This project addresses important questions of technology transfer by evaluating an innovative secondary prevention program for managed care. The program will proactively recruit at-risk drinkers and administer a computer-based low intensity motivationally matched individualized cognitive-behavioral intervention. The study will examine the impact of a brief stage matched intervention, involving periodic assessment and expert system feedback, on high risk alcohol use. It is designed to test whether the stage matched intervention outperforms periodic assessment alone, whether periodic assessment itself is effective, and whether these results differ by gender. Although non-dependent at-risk drinkers contribute substantially to the nation's overall burden of alcohol-related morbidity and mortality, many at-risk drinkers do not perceive their alcohol use a problematic, and few are prepared to change those behaviors. Brief self-help interventions targeted to the individual needs and motivational readiness of at-risk drinkers have great potential to bring about meaningful reduction in harmful drinking. Over the past decade interactive self-help interventions, based on the Transtheoretical Model of change, have demonstrated important public health impacts in large scale clinical trials of smoking and other health behaviors. A three group randomized controlled design will compare a brief intervention condition with two control conditions; a minimal assessment post-test only control and an assessment only control condition. Multiple outcomes and sensitive measures of intermediate variables are used to evaluate the change process. The study will proactively screen the managed care population to identify a gender balanced sample of 1,235 non-dependent """"""""at risk"""""""" drinkers who would not normally be targeted for intervention. There is a six month intervention period followed by 3 outcome assessments at 6 month intervals. Secondary analyses will examine potential mediators of behavior change, and explore the relationship of at-risk drinking to medical care utilization and costs. This unique recruitment and intervention strategy requires few resources from health care providers and is likely to be highly disseminable to other managed care organizations.
