	161 40%	173 44.6%	334 42.2%
Divorced/Separated/Widowed	39 9.7%	30 7.7%	69 8.7%
Education Level (Count of Participants)
High School Graduate/GED	169 41.9%	149 38.4%	318 40.2%
Some College	123 30.5%	128 33%	251 31.7%
2-Year College Degree (AA)	52 12.9%	43 11.1%	95 12%
4-Year Degree (BA/BS)	46 11.4%	50 12.9%	96 12.1%
Graduate Degree	13 3.2%	18 4.6%	31 3.9%
Service Branch (Count of Participants)
Navy	336 83.4%	320 82.5%	656 82.9%
Marine Corps	57 14.1%	54 13.9%	111 14%
Army/Air Force/Coast Guard	9 2.2%	14 3.6%	23 2.9%
Missing	1 0.2%	0 0%	1 0.1%
Number of Combat Deployments (past 5-years) (Count of Participants)
None	211 52.4%	214 55.2%	425 53.7%
1-2	173 42.9%	148 38.1%	321 40.6%
3 or more	19 4.7%	25 6.4%	44 5.6%
Missing	0 0%	1 0.3%	1 0.1%
Alcohol Use Disorders Identification Test (AUDIT) Score (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	7.7 (4.2)	8.0 (5.1)	7.7 (4.6)
Readiness to Change Drinking (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	1.95 (1.17)	1.96 (1.15)	1.96 (1.16)
Controlled Drinking Self-Efficacy Scale (CDSES) (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	76.9 (15.3)	78 (15)	77.9 (15.2)

Outcome Measures

1. Primary Outcome

Title	Alcohol Use Disorders Identification Test (AUDIT) Total
Description	The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Excludes low-risk participants defined as AUDIT <=7 at baseline. A total of 17 participants were excluded from the analysis.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	240	215
Mean (Standard Error) [units on a scale]	5.91 (0.26)	5.5 (0.27)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.274
	Comments	A priori threshold for statistical significance was 0.05
	Method	Repeated Measures--General Linear Model
	Comments

2. Secondary Outcome

Title	AUDIT-C or Drinkers Index
Description	The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Excludes low-risk participants defined as AUDIT <=7 at baseline. A total of 17 participants were excluded from the analysis.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	240	215
Mean (Standard Error) [units on a scale]	4.41 (0.14)	4.05 (0.15)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.083
	Comments
	Method	Repeated Measures--General Linear Model
	Comments

3. Secondary Outcome

Title	Controlled Drinking Self-Efficacy Scale (CDSES)
Description	The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Excludes low-risk participants defined as AUDIT <=7 at baseline. A total of 17 participants were excluded from the analysis.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	240	215
Mean (Standard Error) [units on a scale]	78.42 (1.01)	81.67 (1.07)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.028
	Comments
	Method	Repeated Measures--General Linear Model
	Comments

4. Secondary Outcome

Title	Readiness to Change Scale
Description	A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Excludes low-risk participants defined as AUDIT <=7 at baseline. A total of 17 participants were excluded from the analysis as they were low-risk at baseline. Additionally, missing data on the Readiness to Change measure resulted in a total of 444 participants for this analysis. Six were missing from usual care and five were missing from SBIRT.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	234	210
Mean (Standard Error) [units on a scale]	2.23 (0.08)	2.19 (0.09)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.708
	Comments
	Method	Repeated Measures--General Linear Model
	Comments

5. Post-Hoc Outcome

Title	Alcohol Use Disorders Identification Test (AUDIT) Total (Analysis II)
Description	The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

For this study, at-risk drinking was defined as: AUDIT total >=8, under 21 drinker, any past year heavy episodic drinking (HED). Excludes at-risk participants defined as any amount of HED (AUDIT Question 3 > 0) or under 21 drinker at baseline. A total of 281 participants were excluded from this analysis (N = 190)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	100	90
Mean (Standard Error) [units on a scale]	8.2 (0.47)	7.31 (0.34)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tets (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.197
	Comments	A priori threshold for statistical significance was 0.05.
	Method	Repeated Measures--General Linear Model
	Comments

6. Post-Hoc Outcome

Title	AUDIT-C or Drinkers Index (Analysis II)
Description	The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

For this study, at-risk drinking was defined as: AUDIT total >=8, under 21 drinker, any past year heavy episodic drinking (HED). Excludes at-risk participants defined as any amount of HED (AUDIT Question 3 > 0) or under 21 drinker at baseline. A total of 281 participants were excluded from this analysis (N = 190)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	100	90
Mean (Standard Error) [units on a scale]	5.42 (0.24)	4.63 (0.25)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.023
	Comments	A priori threshold for statistical significance was 0.05.
	Method	Repeated Measures--General Linear Model
	Comments

7. Post-Hoc Outcome

Title	Controlled Drinking Self-Efficacy Scale (CDSES) (Analysis II)
Description	The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

For this study, at-risk drinking was defined as: AUDIT total >=8, under 21 drinker, any past year heavy episodic drinking (HED). Excludes at-risk participants defined as any amount of HED (AUDIT Question 3 > 0) or under 21 drinker at baseline. A total of 281 participants were excluded from this analysis (N = 190)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	100	89
Mean (Standard Error) [units on a scale]	70.45 (1.55)	79.34 (1.65)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparisons tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare mean differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	<0.001
	Comments	A priori threshold for statistical significance was 0.05.
	Method	Repeated Measures--General Linear Model
	Comments

8. Post-Hoc Outcome

Title	Readiness to Change Scale (Analysis II)
Description	A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

For this study, at-risk drinking was defined as: AUDIT total >=8, under 21 drinker, any past year heavy episodic drinking (HED). Excludes at-risk participants defined as any amount of HED (AUDIT Question 3 > 0) or under 21 drinker at baseline. A total of 281 participants were excluded from this analysis (N = 190)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	98	89
Mean (Standard Error) [units on a scale]	2.29 (0.13)	2.46 (0.14)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparison tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare means differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	=0.348
	Comments	A priori threshold for statistical significance was 0.05.
	Method	Repeated Measures--General Linear Model
	Comments

9. Post-Hoc Outcome

Title	Alcohol Use Disorders Identification Test (AUDIT) Total (Analysis III--complete Cases)
Description	The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Complete case analysis

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	244	227
Mean (Standard Error) [units on a scale]	5.87 (0.25)	5.48 (0.26)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparison tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare means differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.091
	Comments	A priori threshold for statistical significance was 0.05.
	Method	Repeated Measures GLM
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Final Values)
	Estimated Value	.345
	Confidence Interval	(2-Sided) %; to
	Parameter Dispersion	Type: Standard Error of the Mean; Value: .203
	Estimation Comments

10. Post-Hoc Outcome

Title	AUDIT-C or Drinkers Index (Analysis III Complete Cases)
Description	The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Complete case analysis

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	244	227
Mean (Standard Error) [units on a scale]	4.4 (.14)	4.05 (.15)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparison tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare means differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	.278
	Comments	A priori alpha set at 0.05
	Method	Repeated Measures GLM
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	.393
	Confidence Interval	(2-Sided) %; to
	Parameter Dispersion	Type: Standard Error of the Mean; Value: .362
	Estimation Comments

11. Post-Hoc Outcome

Title	Controlled Drinking Self-Efficacy Scale (CDSES) (Analysis III Complete Cases)
Description	The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Complete case analysis

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	244	227
Mean (Standard Error) [units on a scale]	78.66 (1.0)	81.82 (1.04)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparison tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare means differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.029
	Comments	A priori alpha set at 0.05.
	Method	Repeated Measures GLM
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	3.163
	Confidence Interval	(2-Sided) %; to
	Parameter Dispersion	Type: Standard Error of the Mean; Value: 1.44
	Estimation Comments

12. Post-Hoc Outcome

Title	Readiness to Change Scale (Analysis III Complete Cases)
Description	A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Complete case analysis

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	238	221
Mean (Standard Error) [units on a scale]	2.21 (0.08)	2.20 (0.09)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Data were analyzed using a GLM repeated measures approach. A priori means comparison tests (usual care vs. SBIRT intervention) with Bonferroni corrections were used to compare means differences at follow-up.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.897
	Comments	A priori alpha set at 0.05.
	Method	Repeated Measures GLM
	Comments
Method of Estimation	Estimation Parameter	Mean Difference (Net)
	Estimated Value	-0.015
	Confidence Interval	(2-Sided) %; to
	Parameter Dispersion	Type: Value:
	Estimation Comments

13. Post-Hoc Outcome

Title	Alcohol Use Disorders Identification Test (AUDIT) Total (Analysis IV--Multiple Imputation and Intention to Treat Analysis)
Description	The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; include all participants allocated to a condition at baseline (n = 791)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	403	388
Mean (Standard Error) [units on a scale]	4.47 (0.16)	4.15 (0.13)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Linear mixed-effects models were used to analyze 5 pooled datasets derived from multiple imputation for intent to treat analyses.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.15
	Comments
	Method	Linear mixed effects
	Comments

14. Post-Hoc Outcome

Title	AUDIT-C or Drinkers Index (Analysis IV--Intent to Treat Analyses)
Description	The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; include all participants allocated to a condition at baseline (n = 791)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	403	388
Mean (Standard Error) [units on a scale]	5.95 (0.21)	5.62 (0.23)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Linear mixed-effects models were used to analyze 5 pooled datasets derived from multiple imputation for intent to treat analyses.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.20
	Comments	A priori alpha set at 0.05.
	Method	Linear mixed effects
	Comments

15. Post-Hoc Outcome

Title	Controlled Drinking Self-Efficacy Scale (CDSES) (Analysis IV--Intent to Treat Analyses)
Description	The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; include all participants allocated to a condition at baseline (n = 791)

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	403	388
Mean (Standard Error) [units on a scale]	78.42 (0.85)	81.30 (1.05)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Linear mixed-effects models were used to analyze 5 pooled datasets derived from multiple imputation for intent to treat analyses.
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.38
	Comments	A priori alpha set at 0.05.
	Method	Linear mixed effects
	Comments

16. Post-Hoc Outcome

Title	Readiness to Change Scale (Analysis IV--Multiple Imputation and Intention to Treat Analysis)
Description	A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	403	388
Mean (Standard Error) [units on a scale]	2.22 (0.07)	2.16 (0.07)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Linear mixed-effects models were used to analyze 5 pooled datasets derived from multiple imputation for intent to treat analyses.
	Type of Statistical Test	Other
	Comments	A priori alpha set at 0.05
Statistical Test of Hypothesis	p-Value	0.48
	Comments
	Method	Linear mixed effects
	Comments

17. Post-Hoc Outcome

Title	Alcohol Use Disorders Identification Test (AUDIT) Total (Analysis V--Multiple Imputation and Intention to Treat Analysis)
Description	The primary outcome measure will come from the participant's total score on the AUDIT. Scores on the AUDIT range from 0 to 40 with higher numbers indicating greater problematic alcohol use. Mean AUDIT scores at follow-up will be compared between arms.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; includes participants scoring 8 or greater on the AUDIT at baseline.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	166	161
Mean (Standard Error) [units on a scale]	5.38 (0.25)	4.85 (0.20)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	Linear mixed-effects models were used to analyze 5 pooled datasets derived from multiple imputation for intent to treat analyses.
	Type of Statistical Test	Other
	Comments	A priori alpha set at 0.05.
Statistical Test of Hypothesis	p-Value	0.09
	Comments
	Method	Linear mixed effects
	Comments

18. Post-Hoc Outcome

Title	AUDIT-C or Drinkers Index (Analysis V--Intent to Treat Analyses)
Description	The drinkers index consists of a summary of the first three AUDIT items which represents a combination of quantity, usual frequency, and frequency of heavy drinking. The AUDIT-C can range from 0 to 12 with 12 representing higher levels of drinking quantity and frequency.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; includes participants scoring 8 or greater on the AUDIT at baseline.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	166	161
Mean (Standard Error) [units on a scale]	8.09 (0.39)	7.64 (0.38)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	A priori alpha set at 0.05
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.08
	Comments
	Method	Linear mixed effects
	Comments

19. Post-Hoc Outcome

Title	Controlled Drinking Self-Efficacy Scale (CDSES) (Analysis V--Intent to Treat Analyses)
Description	The 20-item Controlled Drinking Self-Efficacy Scale (CDSES), is a reliable, valid, easy-to-administer scale that assesses confidence to reduce overall consumption and frequency of drinking. Items range from 0% to 100% with 100% indicating more confidence to engage in controlled drinking. The CDSES was administered at both baseline and follow-up to assess changes in this presumed mediating attitude.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; includes participants scoring 8 or greater on the AUDIT at baseline.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	166	161
Mean (Standard Error) [units on a scale]	72.18 (1.38)	77.84 (1.55)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	A priori alpha set at 0.05
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.11
	Comments
	Method	Linear mixed effects
	Comments

20. Post-Hoc Outcome

Title	Readiness to Change Scale (Analysis V--Multiple Imputation and Intention to Treat Analysis)
Description	A readiness to change alcohol use measure (ranging from 1 - not ready to change, to 4 - very ready) was assessed at baseline and follow-up for all participants. Because motivation and readiness to change are hallmark elements of the SBIRT approach and are thought to be integral to behavior change, these constructs will be measured to assess the degree to which they change in the two groups. Some individuals may not abstain or reduce their use over time, but there may be an improvement in their readiness to change.
Time Frame	Baseline, Follow-up (Up to 7 months)

Outcome Measure Data

Analysis Population Description

Intent to treat analysis using multiple imputation; includes participants scoring 8 or greater on the AUDIT at baseline.

Arm/Group Title	Usual Care	SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.	Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
Measure Participants	166	161
Mean (Standard Error) [units on a scale]	2.33 (0.10)	2.35 (0.12)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Usual Care, SBIRT
	Comments	A priori alpha set at 0.05
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.84
	Comments
	Method	Linear mixed effects
	Comments

Adverse Events

Arm/Group Title	Usual Care		SBIRT
Arm/Group Description	Those participants assigned to the usual care control group will be given a brochure on safe drinking limits, will be reminded of the 6-month follow-up, and thanked for their time.		Those assigned to the SBIRT intervention group will receive 1 of 3 tracks: Brief Intervention (BI) for At Risk Individuals (scores lower than 15) - Brief motivational intervention with feedback related to their use and change strategies. Brief Treatment (BT) for High Risk Individuals (scores of 16-19) - Brief Intervention on site and be offered 6 individual confidential sessions with a civilian Brief Treatment Counselor over the phone. Referral to Treatment (RT) for Severe Risk Individuals (scores of 20-40) - Brief Intervention on site and will be given a list of services where they may self-refer for further assessment and support. SBIRT: SBIRT is an "opportunistic" approach whereby patients 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.
All Cause Mortality
	Usual Care		SBIRT
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Usual Care		SBIRT
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/244 (0%)		0/228 (0%)
Other (Not Including Serious) Adverse Events
	Usual Care		SBIRT
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/244 (0%)		0/228 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.