Problem drinking in rural areas is an important health services issue facing the alcoholism treatment field, not only because of the potential for such drinking to create life-functioning problems but also because fewer treatment services are available in rural areas. Accordingly, this research has three primary objectives: (1) To evaluate three secondary prevention drinking reduction interventions for problem drinking rural men and women: bibliotherapy (BT) alone, BT with a telephone motivational interview, or BT with a telephone motivational interview and 6 telephone therapy sessions. The self-help manual focuses on awareness of drinking behavior, danger signals regarding problem drinking situations, and strategies for reducing drinking. Primary outcomes assessed are alcohol/drug use; alcohol-related behaviors/cognitions; and psychological and interpersonal functioning. (2) To study the processes of change involved in these interventions. Three variable domains will be studied: alcohol cognitions, person variables, and drinking reduction skills. These domains and changes in them will be examined as potential mediators of change. (3) To assess effects of gender, which will be an independent variable examined both as a main effect and in interaction with treatment condition with regard to treatment outcome. This project will be the first to evaluate these interventions in rural areas. In addition to investigating treatment outcome, an important aim is to further our understanding of treatment mediators. This endeavor overall is consistent with the long-term goal of identifying interventions which can be efficiently and effectively delivered to subgroups of problem drinkers, in this case rural men and women. As such, the findings will have direct relevance to the administration of health services to persons with alcohol use problems.
