Intervention For Problem Drinkers Research Articles

Coping Flexibility and Alcohol-Related Outcomes: Examining Coping Motives as Mediators

Background: Coping has been implicated in the etiology and treatment of problem drinking. Traditional, static measurement of coping styles (e.g., approach, avoidance, social support) may fail to capture how adaptive a given coping style may be. Coping flexibility is an emerging construct, associated with psychological health, and one that may shed light on coping’s role in drinking risk. Coping flexibility includes (1) discontinuation of an ineffective coping strategy (“Discontinuation”) and (2) production of an alternative strategy (“Implementation”). This study is the first to our knowledge to examine its association to drinking outcomes. Further, because coping deficits are theorized to lead to drinking through coping motives, we also examined mediated pathways from coping flexibility to alcohol outcomes via coping motives. Methods: College students (N = 528) completed an online assessment. Data were analyzed using path analysis. Control variables included sex and coping styles. Results: In path analytic models, Implementation was negatively associated with alcohol use and, indirectly via coping motives, negatively associated with alcohol consequences. The direct effect on alcohol use remained when controlling for coping styles and sex, but the mediational pathway was no longer significant. Conclusions: This study provides some evidence for the protective role of coping flexibility in alcohol use behavior, which may have implications for how best to address coping skills in alcohol interventions. The direct effect of Implementation on drinking suggests that there may be utility in teaching clients a flexible approach to coping in treatment. Replication, particularly with longitudinal designs, is needed.

Cultural adaptation of the mental health first aid guidelines for Brazilians with problem drinking: a Delphi expert consensus study

BackgroundHarmful use of alcohol is highly prevalent around the world and results in a large disease burden. Most people who meet the criteria for an alcohol use disorder do not receive treatment. Those in a person’s social network can be useful in recognizing a problem and encouraging the person to seek treatment. However, many people lack the knowledge and skills to do this effectively. This study reports on the cultural adaptation for Brazil of the 2009 English-language mental health first aid guidelines for helping someone with problem drinking.MethodsA Delphi expert consensus study with two expert panels, one comprising health professionals with experience in the treatment of problem drinking and the other comprising people with lived experience was conducted. Participants rated the importance of actions to be taken to help a person with problem drinking.ResultsOver two rounds, 60 participants (30 professionals and 30 people with lived experience) rated 197 items. A total of 166 items were included in the final guidelines.ConclusionsWhile there were many similarities with the English-language guidelines for high-income countries, the guidelines also incorporate actions of importance for Brazil, including compulsory treatment and different approaches to dealing with people with problem drinking. Further research is necessary to assess their impact.

Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials.

BackgroundFace-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs).Methods and findingsSystematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI −7.57 to −2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63–2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06–6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21–2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: −6.78 SUs, 95% CI −12.11 to −1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22–4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29–0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: −9.27 SUs, 95% CI −13.97 to −4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13–6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses.ConclusionTo our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.

Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania.

Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than onemonth, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.

Online interventions for problem gamblers with and without co-occurring problem drinking: study protocol of a randomized controlled trial

BackgroundThe current randomized controlled trial seeks to evaluate whether providing access to an Internet intervention for problem drinking in addition to an Internet intervention for problem gambling is beneficial for participants with gambling problems who do or do not have co-occurring problem drinking.MethodsPotential participants will be recruited online via a comprehensive advertisement strategy, if they meet the criteria for problem gambling. As part of the baseline measures, problem drinking will also be assessed. Eligible participants (N = 280) who agree to partake in the study and to be followed up for 6 months will be randomized into one of two versions of an Internet intervention for gamblers: an intervention that targets only gambling issues (G-only) and one that combines a gambling intervention with an intervention for problem drinking (G + A). For problem gamblers who exhibit co-occurring problem drinking, it is predicted that participants who are provided access to the G + A intervention will demonstrate a significantly greater level of reduction in gambling outcomes at 6 months compared to those provided access to the G-only intervention.DiscussionThis trial will expand upon the current research on Internet interventions for addictions and inform the development of treatments for those with co-occurring problem drinking and gambling.Trial RegistrationClinicalTrials.gov, NCT03323606. Registered on 24 October 2017.

A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa

BackgroundPoor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town.MethodsSeven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted.ResultsFindings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital.DiscussionThe study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers.ConclusionsRecommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory.

Despite substantial evidence for their effectiveness, the adoption of alcohol screening and brief interventions (ASBI) in routine primary care remains inconsistent. Financial incentive schemes were introduced in England between 2008 and 2015 to encourage their delivery. We used Normalisation Process Theory-informed interviews to understand the barriers and facilitators experienced by 14 general practitioners (GPs) as they implemented ASBI during this period. We found multiple factors shaped provision. GPs were broadly cognisant and supportive of preventative alcohol interventions (coherence) but this did not necessarily translate into personal investment in their delivery (cognitive participation). This lack of investment shaped how GPs operationalised such “work” in day-to-day practice (collective action), with ASBI mostly delegated to nurses, and GPs reverting to “business as usual” in their management and treatment of problem drinking (reflexive monitoring). We conclude there has been limited progress towards the goal of an effectively embedded preventative alcohol care pathway in English primary care. Future policy should consider screening strategies that prioritise patients with conditions with a recognised link with excessive alcohol consumption, and which promote more efficient identification of the most problematic drinkers. Improved GP training to build skills and awareness of evidence-based ASBI tools could also help embed best practice over time.

Randomized Controlled Trial of a Brief Versus Extended Internet Intervention for Problem Drinkers

PurposeBrief Internet interventions have been shown to reduce alcohol consumption. This trial intended to compare the effects of one such brief intervention to an extended Internet intervention for problem drinkers.MethodUsing online advertising, 490 participants, 18 years or older, were recruited and randomized to receive a brief (CheckYourDrinking.net) versus an extended (AlcoholHelpCentre.net) Internet intervention and were followed up at 6, 12, and 24 months. The per protocol primary analysis assessed difference between condition at the 12-month follow-up.ResultsThe follow-up rate at 12 months was 83.3 %. ANCOVAs of the primary (Alcohol Use Disorder Identification Test (AUDIT)-C) and secondary outcome variables (drinks in a typical week, highest number of drinks on one occasion—baseline drinking as covariate) revealed no significant (p > 0.05) differences between the interventions. Similarly, combined analyses of the 6-, 12-, and 24-month follow-up revealed no significant differences between interventions at all time points.ConclusionThe present study does not provide support for the added benefit of an extended Internet intervention for problem drinkers over a brief Internet intervention.

Barriers for identification and treatment of problem drinkers in primary care

ObjectiveDue to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals’ health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. MethodThe participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. ResultsThe main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. ConclusionsStudies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care.

OR02-5 * THE EFFECTS OF BRIEF INTERVENTION ON HEALTH CHECKUP IN LOCAL RESIDENTS

Introduction. Effectiveness of brief interventions for problem drinkers has already been demonstrated in the workplace. The purpose of this study is to determine the effect of brief intervention in health checkup in local residents. Method. In 2011–2012, the subject is male of 10 or more points have the AUDIT (Alcohol Use Disorder Identify Test) in the health checkup of Nakijin village of Japan. In the intervention group, we conducted brief intervention to the participants. In the control group, we performed only feedback of AUDIT. In health checkup one year later, we compared the rate of improvement of health checkup of the intervention and control groups. To measure the difference between the results before and after the intervention, t-test was performed. Result. Intervention group includes 15 people. (Average age 55.7 y o. The average scores for the AUDIT is 15 points) Control group includes 15 people who matched the AUDIT scores and age of the intervention group. About abdominal circumference, the results of intervention group are −0.3cm,and its of contorol group are +1.5cm (P < 0.05). Conclusion. Brief intervention in on health checkup in local residents is effective for abdominal circumference. In the future, there is a need to further increase the numbers of people intervention.

Treatment preferences among problem drinkers in primary care.

Alcohol misuse is common among primary care patients, yet many do not receive treatment because doctors believe problem drinkers are "in denial," or are unwilling to change their drinking habits. The real problem, however, may be that patients are being offered treatment modalities that do not meet their needs. This study was designed to measure the acceptability of various treatment options among drinkers who were currently not receiving treatment. Patients in a primary care clinic were given a self-report questionnaire that included: (1) the Alcohol Use Disorders Questionnaire, (2) a measure of readiness to change drinking behavior, and (3) a list of treatment modalities to be rated based on level of interest. Within a random sample of 402 patients, 40.2% reported high risk drinking and 16.3% reported problem drinking. Among the latter group, 89.3% were either considering change, or had begun to take steps to make changes in their drinking behaviors. When asked about treatment preferences, the modalities most frequently recommended by physicians-group therapy and Alcoholics Anonymous-were among the least acceptable. The most popular options were getting help from a primary care doctor and taking a medication that would make it easier to avoid drinking without making them sick if they drank. The belief that problem drinkers are unwilling to change was not supported by this study. Treatment for problem drinking should involve a collaborative evaluation of options with an emphasis on patient preference and treatment within the primary care setting.

Exploratory randomized controlled trial evaluating the impact of a waiting list control design

BackgroundEmploying waiting list control designs in psychological and behavioral intervention research may artificially inflate intervention effect estimates. This exploratory randomized controlled trial tested this proposition in a study employing a brief intervention for problem drinkers, one domain of research in which waiting list control designs are used.MethodsAll participants (N = 185) were provided with brief personalized feedback intervention materials after being randomly allocated either to be told that they were in the intervention condition and that this was the intervention or to be told that they were in the waiting list control condition and that they would receive access to the intervention in four weeks with this information provided in the meantime.ResultsA total of 157 participants (85%) were followed-up after 4 weeks. Between-group differences were found in one of four outcomes (proportion within safe drinking guidelines). An interaction was identified between experimental manipulation and stage of change at study entry such that participant change was arrested among those more ready to change and told they were on the waiting list.ConclusionsTrials with waiting list control conditions may overestimate treatment effects, though the extent of any such bias appears likely to vary between study populations. Arguably they should only be used where this threat to valid inference has been carefully assessed.

Claiming Positive Results From Negative Trials: A Cause for Concern in Randomized Controlled Trial Research - Author's Reply

Claiming Positive Results From Negative Trials: A Cause for Concern in Randomized Controlled Trial Research - Author's Reply

Couple communication among problem drinking males and their spouses: a randomized controlled trial

This study evaluated the effects of alcohol‐focused spouse involvement and behavioural couple therapy (BCT) on couple communication in the context of group drinking reduction treatment for male problem drinkers. Sixty‐four male clients and their female partners were randomly assigned to one of three conditions: (i) treatment for problem drinkers only (PDO), (ii) couple alcohol‐focused treatment or (iii) couple alcohol‐focused treatment combined with BCT. Couples whose partners participated in the treatment made fewer negative statements during a couple conflict communication task following treatment than PDO couples. The beneficial effect of spouse involvement on negative couple communication was partially mediated by a reduction in the frequency of clients’ heavy drinking during treatment. There was also evidence that BCT reduced couples’ negative communication and increased problem‐solving communication.Practitioner points Involving the spouse in group drinking reduction treatment for male problem drinkers can improve drinking outcome. Therapists can encourage spouses to decrease counterproductive behaviour and engage in behaviour supportive of drinking reduction. Actively involving the spouse can decrease negative statements during problem‐solving communications. Reduction in negative communication may be a result of, rather than a cause of, the male partner's drinking reduction.

Suicide, an Urgent Health Issue in Korea

Suicide, an Urgent Health Issue in Korea

Predictors of Self-Reported Adherence to Naltrexone Medication in an Outpatient Treatment for Problem Drinking

Objective: The opioid antagonist naltrexone has been proven as an efficacious treatment for alcoholism. However, in clinical trials the reported medication adherence has often been poor, being one of the key problems associated with naltrexone treatment. There are very few studies on predictors of nonadherence, although this information would help clinicians to identify their non-compliant patients. This study investigated predictors of medication adherence in an outpatient treatment programme consisting of naltrexone and cognitive behavioural therapy (CBT). Patients were instructed to take one tablet on each day they perceived as a risk of drinking alcohol (as-needed dosing), preferably 1 to 2 hours before anticipated time of drinking. Participants were patients (n=299) who attended a treatment programme in an outpatient clinic. Method: Predictors of medication adherence (defined as using medication in ≥ 80% of situations of drinking) during the first five months of the treatment programme were investigated with logistic regression analyses. Results: Average naltrexone adherence in this study was 78%. Poor adherence with naltrexone was associated with unemploymentand high craving for alcohol at treatment entry. Conclusions: Adherence to naltrexone was generally high compared to many naltrexone studies using daily medication. Patients with high craving for alcohol may have lower adherence to naltrexone or other opioid antagonists and need practical and therapeutic strategies for improving adherence.

Ultra-brief intervention for problem drinkers: three-month follow-up results from a randomized controlled trial

Helping the large number of problem drinkers who will never seek treatment is a challenging issue. Public health initiatives employing educational materials or mass media campaigns have met with mixed success. However, clinical research has developed effective brief interventions to help problem drinkers. This project employed an intervention that has been validated in clinical settings and then modified into an ultra-brief format suitable for use as a public health intervention. This randomized controlled trial sought to establish the effectiveness of an ultra-brief personalized feedback intervention for problem drinkers. Problem drinkers (N = 1824) recruited via a baseline population telephone survey were randomized to one of three conditions: personalized feedback pamphlet, control pamphlet, or no intervention (control condition). In the week after the baseline survey, households in the two pamphlet conditions were sent their respective pamphlets by mail. Changes in drinking were assessed at three months. The follow-up rate was 83% (1529 participants). Preliminary analysis indicated that there was no significant impact (p > 0.05) of receiving the intervention pamphlet. Although the ultra-brief intervention had demonstrated promising results in two earlier pilot trials, results from the current trial failed to find any impact of this personalized feedback intervention for problem drinkers when delivered to households rather than directly to individuals. Combined with the results from the earlier trials, we surmise that the intervention may have an impact among recipients who voice an interest in receiving such materials but it is ineffective as an unsolicited public health intervention.

Third-generation internet-based brief interventions for problem drinkers: how far can technology take us, and what types of drinkers can be reached?

For over a decade, a number of randomized controlled trials (RCTs) have found that internet-based brief intervention (IBBI) can reduce consumption in people with alcohol use disorders. As technology becomes increasingly sophisticated, IBBI has the potential to offer highly tailored feedback to different populations. First launched in 2005, CheckYourDrinking.net (CYD), version 3.0, is a free anonymous IBBI that has undergone several randomized controlled trials and technical upgrades. Apart from the free online version, the technology has been modified for several specific populations such as college students, youth aged 13-17, public health institutions, and for use as a screening tool in private clinics. To illustrate how algorithms can be modified, we are examining data from 21,640 Canadian men (59%) and women (41%) who anonymously accessed CheckYourDrinking.net version 2.0 from April 8, 2008, to July 28, 2010. Through describing CYD’s development methodology and research-based maturation process, we illustrate how IBBI can be tailored for special populations. Technical limitations and other barriers are discussed. The purpose of this presentation is to share knowledge of the resources required for the ongoing technical enhancement and maintenance of IBBIs. With the use of sophisticated algorithms, IBBIs hold the exciting potential of providing highly tailored feedback to not only people with problem drinking but for those with specific unhealthy drinking patterns (i.e., heavy episodic drinking) and for special populations across languages and cultures. In order to fully understand the potential of IBBI technology, further research is required.

A Systematic Review of Family-Based Interventions Targeting Alcohol Misuse and Their Potential to Reduce Alcohol-Related Harm in Indigenous Communities

Alcohol misuse is a major risk factor for harm in indigenous communities. The indigenous family unit is often the setting for, and is most adversely affected by, alcohol-related harm. Therefore, family-based alcohol interventions offer great potential to reduce alcohol-related harm in indigenous communities. This systematic review aims to identify peer-reviewed published evaluations of family-based alcohol interventions, critique the methodological quality of those studies, describe their intervention characteristics, and identify which interventions appear most promising to reduce alcohol-related harm in indigenous communities. Eleven electronic databases were searched. The reference lists of reviews of family-based approaches focused on alcohol interventions were hand-searched for additional relevant studies not identified by the electronic database search. Initially, 1,369 studies were identified, of which 21% (n = 142) were classified as intervention studies. Nineteen intervention studies were family-based alcohol interventions. Eleven of these studies included family members in the treatment of problem drinkers, and eight studies specifically targeted family members of problem drinkers. Methodological quality of studies varied, particularly in relation to study design, including confounding variables in the analyses, and follow-up rates. The evidence for the effectiveness of family-based alcohol interventions is less than optimal, although the reviewed studies did show improved outcomes. Given the important role of family in indigenous communities, there is merit in exploring family-based approaches to reduce alcohol-related harms. Tailored family-based approaches should be developed that include direct consultation with targeted indigenous communities.

IS IT TIME TO START DISCUSSING WHAT TYPE OF COMPUTER‐DELIVERED INTERVENTION?

. [1] have conducted a randomized trialcomparing face-to-face brief motivational interviewing(BMI) with two different computer-delivered interven-tions (CDIs) for college students facing sanctions for vio-lating campus alcohol policies in the United States. Thefindings,ingeneral,leantowardssupportingthestrengthof the face-to-face BMI over the two CDIs. I applaudCarey’s continued research to attempt to elucidate whatinterventions might work best for problem drinkers andforwhomdifferentinterventionsareeffective(e.g.genderdifferences in the current study). It can be a challenge todemonstrate intervention effects when comparing a briefintervention to a minimally active comparator, let alonewhen comparing the intervention to another putativelyactive intervention.I was, however, left with one primary concern afterreading the study. That is, is it time to start discussingwhat types of computer-delivered interventions arebeing employed in this brief intervention research? BMIis perhaps the most-validated and -researched briefinterventionforproblemdrinkerswithaconsistenttrackrecord of measurable impact [2]. CDIs are still reallyin their infancy but there have been enough trials toconduct several recently published meta-analyses[3,4]. While these analyses note limitations with thecurrentliterature,thereisperhapsenoughresearchcon-ducted to date to at least divide CDIs into two groups: (i)those that have been developed by modifying clinicallyresearched and validated brief interventions for problemdrinkers (e.g. the various personalized feedback inter-ventions that could loosely be said to be descendentsof the Drinker’s Check-up tradition) [5]; and (ii) thosethat are education-orientated, stemming from a desireto promote safe (or no) drinking on American collegecampuses or that are automated versions of educationalprograms for those same students facing sanctions fordrinking on campus. My reading of this literature is thatit is the first group of CDIs—those which trace theirdevelopment from clinically based brief interventions—which have generally been more likely to have publishedtrials which report significant intervention effects. Cer-tainly, it is too early to say definitely that one of thesegroups of CDIs is superior to the other. However, it isnot too early to select a CDI which already has someevidence of efficacy (i.e. has at least one publishedrandomized trial with positive results) when settingout to conduct a trial that most readers may take as acomparison of face-to-face brief interventions versuscomputerized interventions. Personally, I suspect that awell-delivered face-to-face intervention from a skilledclinician will always be superior to a computerizedsubstitute. However, it would be good to have a test todemonstrate this superiority using the state-of-the-artversion of both of these candidates.