We are proposing a four year study in which a randomized clinical trial will be conducted to assess the effect (3-. 6-, and 12-months) of physician-delivered advice versus physician-delivered patient-centered counseling on high-risk and problem drinkers in a primary care medical setting. A secondary objective of the study is the development of a structured educational program for training physicians to recognize and Intervene effectively with these patients. The study will enroll and assess 1350 adult male and female medical patients aged 21-70. High-risk drinking is defined for women as greater than or equal to 3 drinks per day on 3 or more days per week; for men as greater than or equal to 4 drinks per day on 3 or more days per week. Problem drinkers are defined by DSM-IIIR criteria for alcohol abuse or dependence. Physiologically dependent patients will be excluded using an alcohol dependence scale. The study uses a randomized design and will be conducted in 2 Internal medicine practice sites affiliated with the University of Massachusetts Medical Center. It will include 30 physicians who will be randomized to receive training (intervention conditions) or no-training (control condition). The training of the physicians to do alcohol assessment and Intervention will be accomplished through a structured program over a three month training cycle at the beginning of each of two years. Regularly scheduled patients will be screened by a telephone Interview-administered alcohol screening instrument embedded in a health habits survey. Patients screening positive for high-risk or problem drinking will complete a face-to-face interview just prior to their visit with their physician. Patients of intervention physicians who meet entrance criteria for the study will be randomized to the advice or counseling condition. Patients of control physicians will receive usual (control condition). All study patients will be contacted at 3-, 6-, and 12-months for a telephone interview intended to assess self-reported outcome variables. A collateral telephone contact with a spouse or other person named by the study subject will be made to corroborate the subject's self report at 6- and 12-months. Six outcomes were selected: change in mean alcohol consumption; negative consequences of drinking; number of high-risk drinking episodes; progression through stages of change; awareness of alcohol as a health risk factor; and perceive global health status.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA009153-02
Application #
2045377
Study Section
Clinical and Treatment Subcommittee (ALCP)
Project Start
1993-03-01
Project End
1997-02-28
Budget Start
1994-03-01
Budget End
1995-02-28
Support Year
2
Fiscal Year
1994
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
660735098
City
Worcester
State
MA
Country
United States
Zip Code
01655
Ockene, Judith K; Reed, George W; Reiff-Hekking, Sarah (2009) Brief patient-centered clinician-delivered counseling for high-risk drinking: 4-year results. Ann Behav Med 37:335-42
Reiff-Hekking, Sarah; Ockene, Judith K; Hurley, Thomas G et al. (2005) Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up. J Gen Intern Med 20:7-13
Rosal, M C; Ockene, J K; Hurley, T G et al. (2000) Prevalence and co-occurrence of health risk behaviors among high-risk drinkers in a primary care population. Prev Med 31:140-7
Ockene, J K; Adams, A; Hurley, T G et al. (1999) Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: does it work? Arch Intern Med 159:2198-205
Adams, A; Ockene, J K; Wheller, E V et al. (1998) Alcohol counseling: physicians will do it. J Gen Intern Med 13:692-8
Ockene, J K; Wheeler, E V; Adams, A et al. (1997) Provider training for patient-centered alcohol counseling in a primary care setting. Arch Intern Med 157:2334-41