Feedback from recently returned veterans on an anonymous web-based brief alcohol intervention

Addiction Science & Clinical Practice

Gwen T Lapham²  Eric J Hawkins⁵  Laura J Chavez²  Carol E Achtmeyer⁶  Emily C Williams²  Rachel M Thomas⁷  Evette J Ludman¹  Kypros Kypri³  Stephen C Hunt⁴  Katharine A Bradley¹ 

[1] Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, USA

[2] Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA

[3] School of Medicine and Public Health, University of Newcastle, Level 3, David Maddison Clinical Sciences Building, Callaghan, New South Whales, 2308, Australia

[4] Department of Medicine, University of Washington, Box 356420, Seattle, WA, 98195, USA

[5] Center of Excellence in Substance Abuse Treatment and Education (CESATE), 1660 South Columbian Way, Seattle, WA, 98108, USA

[6] General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA

[7] Health Services Research & Development (HSR&D), Northwest Center of Excellence, Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA

关键词: Veteran;    Iraq war;    Feedback;    Brief intervention;    Alcohol;    Internet;   

Others  :  789355
DOI  :  10.1186/1940-0640-7-17

 received in 2011-12-30, accepted in 2012-07-04,  发布年份 2012

【 摘 要 】

Background

Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) are at increased risk for alcohol misuse, and innovative methods are needed to improve their access to alcohol screening and brief interventions (SBI). This study adapted an electronic SBI (e-SBI) website shown to be efficacious in college students for OEF/OIF veterans and reported findings from interviews with OEF/OIF veterans about their impressions of the e-SBI.

Methods

Outpatient veterans of OEF/OIF who drank ≥3 days in the past week were recruited from a US Department of Veterans Affairs (VA) Deployment Health Clinic waiting room. Veterans privately pretested the anonymous e-SBI then completed individual semistructured audio-recorded interviews. Their responses were analyzed using template analysis to explore domains identified a priori as well as emergent domains.

Results

During interviews, all nine OEF/OIF veterans (1 woman and 8 men) indicated they had received feedback for risky alcohol consumption. Participants generally liked the standard-drinks image, alcohol-related caloric and monetary feedback, and the website’s brevity and anonymity (a priori domains). They also experienced challenges with portions of the e-SBI assessment and viewed feedback regarding alcohol risk and normative drinking as problematic, but described potential benefits derived from the e-SBI (emergent domains). The most appealing e-SBIs would ensure anonymity and provide personalized transparent feedback about alcohol-related risk, consideration of the context for drinking, strategies to reduce drinking, and additional resources for veterans with more severe alcohol misuse.

Conclusions

Results of this qualitative exploratory study suggest e-SBI may be an acceptable strategy for increasing OEF/OIF veteran access to evidenced-based alcohol SBI.

【 授权许可】

   
2012 Lapham et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

【 参考文献 】

• [1]Defense Manpower Data Center: CTS Deployment File Baseline Report for Operation Enduring Freedom and Operation Iraqi Freedom. US Department of Defense, Washington, DC; 2011.
• [2]Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 2004, 351:13-22.
• [3]Jacobson IG, Ryan MA, Hooper TI, Smith TC, Amoroso PJ, Boyko EJ, Gackstetter GD, Wells TS, Bell NS: Alcohol use and alcohol-related problems before and after military combat deployment. JAMA 2008, 300:663-675.
• [4]Milliken CS, Auchterlonie JL, Hoge CW: Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA 2007, 298:2141-2148.
• [5]Calhoun PS, Elter JR, Jones ER, Kudler H, Straits-Troster K: Hazardous alcohol use and receipt of risk-reduction counseling among U.S. veterans of the wars in Iraq and Afghanistan. J Clin Psychiatry 2008, 69:1686-1693.
• [6]Hawkins EJ, Lapham GT, Kivlahan DR, Bradley KA: Recognition and management of alcohol misuse in OEF/OIF and other veterans in the VA: a cross-sectional study. Drug Alcohol Depend 2010, 109:147-153.
• [7]McDevitt-Murphy ME, Williams JL, Bracken KL, Fields JA, Monahan CJ, Murphy JG: PTSD symptoms, hazardous drinking, and health functioning among U.S.OEF and OIF veterans presenting to primary care. J Trauma Stress 2010, 23:108-111.
• [8]Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM: Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatr Serv 2009, 60:1118-1122.
• [9]Erbes CR, Curry KT, Leskela J: Treatment Presentation and Adherence of Iraq/Afghanistan Era Veterans in Outpatient Care for Posttraumatic Stress Disorder. Psychol Serv 2009, 6:175-183.
• [10]Kaner E, Beyer F, Dickinson H, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007. CD004148
• [11]Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR: Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care 2006, 12:597-606.
• [12]Lapham GT, Achtmeyer CE, Williams EC, Hawkins EJ, Kivlahan DR, Bradley KA: Increased documented brief alcohol interventions with a performance measure and electronic decision support. Med Care 2012, 50:179-187.
• [13]Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, Kivlahan DR: Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med 2011, 26:299-306.
• [14]Ouimette PC, Vogt D, Wade M, Tirone V, Greenbaum MA, Kimerling R, Laffaye C, Fitt JE, Rosen CS: Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychol Serv 2011, 8:212-223.
• [15]Linke S, Murray E, Butler C, Wallace P: Internet-based interactive health intervention for the promotion of sensible drinking: patterns of use and potential impact on members of the general public. J Med Internet Res 2007, 9:e10.
• [16]Cunningham JA, Humphreys K, Koski-Jannes A: Providing personalized assessment feedback for problem drinking on the Internet: a pilot project. J Stud Alcohol 2000, 61:794-798.
• [17]Saitz R, Helmuth ED, Aromaa SE, Guard A, Belanger M, Rosenbloom DL: Web-based screening and brief intervention for the spectrum of alcohol problems. Prev Med 2004, 39:969-975.
• [18]Gerbert B, Bronstone A, Pantilat S, McPhee S, Allerton M, Moe J: When asked, patients tell: disclosure of sensitive health-risk behaviors. Med Care 1999, 37:104-111.
• [19]Straits-Troster K, Kudler H, Jones E, Calhoun P: Executive Summary Report on Focus Groups: Clinical Needs Assessment of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans and Families. VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC; 2007.
• [20]Simon-Arndt CM, Hurtado SL, Patriarca-Troyk LA: Acceptance of Web-based personalized feedback: user ratings of an alcohol misuse prevention program targeting U.S. Marines. Health Commun 2006, 20:13-22.
• [21]Curry SJ: eHealth research and healthcare delivery beyond intervention effectiveness. Am J Prev Med 2007, 32:S127-130.
• [22]Bewick BM, Trusler K, Mulhern B, Barkham M, Hill AJ: The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: a randomised control trial. Addict Behav 2008, 33:1192-1198.
• [23]Copeland J, Martin G: Web-based interventions for substance use disorders: a qualitative review. J Subst Abuse Treat 2004, 26:109-116.
• [24]Elliott JC, Carey KB, Bolles JR: Computer-based interventions for college drinking: a qualitative review. Addict Behav 2008, 33:994-1005.
• [25]Carey KB, Henson JM, Carey MP, Maisto SA: Computer versus in-person intervention for students violating campus alcohol policy. J Consult Clin Psychol 2009, 77:74-87.
• [26]Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D: Computer-delivered interventions for alcohol and tobacco use: a meta-analysis. Addiction 2010, 105:1381-1390.
• [27]Khadjesari Z, Murray E, Hewitt C, Hartley S, Godfrey C: Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review. Addiction 2011, 106:267-282.
• [28]Kypri K, Langley JD, Saunders JB, Cashell-Smith ML, Herbison P: Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Arch Intern Med 2008, 168:530-536.
• [29]Kypri K, Hallett J, Howat P, McManus A, Maycock B, Bowe S, Horton NJ: Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students. Arch Intern Med 2009, 169:1508-1514.
• [30]Babor TF, de la Fuente JR, Saunders J, Grant M: AUDIT. Alcohol Use Disorders Identification Test: guidelines for use in primary health care. World Health Organization, Geneva; 1989.
• [31]Kypri K, Saunders JB, Williams SM, McGee RO, Langley JD, Cashell-Smith ML, Gallagher SJ: Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Addiction 2004, 99:1410-1417.
• [32]Miller WR, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. Guilford Press, New York; 1991.
• [33]Hallett J, Maycock B, Kypri K, Howat P, McManus A: Development of a Web-based alcohol intervention for university students: processes and challenges. Drug Alcohol Rev 2009, 28:31-39.
• [34]Bradley KA, Williams EC, Achtmeyer CE, Hawkins EJ, Harris AH, Frey MS, Craig T, Kivlahan DR: Measuring performance of brief alcohol counseling in medical settings:a review of the options and lessons from the Veterans Affairs (VA) health care system. Subst Abus 2007, 28:133-149.
• [35]Wright SM, Craig T, Campbell S, Schaefer J, Humble C: Patient satisfaction of female and male users of Veterans Health Administration services. J Gen Intern Med 2006, 21(Suppl 3):S26-32.
• [36]Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A: The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000, 15:1021-1027.
• [37]US Chief Information Officers Council: Paperwork Reduction Act of 1995. 1995. [http://www.cio.gov/documents/paperwork_reduction_act_1995.html webcite]
• [38]US Department of Veterans Affairs: VA Handbook 6310.3. [http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=36&FType=2 webcite]
• [39]Gask L, Ludman E, Schaefer J: Qualitative study of an intervention for depression among patients with diabetes: how can we optimize patient-professional interaction? Chronic Illn 2006, 2:231-242.
• [40]King N: Template analysis. In Qualitative Methods and Analysis in Organizational Research: A Practical Guide. Edited by Symon G, Cassell C. Sage, Thousand Oaks, CA; 1998:118-134.
• [41]Saitz R, Palfai TP, Freedner N, Winter MR, Macdonald A, Lu J, Ozonoff A, Rosenbloom DL, Dejong W: Screening and brief intervention online for college students: the ihealth study. Alcohol Alcohol 2007, 42:28-36.
• [42]US National Institute on Alcohol Abuse and Alcoholism: Helping Patients Who Drink Too Much: A Clinician’s Guide (Updated 2005 Edition). [http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm webcite]
• [43]Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR: AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res 2007, 31:1208-1217.
• [44]Lewis MA, Neighbors C: Optimizing personalized normative feedback: the use of gender-specific referents. J Stud Alcohol Drugs 2007, 68:228-237.
• [45]Management of Substance Use Disorders Working Group: VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders. [http://guideline.gov/content.aspx?id=15676 webcite]
• [46]US Federal Register: Interim Final Rule. Sharing Information Between the Department of Veterans Affairs and the Department of Defense (38 CFR Part 1). [http://www.va.gov/ORPM/docs/20111020_AN95_SharingInformationBetweentheDVAandDOD.pdf webcite]
• [47]Maurage P, Joassin F, Speth A, Modave J, Philippot P, Campanella S: Cerebral effects of binge drinking: respective influences of global alcohol intake and consumption pattern. Clin Neurophysiol 2012, 123:892-901.
• [48]Dawson DA, Grant BF, Li TK: Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res 2005, 29:902-908.
• [49]Saha TD, Stinson FS, Grant BF: The role of alcohol consumption in future classifications of alcohol use disorders. Drug Alcohol Depend 2007, 89:82-92.
• [50]Cunningham JA, Humphreys 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.