Primary care physicians can provide effective brief interventions to reduce problem drinking, but time constraints and reluctance of both patients and physicians to address this issue are significant barriers. Proposal - In Phase I, we will create an interactive patient-directed computer-facilitated intervention (CFI) for problem drinking. CFI's first aim is to facilitate patients' self-change. Before the physician visit, CFI will screen the patient for problem drinking, conduct an assessment, provide feedback, and guide the patient in writing a behavioral contract. CFI's second aim is to facilitate and enhance physician-based intervention. By helping the patient become aware of alcohol-related risks and problems, CFI will facilitate discussion during the office visit focused on the patient's perceptions about the pros and cons of drinking and strategies to move toward change. The physician will reinforce the patient's contract choices and encourage a follow-up visit, either with the physician or, if the patient's problems are more severe and he or she is willing, with a mental-health counselor. Methods - CFI will be based on workbooks used in previous successful intervention trials and will use items found in alcohol assessment instruments (DIS, ASI, APPQ, and others). An iterative process of qualitative research with problem drinkers will guide selection of salient and engaging items. Interviews with problem drinkers and physicians will be done prior to the start of SBIR funding and during the grant's second 3 months. Importance - Previous computer programs have provided screening for health risks, but CFI will go beyond that, enabling physicians to provide effective interventions to substantial numbers of unrecognized problem drinkers. PROPOSED COMMERCIAL APPLICATIONS: The Phase I product will help clinicians efficiently, effectively, and comfortably intervene with problem drinkers. In settings like college student health services, where problem drinking is the most serious health risk, the alcohol module by itself will have major market potential. The Phase II product will add modules that address tobacco use and other behavioral issues. This fully developed CSI will have substantial appeal with primary care physicians, managed care organizations, and other purchasers.
Thesaurus Terms: alcoholism /alcohol abuse education, alcoholism /alcohol abuse prevention, computer assisted instruction, computer program /software, educational resource design /development, interactive multimedia alcoholism /alcohol abuse therapy, behavior therapy, disease /disorder proneness /risk, education evaluation /planning behavioral /social science research tag, human subject, interview
