Background Alcohol screening and brief intervention have demonstrated efficacy but limited effectiveness and implementation in real-world primary care settings. Objective To evaluate the effectiveness of a computerized Relational Agent programmed to provide alcohol screening, brief intervention, and referral to treatment. We hypothesized that participants in the experimental condition would report greater reductions in their drinking and higher rates of brief intervention and referrals to specialty care compared to those in treatment as usual (TAU). Design This was a Hybrid I implementation design and stratified RCT. Participants were randomized to TAU or Relational Agent + TAU and assessed at baseline and 3-month follow-up. Participants A total of 178 veteran participants were recruited by referral from primary care staff after a positive alcohol screen, or via letter sent do patients screening positive during recent visit. Intervention(s) TAU involved yearly reminders to screen alcohol use and provide brief intervention and treatment referrals, as needed. The Relational Agent added an automated brief intervention, a 1-month follow-up Relational Agent visit, and referral to treatment if needed. Main Measures We measured average drinks per day, drinking days per week, number of brief interventions, and number of referrals over 3 months. Key Results Participants decreased their drinking in both study conditions, with no significant between-group differences on primary alcohol measures. However, Relational Agent + TAU participants evidenced greater improvements regarding negative alcohol-related consequences over 3 months, and were significantly more likely to receive a brief intervention and referral to specialty care. Conclusions The Relational Agent successfully provided brief intervention and referred many more patients to specialty care and was able to intervene with patients with less severe drinking without increasing primary care burden. Trial Registration clinicaltrials.gov , NCT02030288, https://clinicaltrials.gov/ct2/home Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06945-9.

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BackgroundVeterans report relatively high rates of intimate partner violence (IPV) due to high trauma exposure. Alcohol use disorder (AUD), which is more prevalent among veterans, is a risk factor for IPV use and recidivism following IPV intervention. Using data from a prior randomized control trial of a trauma-informed IPV intervention, we examined the moderating effect of AUD on treatment outcomes among veterans.MethodsParticipants were 61 male veterans (M age = 37.18, SD = 13.23; 82% White; 18% met criteria for AUD) who participated in the Strength at Home (SAH) IPV intervention. Generalized mixed modelling was used to examine the effects of AUD and treatment attendance on posttreatment reductions in IPV.ResultsA significant threeway interaction between time, AUD, and session attendance was observed with respect to reductions in psychological IPV. Specifically, psychological IPV decreased significantly over time, but to a lesser extent among individuals with AUD, regardless of treatment attendance.DiscussionResults indicate that participants with AUD receive less benefit from treatment with regard to coercive and controlling abusive behaviors. Findings speak to the need for adapting IPV intervention in order to address problematic alcohol use and related externalizing psychopathology.