IMPLEMENTATION OF SCREENING AND BRIEF INTERVENTIONS FOR ALCOHOL-RELATED PROBLEMS RELEASE DATE: September 17, 2002 PA NUMBER: PA-02-168 EXPIRATION DATE: This PA expires on August 15, 2005, unless reissued. National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://www.niaaa.nih.gov) National Institute on Drug Abuse (NIDA) (http://www.nida.nih.gov) THIS PA CONTAINS THE FOLLOWING INFORMATION o Purpose of this PA o Research Objectives o Mechanism(s) of Support o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Where to Send Inquiries o Submitting an Application o Peer Review Process o Review Criteria o Award Criteria o Required Federal Citations PURPOSE OF THIS PA The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seeks research grant applications on the delivery of screening, identification, and brief intervention services for alcohol-related problems in medical and other similar service settings. This program announcement (PA) invites research applications to test strategies for improving the availability, use of, delivery, quality, effectiveness, cost-effectiveness, and outcomes of protocols to screen for and identify patients with current or potential alcohol use problems and to implement brief interventions to address such problems. This PA also invites research applications to test strategies that facilitate the referral to more intensive treatment for those patients for whom specialty care may be indicated. RESEARCH OBJECTIVES Background A large number of people who do not meet the diagnostic criteria for alcohol dependence still consume more alcohol than is safe for them -- putting them at great risk for health problems, family and work difficulties, motor vehicle crashes, and injuries. In fact, more than 70 percent of drinkers aged 21 or older exceed the guidelines for low-risk drinking. This presents serious implications for public health as well as for treating alcohol use problems. Despite the fact that many people who drink at levels that put them at risk for serious problems do not contact alcohol treatment specialists, they do in fact visit a primary care medical practitioner or come into contact with other medical caregivers. Over the past several decades, interventions were developed in Europe to identify persons drinking at levels that either were causing problems or had the potential to cause problems and to briefly provide advice or counseling to reduce the level of consumption. Many controlled trials tested these techniques in both medical and community settings, and most studies found them efficacious. In recent years, efforts to test time-limited strategies such as brief interventions have been expanded in North America in attempts to reduce the levels of alcohol use among these so-called "risky" drinkers. Medical and other professional personnel have implemented these brief interventions in a variety of settings, including primary care medical practices, hospital emergency rooms (ER) and trauma centers, and college campuses. Research has begun to demonstrate the efficacy and effectiveness of brief interventions across those and other settings and in populations -- adolescents, older adults, and pregnant women -- that typically have not received much attention from the traditional system of specialized alcohol dependence treatment. Brief intervention is a time-limited, patient-centered counseling strategy focused on changing behaviors. Typically, a brief intervention consists of four or fewer sessions lasting from a few minutes to an hour. It is most frequently used to reduce the alcohol consumption of patients who are not alcohol-dependent but may be followed by referral to more intensive treatment for persons who do not respond to brief counseling alone or for persons who are alcohol-dependent. Primary Care Practice Settings: Several early studies in the United Kingdom investigated brief counseling interventions in general medical practices. Wallace and colleagues (Wallace et al.1988) found reduced drinking levels after one year in patients that received two interventions of 5 to 10 minutes each followed by two 5-minute telephone calls. In addition, men in the intervention group had reduced blood pressure and healthier liver enzyme levels. Anderson and Scott (1992) demonstrated that male patients receiving 10 minutes of physician advice plus feedback from assessment measures and a self-help information booklet reduced alcohol consumption at 1-year follow-up. Female patients from both the intervention and control groups showed significant reductions in consumption (Scott and Anderson 1991). The authors suggest that the lack of difference between groups may be attributable to contamination of the control group by informal alcohol interventions. In one of the early North American studies, Israel and colleagues (1996) demonstrated that cognitive-behavior counseling was significantly more effective than simple advice at reducing alcohol consumption, psychosocial problems, liver enzyme levels that reflect alcohol use, and frequency of subsequent physician visits. Fleming and colleagues (1997) observed that men and women receiving two counseling visits of 10 to 15 minutes and two 5-minute follow-up phone calls showed significant reductions in alcohol use during the preceding week, in episodes of binge drinking, and in frequency of excessive drinking. Sustained reductions in alcohol use have been observed at 48-month follow-up. Another study found that primary care physicians and nurse practitioners who received brief training in skills, attitudes, and knowledge regarding high-risk drinking were able to significantly increase their counseling skills, their preparedness to intervene with at-risk drinkers, and the perceived usefulness of intervention (Ockene et al, 1997, 1999; Adams et al, 1998). At six-month follow-up, alcohol consumption was significantly reduced for patients who had received brief interventions during the course of their routine primary medical care. Emergency Care Settings: Gentilello and colleagues (1999) showed that patients admitted for injuries to a Level 1 trauma center that received a single motivational interview (MI) with a psychologist decreased alcohol consumption significantly at 12 months with the reduction most apparent in patients with mild to moderate alcohol problems. In addition, there was a 47 percent reduction in injuries requiring either emergency department or trauma center admission at one-year follow-up and a 48 percent reduction in injuries requiring hospital admission at three-year follow- up. Another study evaluated the use of a 30-minute MI in the ER to reduce alcohol-related consequences and use among adolescents following an alcohol- related event (Monti et al., 1999). Follow-up assessments at six months showed that patients who received the MI had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol- related problems than patients who received standard care. Both groups showed reduced alcohol consumption, but the harm-reduction focus of the MI intervention produced additional benefits by further reducing negative outcomes related to drinking. Similarly, Longabaugh and colleagues (2001) found that patients treated for injuries in a hospital emergency department (ED) receiving both a 40-60 minute MI intervention and a booster MI session 7 to 10 days later reported fewer negative consequences form drinking and fewer alcohol-related injuries at 1-year follow-up, as compared to patients receiving no MI treatment and those receiving the MI treatment with the booster session. Patients in all three groups reduced their days of heavy drinking (6 or more drinks on one occasion). Interventions with Other Populations: Fleming and colleagues (1999) tested the effects of brief advice from primary care physicians in reducing alcohol use by older adult problem drinkers. Patients receiving the brief intervention demonstrated significant reductions in alcohol use from the previous week, episodes of binge drinking, and frequency of excessive drinking. In a project designed to reduce prenatal alcohol consumption among pregnant women, Chang and colleagues (1999, 2000) provided patients with a two-hour assessment only or a two-hour assessment plus a brief intervention by a physician. More than half of the subjects screened had stopped drinking alcohol by the time of random assignment, presumably because of their pregnancy. Among the women who were abstinent prior to the comprehensive assessment, those who received the brief intervention maintained higher rates of abstinence throughout the pregnancy. However, women in both groups significantly reduced their alcohol use. The minimal differences between the groups may very well be attributable to the intensity of the assessment serving as a brief intervention in itself, so that additional contributions from the supplementary intervention were negligible. Finally, the effectiveness of brief interventions for reducing alcohol use and alcohol-related problems among college students has been demonstrated (Marlatt, 1995, 1998). Heavy-drinking students who received a one- hour counseling session with personalized feedback and a discussion of drinking risks and norms showed a decrease in alcohol-related problems and in alcohol use and binge drinking over two years. High-risk drinking freshmen who received individual motivational interviews and personalized feedback reports on drinking patterns and risks had greater reductions in alcohol use and alcohol-related problems than did high-risk drinkers in a comparison group. Cost Analyses of Brief Interventions: Critical examinations of the true costs and actual benefits of a particular intervention are essential, especially in the current era of resource conservation. One recent study estimated the economic benefits of a brief intervention in the primary medical care setting (Fleming et al, 2000). The average per-subject benefit of the intervention was $1,151, while the cost per subject was $205, yielding a benefit-cost ration of 5.6:1. Specifically, this analysis suggests that an investment of $10,000 in treatment resulted in a total benefit of $56,263. It also offers evidence that brief interventions for problem drinkers can generate positive net benefit for patients, the health care system, and society. Specific Areas of Interest Brief interventions with non-dependent but high-risk drinkers have been shown to have positive effects in reducing alcohol use and alcohol-related problems across a broad range of settings and with a broad range of patient subpopulations. Still, a great deal remains to be done in order to consolidate and expand our understanding of this intervention strategy. Consequently NIAAA encourages continued investigation into the implementation and application of brief intervention models in a variety of applied and real-world settings. Examples of potential research questions include but are not limited to: - How can the effects of brief interventions be maintained and even strengthened over time? Will booster sessions or re-interventions at specified intervals achieve this? - What are the active ingredients of these types of interventions? Do they differ across various settings or patient populations? - How can the brief window of intervention opportunity be used most efficiently? - How can screening and brief interventions for alcohol use problems be more fully integrated into the routine practices and procedures of our existing health care system? What are the individual, institutional, financial, and societal barriers to such integration? - Do brief interventions reduce overall health care costs? Do they reduce other societal costs? - How can screening tools be streamlined to improve both their efficiency and their likelihood of use in medical settings yet still achieve an optimum level of sensitivity and specificity? - What technological or managerial innovations can facilitate the implementation and adoption of screening and brief intervention protocols. - How do patient characteristics, especially cultural or ethnic variations, influence the effectiveness of brief interventions for alcohol problems? - How do possible co-occurring disorders (physiological or psychiatric) influence the effectiveness of brief interventions for alcohol problems? - How can referral to more intensive treatments be improved to facilitate patient adherence and increase cost efficiencies? - How can screening and brief intervention protocols originally implemented in medical care settings be adopted by other social agency systems (e.g., family/child welfare, corrections, etc.)? MECHANISM (S) OF SUPPORT This PA will use the NIH research project grant (R01) small grant (R03) and exploratory/developmental grant (R21) award mechanism. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project. The total project period for a research project grant (R01) application submitted in response to this Program Announcement may not exceed 5 years. Under the NIAAA Small Grant mechanism (R03) applicants may request either $25,000 or $50,000 in direct costs per year for up to two years. These awards are not renewable; however, a no-cost extension of up to one year may be granted to the grantee institution prior to expiration of the project period. Before completion of the R03, investigators are encouraged to seek continuing support for research through a research project grant (R01). (See Program Announcement PA- 99-098, "NIAAA Small Grant Program," https://grants.nih.gov/grants/guide/pa-files/PAR-99-098.html, for a complete description of the R03 mechanism.) NIAAA exploratory/developmental grants (R21) are limited to 3 years for up to $100,000/year for direct costs. (See Program Announcement PA- 99-131, "NIAAA Exploratory/Developmental Grant Program," https://grants.nih.gov/grants/guide/pa-files/PA-99-131.html, for a complete description of the R21 mechanism.) The NIDA exploratory/developmental (R21) grants are limited to 3 years and NIDA small grants (R03) are limited to 2 years. Both are non-renewable and limited in direct cost amount per year (R03, $50,000; R21, $100,000). The NIDA R03 mechanism (https://grants.nih.gov/grants/guide/pa-files/PAR-00-059.html) is intended for newer, less experienced investigators, for investigators at institutions without well-developed research traditions and resources, or for experienced investigators wishing to change research directions or test new methods or techniques. The NIDA R21 mechanism (https://grants.nih.gov/grants/guide/pa-files/PA-01-012.html) is intended to encourage exploratory research projects with sound methodology and strong rationales in underdeveloped research areas of drug abuse. This PA uses just-in-time concepts. It also uses the modular as well as the non- modular budgeting formats (see https://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if you are submitting an application with direct costs in each year of $250,000 or less, use the modular format. Otherwise follow the instructions for non-modular research grant applications. ELIGIBLE INSTITUTIONS You may submit (an) application(s) if your institution has any of the following characteristics: - For-profit or non-profit organizations - Public or private institutions, such as universities, colleges, hospitals, and laboratories - Units of State and local governments - Eligible agencies of the Federal government - Domestic or foreign - Faith-based or community based organizations INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH programs. WHERE TO SEND INQUIRIES We encourage your inquiries concerning this PA and welcome the opportunity answer questions from potential applicants. Inquiries may fall into two areas: scientific/research and financial or grants management issues: Direct your questions about scientific/research issues to: Harold I. Perl, Ph.D. Division of Clinical and Prevention Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 505 MSC 7003 Bethesda, MD 20892-7003 For express mail use: Rockville, MD 20852) Telephone: (301) 443-0786 Fax: (301) 443-8774 Email: perl@nih.gov National Institute on Drug Abuse Cecelia McNamara, Ph.D. Behavioral Treatment Development Branch Division of Treatment Research 6001 Executive Blvd Room 4240 MSC 9551 Bethesda, MD 20892-9551Telephone: (301) 443-0107 Email: cmcnamar@mail.nih.gov Direct your questions about financial or grants management matters to: Judy Simons Chief, Grants Management Branch Office of Planning and Resource Management National Institute on Alcohol Abuse and Alcoholism Willco Building, Suite 504 6000 Executive Boulevard, MSC 7003 Bethesda, MD 20892-7003 (301) 443-4704 (telephone) (301) 443-3891 (fax) email: jsimons@willco.niaaa.nih.gov SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at https://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 710-0267, Email: GrantsInfo@nih.gov. APPLICATION RECEIPT DATES: Applications submitted in response to this program announcement will be accepted at the standard application deadlines, which are available at https://grants.nih.gov/grants/dates.htm. Application deadlines are also indicated in the PHS 398 application kit. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting up to $250,000 per year in direct costs must be submitted in a modular grant format. The modular grant format simplifies the preparation of the budget in these applications by limiting the level of budgetary detail. Applicants request direct costs in $25,000 modules. Section C of the research grant application instructions for the PHS 398 (rev. 5/2001) at https://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step guidance for preparing modular grants. Additional information on modular grants is available at https://grants.nih.gov/grants/funding/modular/modular.htm. SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: Applications requesting $500,000 or more in direct costs for any year must include a cover letter identifying the NIAAA staff member who has agreed to accept assignment of the application. Applicants requesting more than $500,000 must carry out the following steps: 1) Contact the IC program staff at least 6 weeks before submitting the application, i.e., as you are developing plans for the study; 2) Obtain agreement from the IC staff that the IC will accept your application for consideration for award; and, 3) Identify, in a cover letter sent with the application, the staff member and IC who agreed to accept assignment of the application. This policy applies to all investigator-initiated new (type 1), competing continuation (type 2), competing supplement, or any amended or revised version of these grant application types. Additional information on this policy is available in the NIH Guide for Grants and Contracts, October 19, 2001 at https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the checklist, and five signed photocopies in one package to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 Bethesda, MD 20817 (for express/courier service) APPLICATION PROCESSING: Applications must be received by or mailed on or before the receipt dates described at https://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR will not accept any application in response to this PA that is essentially the same as one currently pending initial review unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of a substantial revision of an application already reviewed, but such application must include an Introduction addressing the previous critique. PEER REVIEW PROCESS Applications submitted for this PA will be assigned on the basis of established PHS referral guidelines. An appropriate scientific review group convened in accordance with the standard NIH peer review procedures (http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific and technical merit. As part of the initial merit review, all applications will: o Receive a written critique o Undergo a selection process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed and assigned a priority score o Receive a second level review by the appropriate national advisory council or board REVIEW CRITERIA The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments, reviewers will be asked to discuss the following aspects of your application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals: o Significance o Approach o Innovation o Investigator o Environment The scientific review group will address and consider each of these criteria in assigning your application's overall score, weighting them as appropriate for each application. Your application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, you may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) SIGNIFICANCE: Does your study address an important problem? If the aims of your application are achieved, how do they advance scientific knowledge? What will be the effect of these studies on the concepts or methods that drive this field? (2) APPROACH: Are the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Do you acknowledge potential problem areas and consider alternative tactics? (3) INNOVATION: Does your project employ novel concepts, approaches or methods? Are the aims original and innovative? Does your project challenge existing paradigms or develop new methodologies or technologies? (4) INVESTIGATOR: Are you appropriately trained and well suited to carry out this work? Is the work proposed appropriate to your experience level as the principal investigator and to that of other researchers (if any)? (5) ENVIRONMENT: Does the scientific environment in which your work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application will also be reviewed with respect to the following: PROTECTIONS: The adequacy of the proposed protection for humans, animals, or the environment, to the extent they may be adversely affected by the project proposed in the application. INCLUSION: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria included in the section on Federal Citations, below) BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. AWARD CRITERIA Applications submitted in response to a PA will compete for available funds with all other recommended applications. The following will be considered in making funding decisions: o Scientific merit of the proposed project as determined by peer review o Availability of funds o Relevance to program priorities REQUIRED FEDERAL CITATIONS MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components involving Phase I and II clinical trials must include provisions for assessment of patient eligibility and status, rigorous data management, quality assurance, and auditing procedures. In addition, it is NIH policy that all clinical trials require data and safety monitoring, with the method and degree of monitoring being commensurate with the risks (NIH Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 1998: https://grants.nih.gov/grants/guide/notice-files/not98-084.html). INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported clinical research projects unless a clear and compelling justification is provided indicating that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing clinical research should read the AMENDMENT "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research - Amended, October, 2001," published in the NIH Guide for Grants and Contracts on October 9, 2001 (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at https://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm. The amended policy incorporates: the use of an NIH definition of clinical research; updated racial and ethnic categories in compliance with the new OMB standards; clarification of language governing NIH-defined Phase III clinical trials consistent with the new PHS Form 398; and updated roles and responsibilities of NIH staff and the extramural community. The policy continues to require for all NIH-defined Phase III clinical trials that: a) all applications or proposals and/or protocols must provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) investigators must report annual accrual and progress in conducting analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: The NIH maintains a policy that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at https://grants.nih.gov/grants/funding/children/children.htm. REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at https://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at https://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. Applicants may wish to place data collected under this PA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in a NIH solicitation, Internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This PA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople. AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance No. 93.273, and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and administered under NIH grants policies described at https://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. The PHS strongly encourages all grant recipients to provide a smoke-free workplace and discourage the use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. https://grants.nih.gov/grants/guide/pa-files/PA-02-015.html. REFERENCES Adams A, Ockene JK, Wheeler EV Hurley TG, Alcohol counseling: physicians will do it. J Gen Intern Med 1998 Oct; 13(10): 692-8. Anderson, P, Scott, E, Effect of general practitioners' advice to heavy drinking men. British Journal of Addiction, 1992, 87(6): 891-900. Chang G, Goetz MA, Wilkins-Haug L, Berman S, Brief intervention for prenatal alcohol use: an in-depth look. J Subst Abuse Treat 2000 Jun; 18(4): 365-9. Chang G, Wilkins-Haug L, Berman S, Goetz MA, Brief intervention for alcohol use in pregnancy: a randomized trial. Addiction 1999 Oct; 94(10): 1499-508. Fleming MF, Barry KL, Manwell LB, Johnson K, London R, Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA 1997 Apr 2; 227(13): 1039-45. Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA, Brief physician advice for alcohol problems in older adults: a randomized community-based trial. J Fam Pract 1999 May; 48(5): 378-84. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL, Benefit- cost analysis of brief physician advice with problem drinkers in primary care settings. Med Care 2000 Jan; 38(1): 7-18. Gentilello LM, Rivara FP, Donovan DM Jurkovich GJ, Daranciang E., Dunn CW, Villaveces A, Copass M, Ries RR, Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg 1999 Oct; 230(4): 473-80; discussion 480-3. Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, Gengrich R, Rankin JG, Screening for problem drinking and counseling by the primary care physician- nurse team. Alcohol Clin Exp Res 1996 Nov; 20(8): 1443-50. Marlatt, GA, Baer JS, Kivlahan DR, Dimeff LA, Larimer ME, Quigley LA, Somers JM, Williams E, Screening and brief intervention for high-risk college student drinkers: Results from a 2-year follow-up assessment. J Consult Clin Psychol 1998, 66(4): 604-615. Marlatt, GA, Baer JS, Larimer M, Preventing alcohol abuse in college students: A harm-reduction approach. In: Boyd GM, Howard J, Zucker, RA; eds. Alcohol Problems Among Adolescents: Current Direction in Prevention Research. Hillsdale, NJ: Lawrence Erlbaum Associates, 1995. pp. 147-172. Monti PM, Colby SM, Barnett NP, Spirito A, Rohsenow DJ, Myers M, Woolard R, Lewander W, Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Consult Clin Psychol 1999 Dec; 67(6): 989-94 Longabaugh R, Woolard RE, Nirenberg TD, Minugh AP, Becker B, Clifford PR, Carty K, Sparadeo F, Gogineni A. Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. J Stud Alcohol 2001 Nov; 62(6): 806-16. Ockene JK, Adams A, Hurley TG, Wheeler EV, Hebert JR, Brief physician-and nurse practitioners-delivered counseling for high-risk drinkers: does it work? Arch Intern Med 1999 Oct 11; 159(8): 2198-205. Ockene JK, Wheeler EV, Adams A, Hurley TG, Hebert J, Provider training for patient-centered alcohol counseling in a primary care setting. Arch Inter Med 1997 Nov 10; 157(20): 2334-41. Scott, E, Anderson, P, Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug and Alcohol Review 1991, 10(4): 313-321. Wallace P, Cutler S, Haines A. Randomized controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ 1988 297(6649): 663-668.
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